How speech and language therapists are helping patients recover from COVID-19
There has been a lot of coverage in the media about how the many outstanding nurses, doctors and critical care teams have cared for patients with COVID-19, but what about those patients who are no longer COVID-19 positive and are still recovering from the effects of the virus?
Patients who have COVID-19 pneumonia and require ventilating and sedating lose a lot of muscle mass and strength and this weakness leaves them physically unable to go home from hospital while they undergo rehabilitation, which may take weeks or months.
And following a period of ventilation and sedation a patient may struggle to speak or swallow.
Two patients with COVID-19 who were cared for at Musgrove Park Hospital experienced these issues after spending an extensive period of time on a ventilator.
They were able to access support from our team of speech and language therapists from the time they were in intensive care and high dependency, to their transfer to medical rehabilitation wards, where they recovered their voices and swallowing to the point they no longer required speech and language therapy.
Our speech and language therapy teams are usually based out in the community but the merger of our organisations made it much easier for them to care for patients while they were in intensive care, which helps to begin their rehabilitation much more quickly.
David, a 62 year old from Taunton, was admitted to hospital with a fever and cough before he tested positive with COVID-19.
David was in fact the first COVID-19 positive patient at Musgrove Park who needed to have a tracheostomy inserted during his time in critical care, to help him progress to getting off the ventilator.
And thanks to a clinical pathway that didn’t even exist before the pandemic, he was able to receive input and support from our speech and language therapists while still in intensive care to help rehabilitate his voice and help him to swallow.
A tracheostomy involves creating an opening in the neck in order to place a tube into a person's windpipe to allow air to enter the lungs. Sometimes these are necessary to support a patient weaning from ventilation but this means that a patient cannot use their voice and may have difficulties eating and drinking.
After being sedated and on a ventilator for just over two weeks, David was very weak when his sedation was able to be reduced and, along with significant physical weakness, he also experienced difficulties swallowing so he could only be fed with a tube through his nose.
The tracheostomy remained in place for a further 10 days after his time on intensive care during which our speech and language therapy team was able to work with the medical, nursing and physiotherapy teams to support him to start talking again and to rehabilitate his swallow muscles.
Our speech and language therapy team was able to review David most days and work closely with dietitians to reduce his reliance on tube feeding as his swallow improved.
David needed modified foods and fluids as his swallow muscles were considerably weakened or deconditioned following the lengthy time spent intubated.
David is definitely a ‘foodie’, being half Italian, and his first taste of a tiramisu was definitely memorable! He required his fluids to be thickened for quite some time while he was recovering and one thing he was working hard towards was a ‘normal’ cup of coffee (from a coffee shop, not the hospital coffee!) – and he was able to achieve this before he went home.
He originally struggled to sit up in bed independently and was quickly out of breath but a few weeks on he became a lot more independent to the extent that before he left hospital he was able to take a shower and even able to make a drink and a snack independently in our kitchen area.
David is now working really hard to get back into a good physical condition, his eating and drinking difficulties have now resolved and our teams of therapists are working closely with him on his rehabilitation in the community.
Debbie, a 57 year old woman from Bridgwater, was sedated and ventilated for 21 days in intensive care. She had a tracheostomy tube inserted and this was in place for 23 days.
Our speech and language therapy team was able to support Debbie using a speaking valve on her tracheostomy to support her communication and enabled her to FaceTime her grandchildren from her hospital bed.
Debbie was fed via a feeding tube and our speech and language therapy team worked with her to strengthen her swallowing muscles so that she was strong enough to be able to eat adequate amounts of food to no longer require the feeding tube.
Debbie said she loved a good cup of tea (builder’s strength!) and it was wonderful to share her enjoyment of those first few cuppas.
Emma Wicks, one of our speech and language therapists, said: “Both of these patient examples demonstrate that our speech and language therapists have such an important role to support patients in their recovery from ventilation.
“Speech and language therapists are familiar with post-extubation dysphagia (swallowing difficulties after a period of intubation/ventilation), these typically recover, but for a period of time patients require appropriate modification of food and fluids they can eat and drink and specialist support to strengthen their muscles.
“The nature of the COVID-19 illness is such that the period of time spent intubated and ventilated is much longer than would usually be seen in critical care for a number of patients, and consequently swallowing weakness is a common outcome.
“By working within the critical care unit to support these patients affected by COVID, our speech and language therapy service was able to ensure a timely and safe return to full oral diet for all of the patients they have worked with.”