Speech-language pathology approaches to neurorehabilitation in acute care during COVID-19: Capitalizing on neuroplasticity.

Nicole Langton-Frost, Martin B Brodsky
Author Information
  1. Nicole Langton-Frost: Department of Physical Medicine and Rehabilitation, Johns Hopkins University, Baltimore, Maryland, USA.
  2. Martin B Brodsky: Department of Physical Medicine and Rehabilitation, Johns Hopkins University, Baltimore, Maryland, USA. ORCID

Abstract

Neurologic manifestations associated with a coronavirus disease 2019 (COVID-19) diagnosis are common and often occur in severe and critically ill patients. In these patients, the neurologic symptoms are confounded by critical care conditions, such as acute respiratory distress syndrome (ARDS). Patients with dual diagnoses of COVID-19 and neurologic changes such as myopathy, polyneuropathy, and stroke are likely at a higher risk of experiencing deficits with swallowing, communication, and/or cognition. Speech-language pathologists are an integral part of both the critical care and neurologic disorders multi-disciplinary teams, offering valuable contributions in the evaluation, treatment, and management of these areas. Patients in intensive care units (ICUs) who require mechanical ventilation often experience difficulty with communication and benefit from early speech-language pathology intervention to identify the most efficient communication methods with the medical team and caregivers. Moreover, patients with neurologic manifestations may present with cognitive-linguistic impairments such as aphasia, thereby increasing the need for communication-based interventions. Difficulties with voice and swallowing after extubation are common, often requiring frequent treatment sessions, possibly persisting beyond ICU discharge. After leaving the ICU, patients with COVID-19 often experience physical, cognitive, and mental health impairments collectively called post-intensive care syndrome. This is often a lengthy road as they progress toward full recovery, requiring continued speech-language pathology treatment after hospital discharge, capitalizing on the principles of neuroplasticity.

References

  1. Neurology. 2021 Jan 26;96(4):e575-e586 [PMID: 33020166]
  2. Neurosci Biobehav Rev. 2016 Jun;65:142-56 [PMID: 27039344]
  3. Arch Phys Med Rehabil. 2014 Jul;95(7):1374-82 [PMID: 24816250]
  4. Clin Nutr. 2020 Sep;39(9):2786-2792 [PMID: 31866129]
  5. Ann Am Thorac Soc. 2017 Mar;14(3):376-383 [PMID: 27983872]
  6. Disabil Rehabil. 2018 Jun;40(12):1452-1455 [PMID: 28291953]
  7. Am J Speech Lang Pathol. 2003 Nov;12(4):400-15 [PMID: 14658992]
  8. Ann Phys Rehabil Med. 2019 Sep;62(5):313-320 [PMID: 31028900]
  9. Eur J Clin Nutr. 2020 Jun;74(6):860-863 [PMID: 32433599]
  10. Stroke. 2013 Dec;44(12):3452-7 [PMID: 24149008]
  11. Eur J Phys Rehabil Med. 2021 Feb;57(1):24-43 [PMID: 32519528]
  12. JAMA. 2020 Aug 25;324(8):782-793 [PMID: 32648899]
  13. FASEB J. 2004 Jun;18(9):1025-7 [PMID: 15084522]
  14. Arch Phys Med Rehabil. 2021 Jun;102(6):1084-1090 [PMID: 33529610]
  15. Curr Neurol Neurosci Rep. 2020 Nov 2;20(12):61 [PMID: 33136216]
  16. J Clin Neurosci. 2020 Jul;77:8-12 [PMID: 32409215]
  17. Neuropsychol Rehabil. 2012;22(6):809-35 [PMID: 22712452]
  18. JAMA Neurol. 2019 May 1;76(5):561-570 [PMID: 30742198]
  19. Lancet. 2005 Feb 26-Mar 4;365(9461):764-72 [PMID: 15733717]
  20. J Stroke Cerebrovasc Dis. 2016 Nov;25(11):2694-2700 [PMID: 27475521]
  21. Neurorehabil Neural Repair. 2016 Oct;30(9):804-16 [PMID: 26747128]
  22. Am J Speech Lang Pathol. 2020 Nov 12;29(4):2242-2253 [PMID: 32960646]
  23. Crit Care Med. 2018 Sep;46(9):e825-e873 [PMID: 30113379]
  24. Stroke Vasc Neurol. 2020 Sep;5(3):279-284 [PMID: 32616524]
  25. BMC Neurol. 2019 Dec 2;19(1):310 [PMID: 31791260]
  26. Cochrane Database Syst Rev. 2018 Oct 30;10:CD000323 [PMID: 30376602]
  27. J Speech Lang Hear Res. 2019 Nov 18;62(12):4464-4482 [PMID: 31805247]
  28. J Laryngol Otol. 2020 Nov 10;:1-6 [PMID: 33168109]
  29. Lancet Respir Med. 2020 Jul;8(7):717-725 [PMID: 32422180]
  30. Laryngoscope. 2020 May;130(5):1249-1255 [PMID: 31385620]
  31. J Speech Lang Hear Res. 2008 Feb;51(1):S225-39 [PMID: 18230848]
  32. Am J Med. 2010 Nov;123(11):1049-58 [PMID: 21035593]
  33. Clinics (Sao Paulo). 2020 Jun 12;75:e2021 [PMID: 32555948]
  34. Int J Stroke. 2016 Jul;11(5):586-92 [PMID: 27151156]
  35. Aust Crit Care. 2020 Sep;33(5):397-398 [PMID: 32861317]
  36. Am J Speech Lang Pathol. 2020 Nov 12;29(4):1821-1832 [PMID: 32946270]
  37. Intensive Care Med. 2016 May;42(5):725-738 [PMID: 27025938]
  38. Stroke. 2020 Jul;51(7):2002-2011 [PMID: 32432996]
  39. Neurology. 2010 Nov 23;75(21):1912-9 [PMID: 21098406]
  40. Crit Care. 2016 Aug 18;19:261 [PMID: 27538536]
  41. Otolaryngol Head Neck Surg. 2021 Jun;164(6):1134-1135 [PMID: 33167752]
  42. Neurorehabil Neural Repair. 2016 Sep;30(8):794-800 [PMID: 26721868]
  43. Stroke. 2013 Feb;44(2):483-9 [PMID: 23321442]
  44. Intensive Crit Care Nurs. 2018 Jun;46:10-16 [PMID: 29551223]
  45. Arch Phys Med Rehabil. 2016 Apr;97(4):567-574 [PMID: 26711168]
  46. Neuropsychol Rev. 2017 Dec;27(4):440-484 [PMID: 29282641]
  47. PM R. 2022 Feb;14(2):217-226 [PMID: 34595841]
  48. J Stroke Cerebrovasc Dis. 2020 Aug;29(8):104949 [PMID: 32410807]
  49. Neurol Sci. 2020 Dec;41(12):3437-3470 [PMID: 33089477]
  50. Crit Care. 2020 Apr 28;24(1):176 [PMID: 32345343]
  51. Int J Stroke. 2021 Jul;16(5):556-572 [PMID: 33019888]
  52. Am J Speech Lang Pathol. 2020 Aug 4;29(3):1320-1334 [PMID: 32525695]
  53. N Engl J Med. 2013 Oct 3;369(14):1306-16 [PMID: 24088092]
  54. Lancet Neurol. 2006 Jan;5(1):31-7 [PMID: 16361020]
  55. Clin Rehabil. 2009 Jan;23(1):79-90 [PMID: 19114440]
  56. J Stroke Cerebrovasc Dis. 2017 Mar;26(3):480-487 [PMID: 28041902]
  57. Dysphagia. 2007 Jul;22(3):251-65 [PMID: 17457549]
  58. JAMA. 2012 Jun 20;307(23):2526-33 [PMID: 22797452]
  59. Crit Care Med. 2013 Sep;41(9 Suppl 1):S81-98 [PMID: 23989098]
  60. Stroke. 2014 Feb;45(2):545-52 [PMID: 24309584]
  61. Crit Care Med. 2012 Feb;40(2):502-9 [PMID: 21946660]
  62. Brain Behav Immun Health. 2020 Dec;9:100163 [PMID: 33111132]
  63. Dysphagia. 2009 Jun;24(2):218-29 [PMID: 19130130]
  64. Iran J Neurol. 2015 Jul 6;14(3):119-24 [PMID: 26622975]
  65. Dysphagia. 2021 Apr;36(2):161-169 [PMID: 32519150]
  66. Otolaryngol Head Neck Surg. 2021 May;164(5):984-1000 [PMID: 32960148]
  67. Disabil Rehabil. 2018 Dec;40(25):3050-3053 [PMID: 28826268]
  68. Int J Stroke. 2012 Dec;7(8):635-44 [PMID: 21978210]
  69. Arch Phys Med Rehabil. 2021 May;102(5):835-842 [PMID: 33166525]
  70. JAMA Cardiol. 2020 Jul 1;5(7):831-840 [PMID: 32219363]
  71. Arch Phys Med Rehabil. 2010 May;91(5):743-9 [PMID: 20434612]
  72. Rehabil Nurs. 2019 Nov/Dec;44(6):302-310 [PMID: 31689247]
  73. J Speech Lang Hear Res. 2018 May 17;61(5):1261-1278 [PMID: 29710193]
  74. Health Technol Assess. 2017 Sep;21(54):1-120 [PMID: 28967376]
  75. Intensive Care Med. 2020 Jul;46(7):1326-1338 [PMID: 32514597]
  76. Heart Lung. 2015 Sep-Oct;44(5):408-415.e2 [PMID: 26354859]
  77. Clin Otolaryngol. 2021 Nov;46(6):1290-1299 [PMID: 34197688]
  78. Lancet Neurol. 2020 Sep;19(9):767-783 [PMID: 32622375]
  79. Eur J Neurol. 2015 Sep;22(9):1288-94 [PMID: 26040251]
  80. Arch Phys Med Rehabil. 2019 Jul;100(7):1283-1288 [PMID: 30735625]
  81. J Stroke Cerebrovasc Dis. 2016 Oct;25(10):2535-42 [PMID: 27423366]
  82. Neurology. 2016 Jun 7;86(23):2138-45 [PMID: 26888985]
  83. Curr Atheroscler Rep. 2017 Nov 7;19(12):59 [PMID: 29116473]
  84. Arch Phys Med Rehabil. 2016 Dec;97(12):2188-2201.e8 [PMID: 27063364]
  85. Int J Speech Lang Pathol. 2013 Oct;15(5):492-502 [PMID: 23336825]
  86. Eur J Cardiovasc Nurs. 2019 Aug;18(6):435-448 [PMID: 31027426]
  87. JAMA Neurol. 2020 Jun 1;77(6):683-690 [PMID: 32275288]
  88. Stroke. 2019 Dec;50(12):e344-e418 [PMID: 31662037]
  89. Semin Speech Lang. 2006 Nov;27(4):260-7 [PMID: 17117352]
  90. Nutr Clin Pract. 2018 Aug;33(4):553-566 [PMID: 29397032]

MeSH Term

COVID-19
Critical Care
Humans
Neurological Rehabilitation
Neuronal Plasticity
Respiration, Artificial
SARS-CoV-2
Speech-Language Pathology

Word Cloud

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