SLP Outcomes and Experiences from an Inpatient Rehabilitation Unit on the COVID-19 Front Lines

RESEARCH OBJECTIVES: To contribute to COVID-19 data by reporting experiences from Speech Language Pathologists (SLPs) working at the height of the COVID-19 pandemic in New York City. We report incidence of dysphagia, cognitive impairments, and/or dysphonia in patients at acute inpatient rehabilitation facility (IRF), and summarize facility changes implemented to meet patient needs while maintaining requirements of an IRF. DESIGN: This is a retrospective study; data obtained through retroactive chart reviews of electronic medical records. SETTING: Data gathered at Rusk Rehabilitation NYU Langone Orthopedic Hospital (LOH) in New York City. In March 2020, NYU LOH converted 75 orthopedic surgical beds to acute COVID-19 medicine beds. Simultaneously, rehabilitation unit shifted to managing rehabilitation needs of patients with COVID-19 related debility post-ICU/acute care. PARTICIPANTS: Subjects include 61 patients, ages 18+, who received SLP services during inpatient rehabilitation with primary diagnosis of COVID-19-acute respiratory failure, ARDS, or COVID-19 related debility. Admissions occurred April 1st-June 30th 2020. Reported demographics include age, gender, and discharge destination. Patients excluded if primary diagnosis was neurological with incidental positive COVID-19. INTERVENTIONS: Patients received daily SLP intervention per IRF requirements. Intensity of daily services (30 vs 60 minute sessions) determined by therapy team based on individual patient needs/tolerance. MAIN OUTCOME MEASURES: Dysphagia outcomes are reported using the Functional Oral Intake Scale (FOIS) for admitting and discharge diets. Data for other disorders presented as incidence findings. RESULTS: Data presents strong evidence for presence of dysphagia, cognitive impairments and dysphonia following COVID-19. 31.2% demonstrated dysphagia, 57.3% of patients demonstrated cognitive impairments, and 52.4% of patients demonstrated dysphonia. Practice reflections include: importance of PPE, reducing infection spread, establishing safe objective swallowing assessments, and inclusion of virtual modalities. CONCLUSIONS: There is a high occurrence of dysphagia, cognitive impairments, and dysphonia in patients with severe cases of COVID-19. Standard practice of rehabilitation for patients with COVID-19 illness should include SLP contribution to help patients achieve highest level of function. AUTHOR(S) DISCLOSURES: All authors work full-time and are currently employed by the facility where this research occurred. No other financial or non-financial connections/conflicts to disclose.