Speech Therapy for Wounded Warriors
Dysphagia is a condition in which the patient has difficulty swallowing. It may take more time or effort to transition food or liquid from the mouth to the stomach. For some patients this may also involve moderate to severe pain, and it may be impossible for them to complete the act of swallowing. Causes and treatments for dysphagia differ, but for many of our combat veterans, the cause has been identified as traumatic brain injury (TBI).
What is TBI?
TBI is a brain injury which is required when sudden trauma damages the brain. It can happen when there is a sudden and violent impact with the head from an object, or when something pierces the skull and moves into the brain. Patients with a mild TBI might remain conscious or only lose consciousness for a short period. Symptoms of a mild TBI may include confusion, dizziness, headache, blurred vision, lightheadedness, fatigue, ringing ears, altered sleep patterns, changes in behavior or mood, lack of focus, memory problems, or difficulty thinking clearly. A person with a moderate TBI will have the same symptoms but may also have nausea and vomiting, a headache that intensifies or doesn’t go away, seizures, slurred speech, dilation of the pupil, heightened confusion, agitation, loss of feeling in the extremities, restlessness, and loss of coordination.
Walter Reed Medical Center
The Walter Reed Medical Center department of Audiology and Speech Pathology works with veterans to learn more about TBI and its effect on speech issues. In a recent study, they found that about 20% of active duty patients admitted due to a TBI suffered from dysphagia. There are several secondary issues caused by dysphagia, such as malnutrition, dehydration, and aspiration pneumonia. In extreme cases, this can lead to the death of a patient who does not receive adequate medical care.
The Center brought together a team of speech-language pathologists and specialists from other fields to develop the best practices for patient prognosis, referral, and management. They utilized computer-based programs, assistive technology, and incorporated services from a variety of disciplines in a primarily outpatient setting. As the patients began to recover, the SLP would follow their progress and help develop an ongoing treatment plan to be put in place near their home base. The patients and their families were educated about the cognitive changes that were possible with mild to moderate TBI in order to facilitate family support in the healing process. The SLPs from the study routinely contacted the new providers for the patients to answer questions, offer recommendations, and check on progress.
It is important to note that it is often necessary for specialists in different fields to work together to address the concerns of the patient. If a patient changes providers, the information from one SLP to the next can be invaluable in providing optimal treatment. Some of the complementary fields utilized in the study included alternative medicine to improve relaxation and musical therapy to improve speech clarity. SLPs need to consider the resources available to them and to the patient which may be accessed to optimize treatment.