Speech-Language Pathology & Covid-19: How These Heroes Have Adapted to the Pandemic
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“Speech-language pathologists (SLPs) have been on the frontlines of service delivery during the pandemic.”
Monica Sampson, PhD, CCC-SLP, Director of Health Care Services in Speech-Language Pathology for the American Speech-Language-Hearing Association (ASHA)
Covid-19 has reintroduced America’s healthcare workers as national heroes. Every sector of health services has been stretched thin but they have continued to adapt to overcome the challenges. In particular, speech-language pathologists (SLPs) have played a unique and critical role during the pandemic, and the rapid changes the profession has undergone in the last eight months may last well into the future.
Speech-language pathology in many ways attends to the overlooked and in the process, is often overlooked itself. In short, SLPs work with people on issues of speech and language. But those two areas factor into many different social, cognitive, and physical disorders. SLPs may help people learn to speak again after a traumatic brain injury or help those with autism to improve their social communication skills. It’s a vast territory of practice, and Covid-19 has only widened it further.
“Speech-language pathologists (SLPs) have been on the frontlines of service delivery during the pandemic,” says Monica Sampson, PhD, CCC-SLP, Director of Health Care Services in Speech-Language Pathology for the American Speech-Language-Hearing Association (ASHA). “We have had to contend with the same frustrations of limited access to personal protective equipment (PPE), increased stress and burnout during this time, and the inability to serve some of our most vulnerable patients due to limited telehealth coverage from insurance payers.”
The Role of SLPs in Covid-19 Recovery
A patient’s recovery from Covid-19 often requires speech-language treatment. Patients who have spent a significant amount of time on a ventilator may have trouble speaking, and may need help communicating in other ways. Covid-19 can also cause vocal cord damage, whether from ventilator use, fluid buildup in the lungs, or as a side effect of stroke or other complications.
Some patients who spend time on a ventilator or experience low oxygen to the brain can become confused and disoriented, and may experience long-term cognitive problems. SLPs can develop individualized treatment plans that help a patient get back to pre-pandemic functionality.
“SLPs have also been called on to assume a variety of roles to assist in healthcare settings where the needs have been so great and providers have been spread so thin,” Sampson says.
The Unique Challenges of Speech-Language Pathology Care During a Pandemic
Working with recovering Covid-19 patients comes on top of an SLP’s usual scope of practice, as other speech-language issues do not pause during a pandemic. But everything has had to adapt. Countermeasures such as social distancing and mask-wearing have had major effects on a profession predicated upon the pursuit of effective communication.
“A major challenge for SLPs, regardless of where they work, is providing in-person services while wearing masks,” says Diane Paul, PhD, CCC-SLP, ASHA Director of Clinical Issues in Speech-Language Pathology. “Much of what we do requires access to patients’ or students’ mouths. Use of masks prevents this and also limits SLPs’ ability to visually cue them.”
Solid face masks inhibit effective communication in many ways, and the problems are more than a minor inconvenience for the portion of the population that already has trouble speaking or hearing. Masks muffle sound; they take away the ability to read lips and see facial expressions. Responsible social distancing of six feet or more only compounds the issue.
As health workers themselves, SLPs fully understand the need for masks and social distancing, but they also advocate for solutions to help those who are adversely affected, and offer tips for better communication.
On June 8, ASHA sent a letter to CDC Director Robert Redfield asking the agency to emphasize the need for clear face masks and other communication aids as important accessibility measures. By July, the CDC had updated its guidelines to include adaptations and alternatives for those with issues with hearing and communication. In his reply to ASHA, CDC Director Robert Redfield also acknowledged the critical work being done by ASHA and SLPs.
“SLPs have been strong and resilient in how they have adapted and transformed their service delivery during the pandemic, regardless of where they work,” Paul says. “They have demonstrated extraordinary creativity, perseverance, and innovation—all of which we fully expect to outlast the pandemic.”
SLPs & Telepractice
Another big change for SLPs has been the increasing virtualization of services. SLPs in school-based settings have had to pivot, with extremely short notice, into virtual practice, where technical support and access may be lacking.
The ASHA guidelines for virtual services, also known as telepractice, explicitly state that the quality of care provided in this medium needs to be comparable to in-person services. The ASHA Code of Ethics further requires that any SLP providing care needs to be competent in doing so. These safeguards allow SLPs to make individual determinations as to whether tech-based treatment options are appropriate for each person they serve.
“Telepractice is not one-size-fits-all,” Sampson says. “Several factors determine an individual’s success with telepractice, and SLPs are uniquely qualified to make that call. Clearly, there are tasks that cannot be done by the SLP virtually—e.g., feeling a person’s swallow by touching their throat. However, because telepractice allows for the use of facilitators such as family members or other health care staff, some of these challenges can be overcome with pre-planning.”
The Post-Pandemic Future of Speech-Language Pathology
Whether the increase in telepractice outlasts the pandemic may depend upon state and local regulations, as well as policies around insurance reimbursement. But other adaptations the profession has undergone may be more future-proof.
During the Covid-19 pandemic, SLPs have been strengthening their relationships with other members of the interprofessional care team—especially the families of those whom they serve. ASHA has seen an increase in the use of family-centered care and coaching via virtual means, particularly in early intervention in the birth to three-year population. This strategy is one that’s likely to continue to expand.
“We anticipate this to have a positive impact on treatment outcomes even beyond the pandemic,” Paul says. “We have also been able to tag team with our colleagues in other disciplines to ensure that Covid-19 survivors have access to communication even when they are critically ill and unable to speak, and maximize their quality of life as it relates to communication, cognition, and swallowing after discharge from the hospital.”
ASHA’s mission is to make effective communication a human right—accessible and achievable for all. SLPs will continue to pursue that mission through increasingly adaptive and innovative means. Whether working in a healthcare or school-based setting, with newborns or with those at the end of their lives, SLPs will keep fighting to help others hear and be heard.
“SLPs have a tremendous impact on people’s quality of life and have fun doing it,” Sampson says. “Imagine a life without effective communication, or a world where you can’t share a meal, or an environment that’s challenged by memory impairments—SLPs ensure that no one has to live that way.”