Speech-language pathology treatment time during inpatient spinal cord injury rehabilitation: the SCIRehab project

Abstract

Background/objectiveFollowing spinal cord injury (SCI), speech-language pathologists (SLPs) perform assessments and provide treatment for swallowing, motor speech, voice, and cognitive–communication disorders that result from the SCI and/or co-occurring brain injuries. This paper describes the nature and distribution of speech-language pathology (SLP) activities delivered during inpatient SCI rehabilitation and discusses predictors (patient and injury characteristics) of the amount of time spent in specific SLP treatment activities.MethodsSix rehabilitation centers enrolled 600 patients with traumatic SCI for an observational study of acute inpatient rehabilitation treatment (SCIRehab). SLPs documented the details of assessment and treatment and time spent on each of a set of specific SLP activities during each patient encounter. Patterns of time use are described for all patients by neurological injury category. Ordinary least squares stepwise regression models are used to identify patient and injury characteristics predictive of treatment time in the specific SLP activities identified.ResultsSLP consults were requested for 40% of SCIRehab patients. Fifty-seven percent of these patients received intense therapy (defined as more than five sessions during the rehabilitation stay); the remainder received primarily evaluation or less intense services (one to five sessions). The patients who participated in intense treatment received a mean total of 16.1 hours (range 2.5–105.2 hours, standard deviation (SD) 16.5, median 9.7 hours) of SLP; significant differences were seen in the amount of time spent in each activity among neurological injury groups. Cognitive–communication and swallowing therapy were the most common SLP activities. Patients with motor levels of injury at C1–C4 spent the highest percentage of their therapy time working on swallowing therapy while patients with low tetraplegia and paraplegia, and those classified as AIS D (regardless of motor level of injury) focused the greatest percentage of time on cognitive–communication work. Patient and injury characteristics explained a portion of the variation in time spent on cognitive–communication therapy but did not explain the variation in time spent on swallowing and other SLP treatment activities.ConclusionThe need for swallowing and cognitive treatment by SLP is common during inpatient rehabilitation due to dysfunction resulting from use of artificial airways and feeding approaches, as well as secondary brain injuries. The large amount of variability seen in SLP treatment time, which is not explained well by patient and injury characteristics, sets the stage for future analyses to associate treatments with outcomes.