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Practice research supports SLP collaboration in primary care

Patients like speech-language pathologists on hand in their primary care. Reliable poll data has shown that, where relevant, user satisfaction associates directly with the number of SLP’s available in family health strategy planning.1

Speech disorders top the list in professional partnership. These are the patients, children and adults, who reproduce sounds poorly, for any number of reasons. Sometimes it’s voice (and related cognitive) issues having to do with hyperkinetic disorders. SLP’s play an important role in contributing to the differential diagnosis and management of impaired speech and even deglutition associated with these.2 In aphasia, secondary to stroke, speech language therapy can elicit significant improvement,3 and in primary progressive aphasia, in which the patient develops language deficits while other cognitive domains remain relatively preserved, the same is true.4 In stuttering, common in persons of all ages, of varying etiology, and for which exact diagnosis and treatment is critical, the mainstay of intervention is speech analysis and therapy.5

Oropharyngeal dysphagia is another common, and frequently underreported, opportunity for team care. It can manifest as difficulty initiating swallowing, coughing, choking, or aspiration, and it is most often caused by chronic neurological conditions such as stroke, Parkinson’s disease, or dementia, and it can arise from other causes as well. It is a well described geriatric syndrome, affecting 10% to 33% of older adults.6 Speech-language pathologists and other specialists, in collaboration with family physicians, can provide structured assessments and make appropriate recommendations for safe swallowing, palliative care, or rehabilitation.7 Even resistant hypertensive patients with obstructive sleep apnea (itself the cause of numerous syndromes of concern to speech-language pathologists), show improved swallowing performance after swallowing therapy.8

Speech-language pathologists are playing a crucial role in the assessment and management of chronic cough, too. This is true for patients infected with severe acute respiratory syndrome coronavirus,9 and for patients with refractory cough for other reasons. They frequently warrant referral to a pulmonologist, an otolaryngologist, or, particularly where reflux issues are suspected, to a speech therapist.10 Trials have now shown that speech therapy has resulted in decreases in cough severity and improvement of quality of life.11, 12

1 Zanin LE, Albuquerque IMN, Carneiro MDSM, Melo DH. Evaluation of speech-language pathology care in the family health strategy from user perspective. Codas. 2017 Dec 7;29(6):e20160192. Portuguese, English. doi: 10.1590/2317-1782/20172016192.

2 Barkmeier-Kraemer JM, Clark HM. Speech-Language Pathology Evaluation and Management of Hyperkinetic Disorders Affecting Speech and Swallowing Function. Tremor Other Hyperkinet Mov (N Y). 2017 Sep 21;7:489. doi: 10.7916/D8Z32B30.

3 Laska AC, Kahan T, Hellblom A, Murray V, von Arbin M. A randomized controlled trial on very early speech and language therapy in acute stroke patients with aphasia. Cerebrovasc Dis Extra. 2011 Jan-Dec;1(1):66-74. doi: 10.1159/000329835.

4 Kanter SJ, Factora RM, Suh TT. Does this patient have primary progressive aphasia? Cleve Clin J Med. 2006 Nov;73(11):1025-7. doi: 10.3949/ccjm.73.11.1025.

5 Perez HR, Stoeckle JH. Stuttering: Clinical and research update. Can Fam Physician. 2016 Jun;62(6):479-84.

6 Thiyagalingam S, Kulinski AE, Thorsteinsdottir B, Shindelar KL, Takahashi PY. Dysphagia in Older Adults. Mayo Clin Proc. 2021 Feb;96(2):488-497. doi: 10.1016/j.mayocp.2020.08.001.

7 Wilkinson JM, Codipilly DC, Wilfahrt RP. Dysphagia: Evaluation and Collaborative Management. Am Fam Physician. 2021 Jan 15;103(2):97-106.

8 Borges TGV, Muniz CR, Ferreira FR, Brendim MP, Muxfeldt ES. Swallowing outcome to speech therapy intervention in resistant hypertensive patients with obstructive sleep apnea. Eur Arch Otorhinolaryngol. 2023 Jan;280(1):443-453. doi: 10.1007/s00405-022-07612-3.

9 Vergara J, Skoretz SA, Brodsky MB, Miles A, Langmore SE, Wallace S, Seedat J, Starmer HM, Bolton L, Clavé P, Freitas SV, Bogaardt H, Matsuo K, de Souza CM, Mourão LF. Assessment, Diagnosis, and Treatment of Dysphagia in Patients Infected With SARS-CoV-2: A Review of the Literature and International Guidelines. Am J Speech Lang Pathol. 2020 Nov 12;29(4):2242-2253. doi: 10.1044/2020_AJSLP-20-00163.

10 Michaudet C, Malaty J. Chronic Cough: Evaluation and Management. Am Fam Physician. 2017 Nov 1;96(9):575-580.

11 Dąbrowska M, Grabczak EM, Rojek D, Łobacz A, Klimowicz K, Truba O, Rybka A, Krzeski A, Krenke R. Speech therapy in the management of difficult-to-treat chronic cough - preliminary results. Adv Respir Med. 2018 Dec 30. doi: 10.5603/ARM.a2018.0044.

12 Wright ML, Sundar KM, Herrick JS, Barkmeier-Kraemer JM. Long-Term Treatment Outcomes after Behavioral Speech Therapy for Chronic Refractory Cough. Lung. 2021 Oct;199(5):517-525. doi: 10.1007/s00408-021-00481-3.

MyoNews from BreatheWorksTM is a report on trends and developments in oromyofunctional disorder and therapy. These updates are not intended as diagnosis, treatment, cure or prevention of any disease or syndrome.

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