Care After Stroke

2022

Speech Pathology

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Role of the Speech Pathologist in Stroke

Assessment, diagnosis and treatment of:
• Dysphagia (difficulty swallowing)
• Communication:
• Basic Language
• Motor Speech
• High level cognitive-language skills
• Pragmatics (social skills)
• Fluency
• Voice

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Swallowing and Dysphagia

• literature suggests between 27-64% of stroke patients may
have trouble swallowing
• brainstem CVA (medulla, pons) can severely affect swallow
• cortical CVA can affect muscle strength/coordination (chewing,
clearing mouth), impulsivity, swallow strength and coordination,
timing and sensation
• many different cortical regions associated with each phase of
swallowing.

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Mr Lin
• Initial SP contact would be ED as part of stroke pathway
1. cranial nerve exam (particular focus on V, VII, IX/X, XII)
2. clinical exam of swallowing
3. cough reflex testing to provide further information re risk of silent aspiration
4. brief review of communication

May commence oral intake (+/- specific recommendations about type of food or fluids)
May request imaging of swallow for more objective assessment (VFSS or FEES)

Ongoing clinical assessment on stroke ward to upgrade diet/fluids as function improves +/- provide rehab

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Normal swallowing

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Disordered swallowing

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Dysphagia Management
1. Safety strategies and education (posture, rate, environmental modification)
2. Compensatory strategies (temperature, carbonation, positioning)
3. Food/fluid texture modification (‘last resort’)

Try some!

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Dysphagia Management
Pretend you are a patient – the person sitting next to you is your doctor. They have just come to see you
during ward rounds. You are worried about plans for discharge, and worried about a recent medication
change that you don’t understand.

You have 30 seconds to ask about your concerns…

BUT

You can’t speak

You can’t use your right arm / hand

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Types of Communication Disorders

Following Stroke
• Aphasia (basic language – listening, speaking, reading, writing)
• Dysarthria (motor speech - disorder in neuromuscular execution)
• Dyspraxia (motor speech - disorder in motor speech programming and planning of positioning and
sequencing)
• Dysphonia (Voice)
• High level language disorder (cognitive deficits; difficulties in planning, reasoning, organisation,
comprehension of complex/lengthy material, understanding humour/sarcasm, speed of information
processing etc.)
• Cognitive communication disorders (High level cognitive-language disorder +/- behavioural
characteristics including social behaviours and pragmatics, emotional expression etc)

https://www.youtube.com/watch?v=3oef68YabD0 B

https://www.youtube.com/watch?v=IP8hkopObvs SS1
https://www.youtube.com/watch?v=6zNKz7YoUao SS2 Slide 9
https://www.youtube.com/watch?v=PFFr5TFtgII SS3
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Rehabilitation
Daily input from SP starting as early as possible
Full assessment of communication function
• What difficulties are they having? What do we need to treat?
• What do they need to be able to do to leave hospital safely?
• What impact will these difficulties have on their life (work, family roles etc)

Therapy sessions (individual, group, joint with OT or NP) aimed at either retraining lost function or
compensating for new level of function. Combination of impairment and functional therapy.

SP role to provide education and strategies to staff/family members to facilitate participation in

therapy/cares. Also involved in case management, discharge planning, onward referrals to community
rehab and service providers.

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Questions?

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Slide 12