Triggers for a Speech Referral:

Speech/Language
  • speech is slurred
  • difficulty expressing needs and routine information intelligibly
  • loss of ability to communicate needs (from mild to severe)
  • sounds produced differ from sounds intended (says “tog” instead of “dog)
  • labored speech production
  • difficulty understanding others
  • difficulty following directions or conversations
  • appears confused
  • misreads basic functional information or is unable to write basic information (difficulty completing admission paperwork)
  • difficulty with topic maintenance
  • speaks in sentences, but doesn’t get point across (“I want to go with him. You know, him. I want to go with him.”)
  • left or right neglect (often affects reading, writing, and eating)
  • problems with vocal quality: chronic hoarse vocal quality following intubation
  • poor respiratory support/control for speech

Cognition
  • reduced awareness of environment and medical condition
  • impaired orientation (day, date, situation, person, etc…)
  • impaired judgment/safety awareness
  • impaired memory
  • impaired problem solving skills
  • difficulty performing daily tasks (money management, answering the phone, scheduling an appointment, etc.)

Swallowing
  • coughing during or after swallow
  • “wet” or “gurgled” vocal quality after swallow
  • unable to manage oral secretions
  • evaluation of patient’s swallowing abilities post intubation/prior to PO intake
  • eats rapidly or extremely slow
  • denies or neglects food on one side of plate
  • fatigues when eating or drinking
  • food residue remains on lips or in mouth after eating
  • cannot keep lips closed while chewing
  • difficulty chewing
  • food/liquid leaks through lips during swallow
  • elderly patient with chronic pneumonia may warrant a bedside swallow evaluation

VitalStim© (if available)
The only FDA approved electrical stimulation device for the treatment of dysphagia (difficulty swallowing). This non-invasive, external stimulation therapy uses electrodes that are applied to the affected muscles of the throat to promote proper swallowing. Only speech pathologists that are certified in this type of therapy may use the device.

Typical course of action for speech referrals:
  • Obtain physician’s order for ST to evaluate and treat as indicated
  • ST will evaluate the patient at bedside
  • If treatment is indicated, I will write an order – typically for 2x/week
  • I might recommend further testing (i.e. modified barium swallow study, MBS, in the case of dysphagia). I can use VitalStim therapy effectively when I get the report from this study.
Common Etiologies of Speech/Language/Cognitive/Swallowing Disorders:
  • Head and neck cancer
  • Parkinson’s disease
  • CVA
  • Traumatic Brian Injury (TBI)
  • Central nervous system tumors
  • Laryngitis
  • Vocal nodules
  • Alzheimer’s disease
  • Dementia
  • Post CABG
  • Diabetes