Speech and Language Therapy
QUESTIONS WE HAVE ANSWERED
Could you please provide clarity on the proper disposal of PPE?
What type of bin should be used? Can certain types of PPE be disposed in domestic bins (e.g. masks)?
If PPE is worn with a person who is known or suspected to have COVID-19 then it should be disposed of in a healthcare risk waste bin (yellow). If a healthcare risk waste bin is unavailable, the following procedure should be followed:
- All items of PPE should be disposed of into a plastic bag
- The bag should not be filled more than three quarters full
- The bag should be securely tied and placed inside another second, plastic bag (double bag)
- The bag should be stored securely for 72 hours and can then be disposed of with general domestic waste
If PPE is worn in the absence of a specific known risk of COVID-19 it can be discarded immediately as general domestic waste. There is no distinction made between different types of PPE in terms of disposal procedures.
The content of this document is correct as of 11/12/20.
1.Can a Classroom Feeding Observation for Dysphagia take place within a Pod?
2.When conducting a Classroom Feeding Observation for Dysphagia do parents of children in the same Pod as the patient need to be informed of, and consent to, the observation?
1.Yes, assuming local and national COVID-19 guidelines are followed including PPE and social distancing, a Classroom Feeding Observation for Dysphagia can take place within a Pod.
2.Yes, assuming local and national COVID-19 guidelines are followed including PPE and social distancing, a Classroom Feeding Observation for Dysphagia can take place within a Pod.
The content of this document is correct as of 18/09/2020.
This response was based on the Department of Education COVID-19 Response Plan for Reopening our Primary and Special Schools, version 2, published in August 2020. Access this document here.
- What is the evidence to support high flow nasal oxygen in COVID-19 management?
- Does high flow nasal oxygen result in increased droplet dispersion and aerosol generation in COVID-19 patients?
High flow nasal oxygen for the management of COVID-19 is a controversial topic due to a lack of high-quality research into its efficacy and its potential as an aerosol-generating procedure. Systematic reviews commissioned by the World Health Organization found that high-flow nasal cannulas may reduce the need for invasive ventilation and the escalation of treatments over conventional oxygen therapy in COVID-19 patients. However, they caution that this potential advantage must be weighed against the currently unknown risk of droplet and aerosol transmission: there is currently no research evidence directly examining the consequent dispersion of COVID-19 virus for this procedure. A number of actions can reduce any potential risk: deliver HFNO in negative-pressure rooms and/or ensure proper ventilation; use an increased area of precaution; ensure staff have protective PPE; and place surgical masks on patients receiving the HFNO.
The content of this document is correct as of 04/12/20.
- Is there any evidence to suggest chest physiotherapy is an aerosol-generating procedure?
- Does the evidence compare different types of chest physiotherapy treatment techniques – and whether certain treatments may be more aerosol generating than others? (i.e. positive pressure devices, oscillating devices, cough assist, breathing techniques, patient coughing, suction etc).
There is insufficient evidence to state that chest physiotherapy is an aerosol-generating procedure. However, absence of evidence is not evidence of absence. International and national professional physiotherapy bodies have endorsed guidelines for physiotherapy management during COVID-19 which state that chest physiotherapy interventions are potentially aerosol-generating procedures and strongly recommend using airborne precautions when delivering these interventions. Furthermore, a recent systematic review classified chest physiotherapy interventions as potentially aerosol-generating and recommended, for the purposes of selecting personal protective equipment, that such procedures be treated as aerosol-generating.
The content of this document is correct as of 04/12/20.
What is the latest evidence regarding conscious proning of COVID-19 patients?
At what level of oxygen is it best to commence proning?
When should you stop proning as the patient is improving?
The current evidence for conscious proning is of poor quality and fails to answer several key questions required to inform clinical practice, including the optimum conditions for commencing and ceasing proning. There are multiple RCTs underway that will address these gaps in knowledge over the coming months.
The content of this document is correct as of 27/11/2020.
1.What is current guidance for cleaning a room after a hands-on physiotherapy session?
2.What are the current recommended products for effectively cleaning surfaces?
3.Do I have to wait a certain amount of time to clean my treatment room after a session?
1.Clean with detergent and water followed by rinsing and drying. If a surface is suspected or known to have been contaminated by infectious material a disinfected should be used after cleaning.
2.A neutral detergent with water for cleaning and a chlorine-based product, such as sodium hypochlorite, for disinfecting.
3.HSPC cleaning protocols do not stipulate that a certain amount of time should be left between seeing a patient and cleaning. HSPC guidelines state that COVID-19 virus droplets produced by an infected patient will land on surfaces “within minutes” of production. They do not state how many minutes precisely. Research has found that large droplets fall within 1 second while smaller droplets can take up to 9 minutes to fall to the ground.
The content of this answer is correct as of 02/10/2020
What is the current guidance for Occupational Therapists practicing telehealth?
There are a number of best practice guidance documents currently available. We have summarised the information and guidance from the Irish COVID-19 Occupational Therapy in Acute Hospitals Interest Group, the Association of Occupational Therapists of Ireland, the World Federation of Occupational Therapists, the American Occupational Therapy Association and Occupational Therapy Australia (OTA).
Can the below tests be administered via telepractice?
- Beery-Buktenica Developmental Test of Visual-Motor Integration
- Detailed assessment of speed of handwriting (DASH)
Yes, both Beery and the DASH have publisher recommendations for administration via telepractice. Detailed instructions for the DASH can be found here and detailed instructions for the Beery can be found here.
Both tests are published by Pearson. The DASH telepractice information is available on the Pearson UK website but it does not appear on their US website. For the Beery, vice versa, the telepractice information is available on the Pearson US website and does not appear on their UK website.
What is the impact on return to work for patients with COVID-19 who have been hospitalised?
In Ireland, 3,676 people have been hospitalised because of COVID-19. There is no information on the consequent work status of these individuals. This is also the case on the global stage. There are indications from small scale studies and research on similar diseases (SARS & MERS) that some individuals hospitalised with COVID-19 will experience delayed return to work. Fatigue and breathlessness are the most common post-discharge symptoms. Scientists and professional bodies are calling for occupational therapists and other allied health professionals to prepare for the surge in demand for services but more research is needed to determine the long-term consequences of a COVID-19 hospitalisation and its impact on return to work.
The content of this document is correct as of 08/10/2020.
How can a person who is a ‘close contact’ without their own transport safely travel to a COVID-19 testing centre? Are there any specific arrangements for students or healthcare workers? Can they use public transport, taxi or is there any arrangement with the ambulance centre to support this?
A person who is a ‘close contact’, without their own car, should ask one person that they live with to drive them to the testing centre. If the ‘close contact’ does not live with anyone who has a car they should ask someone who they have been in close contact with very recently to drive them. They should follow the HSE guidance on how to safely travel in a car in such a circumstance. A person who is a close contact should not use public transport, this includes using a taxi service. There are no special arrangements in place for students or healthcare workers.
The content of this document is correct as of 10/11/2020.
Do I need to wear a mask if maintaining a 2m distance in a treatment room while delivering face-to-face CBT in Primary Care?
The National Public Health Emergency Team (NPHET) has recommended that healthcare workers use a surgical mask for all patient care activities when a safe distance (2m) cannot be maintained. This implies that when a 2m distance can be maintained a mask is not necessary. However, the NPHET guidance does not state this explicitly and does not address the issues of room size/occupancy or duration of contact. The European Centre for Disease Prevention and Control considers maintaining a 2m distance in a closed environment, such as a treatment room, as low-risk for exposure to COVID-19. The HSE Health Protection Surveillance Centre state that in low-risk circumstances, where wearing a mask may impact on patient care, a clear face visor is an acceptable alternative.
The content of this document is correct as of 30/09/2020.
These documents were used to answer this question:
- Health Protection Surveillance Centre (2020). Interim Guidance on Infection Prevention and Control for the Health Service Executive 2020 v1.2. HSE: September 2020.
- Health Protection Surveillance Centre (2020). Guiding principles for Infection Prevention and Control when returning to routine General Practice during pandemic COVID-19 v2.1. HSE: July 2020.
- European Centre for Disease Prevention and Control (2020). Public health management of persons having had contact with cases of novel coronavirus in the European Union. ECDC: February 2020.
Dr Liz Kingston, member of the RapidInfo4U Panel of Experienced Clinicians and Lecturer at the University of Limerick, with a clinical speciality in infection prevention and control, was consulted to answer this question.
When cleaning areas between patients are detergent wipes (e.g. Sanicloths) required or will a general detergent spray and disposable tissue suffice?
When disinfecting areas between patients are disinfectant wipes required or can we use disinfectant spray and disposable tissues?
The HSE Health Protection Surveillance Centre guidelines do not stipulate that wipes are required to clean or disinfect areas between patients. Disposable tissues, cloth, or paper towels are sufficient to use in conjunction with the appropriate detergent solution and disinfectant.
The content of this document is correct as of 06/11/2020.
This response was based on HSE Health Protection Surveillance Centre Interim Guidance on Infection Prevention and Control for the Health Service Executive 2020 v1.2. Available here.
Is there sufficient evidence to warrant a change in the established position (i.e. NICE guidelines of June 2020) regarding vitamin D for the prevention or treatment of COVID-19?
No, there is insufficient evidence to warrant a change in the established position (i.e. NICE guidelines of June 2020) regarding vitamin D for the prevention or treatment of COVID-19. Best practice remains maintaining recommended levels of Vitamin D, which may include supplementation of vitamin D in groups at high-risk of deficiency.
The content of this document is correct as of 17/09/2020.
This document has been written on behalf of the Royal College of Speech and Language Therapists (RCSLT) by an expert panel. This document provides revised guidance to support the delivery of SLT-led endoscopy during the COVID-19 pandemic and is relevant to a wide range of clinical conditions. The expert group have considered the feedback from RCSLT members and made the following key recommendations:
- This paper clarifies that the guidance applies to all patients regardless of their
COVID-19 status and care settings
- PPE requirements are in line with the high, medium, and low risk patient
pathways as defined by PHE (see section 5.2)
- FEES or SLT led endoscopy can be performed by either level 2 or 3 SLT
- Trainee (level 1) SLTs can be involved in supporting FEES or SLT led endoscopy
assessment procedures. The standard protocols for all SLT-led endoscopy
procedures should be followed as set out in the relevant RCSLT position papers
(FEES, EEL, Adult Respiratory Care).
- SLT-led endoscopy may be used for the purposes of clinical assessment,
research, audit, and service evaluation where relevant approvals have been
Click here for document
The Dysphagia Research Society (DRS) is a multidisciplinary society of researchers and clinicians (speech-language pathologists, swallowing scientists, physicians, engineers, physical therapists, occupational therapists, dietitians and others) with expertise in swallowing disorders (dysphagia).
DRS COVID-19 Taskforce
The DRS has established a multidisciplinary COVID-19 Taskforce of international academic and healthcare professionals with expertise in Speech-Language Pathology, Otolaryngology, Gastroenterology, Critical/Intensive Care, Infectious Diseases and Respiratory Care.
COVID-19 resource page
The DRS COVID-19 Taskforce has put together a COVID-19 resource page of credible sources related to COVID-19 research and clinical educational/practice materials.
The DRS COVID-19 Taskforce has written a guidance document on use of personal protective equipment, aerosol-generating procedures, and oropharyngeal dysphagia management during COVID-19.
Published review paper
The DRS COVID-19 Taskforce has published a review paper which provides current evidence on COVID-19 transmission during commonly used dysphagia practices and provides recommendations for protection while conducting these procedures. The paper summarizes current understanding of dysphagia in patients with COVID-19 and draws on evidence for dysphagia interventions that can be provided without in-person consults and close proximity procedures including dysphagia screening and telehealth.
ASHA guidance: Ten Ways Children With Language Disorders Can Maintain Both Physical Distance and Social Connection During the Coronavirus Pandemic
The American Speech-Language-Hearing Association (ASHA) is the national professional, scientific, and credentialing association for 211,000 members and affiliates who are audiologists; speech-language pathologists; speech, language, and hearing scientists; audiology and speech-language pathology support personnel; and students.
They have put together this guidance to help children with language disorders to maintain both physical distance and social connection during the pandemic.
Click here for article
This document from the Irish Association of Speech & Language Therapists (IASLT) aims to guide members on the current factors they should consider, in their own service-specific situations, in remodelling SLT Service Provision.
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This position statement from the Irish Association of Speech & Language Therapists (IASLT) addresses the use of Personal Protective Equipment for SLTs performing aerosol-generating procedures as part of dysphagia management of individuals with COVID-19 (positive, suspected or non-COVID).
Click here for document
It is now widely recognised that speech and language therapists have a key role within ICU and in optimising patient recovery following critical care.
This speech and language therapy guidance has been developed as part of the Intensive Care Society’s Rehabilitation Working Party’s work on rehabilitation pathways for COVID-19 patients. It outlines what high-quality rehabilitation service models and pathways could look like for COVID-19.
CONTENT FROM SCIENTIFIC JOURNALS
Zaga, C. J., Pandian, V., Brodsky, M. B., Wallace, S., Cameron, T. S., Chao, C., … & Vogel, A. P. (2020). Speech-Language Pathology Guidance for Tracheostomy During the COVID-19 Pandemic: An International Multidisciplinary Perspective. American Journal of Speech-Language Pathology, 1-15.
Speech-language pathologists are often called on to assist in the care of patients with tracheostomy and known or suspected COVID-19 infection. Appropriate care of these patients is predicated on maintaining the health and safety of the health care team. Careful adherence to best practices can significantly reduce risk of infectious transmission.
Click here for article
The rapid dissemination of COVID-19 and its serious course require a novel approach to healthcare practices. Severe disease progression is often associated with the development of the Acute Respiratory Distress Syndrome and may require some form of respiratory support, including endotracheal intubation, mechanical ventilation, and enteral nutrition through a nasogastric tube. These conditions increase the risk of dysphagia, aspiration, and aspiration pneumonia.
The data on the incidence and risks of dysphagia associated with COVID-19 are not yet available. However, it is assumed that these patients are at high risk, because of respiratory symptoms and reduced lung function. These findings may exacerbate swallowing deficits.
The aim of this review is to summarize available information on possible mechanisms of postintubation dysphagia in COVID-19 patients. Recommendations regarding the diagnosis and management of postintubation dysphagia in COVID-19 patients are described in this contemporary review.
Click here for review
Laryngoscopy is the mandatory gold standard for the accurate assessment and diagnosis of inducible laryngeal obstruction. However, it is considered an aerosol‐generating procedure and so in the context of COVID-19 the availability of laryngoscopy is reduced.
This consensus statement aims to guide clinicians working with inducible laryngeal obstruction (ILO) patient populations in the context of COVID-19. It provides an agreed, recommended strategy for presumptive diagnosis in patients who cannot have laryngoscopy performed due to pandemic restrictions.
click here for article
Provision of speech-language pathology services for the treatment of speech and language disorders in children during the COVID-19 pandemic: Problems, concerns, and solutions
Tohidast, S. A., Mansuri, B., Bagheri, R., & Azimi, H. (2020). Provision of speech-language pathology services for the treatment of speech and language disorders in children during the COVID-19 pandemic: Problems, concerns, and solutions. International journal of pediatric otorhinolaryngology, 138, 110262.
COVID-19 has interrupted the provision of Speech-Language Pathology (SLP) services to children due to the need for face-to-face communication between Speech and Language Pathologists (SLPs) and children during the evaluation and treatment processes.
This article describes the negative effects of COVID-19 on the provision of SLP services and discusses concerns raised by the families, the importance of providing SLP services during the critical period of speech and language development, telepractice services, the roles of speech-language-hearing related scientific associations, and the roles of SLPs during the COVID-19 crisis.
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This short editorial in the Archives of Physical Medicine and Rehabilitation discusses aerosol-generating procedures. Published June 10th, 2020.
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Patterson, J. M., Govender, R., Roe, J., Clunie, G., Murphy, J., Brady, G., … & Carding, P. (2020). COVID‐19 and ENT SLT services, workforce and research in the UK: A discussion paper. International journal of language & communication disorders.
The aim of this article is to discuss the threats and opportunities from the COVID-19 pandemic for SLTs in ENT/laryngology with specific reference to clinical practice, workforce and research leadership.
Click here for article
Virtual Dysphagia Evaluation: Practical Guidelines for Dysphagia Management in the Context of the COVID-19 Pandemic
Soldatova, L., Williams, C., Postma, G.N., Falk, G.W. and Mirza, N., 2020. Virtual Dysphagia Evaluation: Practical Guidelines for Dysphagia Management in the Context of the COVID-19 Pandemic. Otolaryngology–Head and Neck Surgery
With encouraging signs of pandemic containment nationwide, the promise of return to a full range of clinical practice is on the horizon. Clinicians are starting to prepare for a transition from limited evaluation of emergent and urgent complaints to resumption of elective surgical procedures and routine office visits within the next few weeks to months. Otolaryngology as a speciality faces unique challenges when it comes to the COVID-19 pandemic due to the fact that a comprehensive head and neck examination requires aerosol generating endoscopic procedures. Since the COVID-19 pandemic is far from being over and the future may hold other highly communicable infectious threats that may require similar precautions, standard approaches to the clinical evaluation of common otolaryngology complaints will have to be modified. In this communication, we present practical recommendations for dysphagia evaluation with modifications to allow a safe and comprehensive assessment.
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Implementation of telehealth in speech-language and hearing therapy for patients at home: an experience report.
Dimer, N. A., Canto-Soares, N., dos Santos-Teixeira, L., & de Goulart, B. N. G. (2020). The Covid-19 pandemic and the implementation of telehealth in speech-language and hearing therapy for patients at home: an experience report.
This is an experience report on the implementation of real-time telehealth in speech-language and hearing therapy for patients during the COVID-19 pandemic who were previously seen on an outpatient basis in a primary health care service.
Click here for report
Cranial nerve involvement is a finding often observed in patients infected with severe acute respiratory syndrome. To our knowledge, this is the first report of oropharyngeal dysphagia associated with COVID-19.
A 70-year-old male developed dysphagia and consequent aspiration pneumonia during recovery from severe COVID-19. He had altered sense of taste and absent gag reflex. Videoendoscopy, videofluorography, and high-resolution manometry revealed impaired pharyngolaryngeal sensation, silent aspiration, and mesopharyngeal contractile dysfunction. These findings suggested that glossopharyngeal and vagal neuropathy might have elicited dysphagia following COVID-19. The current case emphasizes the importance of presuming neurologic involvement and concurrent dysphagia, and that subsequent aspiration pneumonia might be overlooked in severe respiratory infection during COVID-19.
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Dawson, C., Capewell, R., Ellis, S., Matthews, S., Adamson, S., Wood, M., … & Pracy, P. (2020). Dysphagia presentation and management following coronavirus disease 2019: an acute care tertiary centre experience. The Journal of Laryngology & Otology, 1-13.
This paper describes dysphagia as a sequela of of COVID-19, including its diagnosis and management, hypothesised causes, symptomatology in relation to viral progression, and concurrent variables such as intubation, tracheostomy and delirium, at a tertiary UK hospital.
The paper concludes that dysphagia is prevalent in patients admitted either to the intensive treatment unit or the ward with COVID-19 related respiratory issues. This paper describes the crucial role of intensive swallow rehabilitation to manage dysphagia associated with COVID-19 Including therapeutic respiratory weaning for those with a tracheostomy.
Click here for article.
Management of dysphagia in the patient with head and neck cancer during COVID‐19 pandemic: Practical strategy
Ku, P. K., Holsinger, F. C., Chan, J. Y., Yeung, Z. W., Chan, B. Y., Tong, M. C., & Starmer, H. M. (2020). Management of dysphagia in the patient with head and neck cancer during COVID‐19 pandemic: Practical strategy. Head & Neck.
Despite significant limitations in clinical service provision during the pandemic of COVID‐19, a safe and reasonable dysphagia care pathway can still be implemented with modifications of setup and application of newer technologies.
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Feldstein, L. R., Rose, E. B., Horwitz, S. M., Collins, J. P., Newhams, M. M., Son, M. B. F., … & Singh, A. R. (2020). Multisystem inflammatory syndrome in US children and adolescents. New England Journal of Medicine, 383(4), 334-346.
Understanding the epidemiology and clinical course of multisystem inflammatory syndrome in children (MIS-C) and its temporal association with coronavirus disease 2019 (Covid-19) is important, given the clinical and public health implications of the syndrome.
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OTHER REPUTABLE REPOSITORIES & USEFUL CONTENT
The Royal College of Speech and Language Therapists (RCSLT) are the professional body for speech and language therapists in the UK; providing leadership and setting professional standards.
The RCSLT has a range of relevant and up-to-date resources and information relating to COVID-19.
Click here for RCSLT COVID-19 guidance
Click here for RCSLT report on the Impact of the COVID-19 pandemic on the speech and language therapy profession in the UK
COVID19: Lessons Learnt from London aims to capture the experiences, learning and reflections of allied health professionals. This session focuses on the crucial role of Speech and Language Therapists across the patient pathway from Critical Care to the Community.
- Jodi Allen, Senior Speech and Language Therapist at the National Hospital for Neurology and Neurosurgery
- Alexia Young, Therapy Manager and Speech and Language Therapist at Barking, Havering and Redbridge University Hospitals NHS Trust
- Lauren Harnett, Clinical Lead Speech and Therapist at Whittington Health NHS Trust Claire Twinn, Head of Speech and Language Therapy at Guys and St Thomas NHS Foundation Trust
- Caitlin McGrath, Speech and Language Therapist, Islington Community Neuro-Rehabilitation Team
Dysphagia Café is a global resource community for the Dysphagia Clinician to learn and collaborate about old and new ideas for the benefit of our pediatric and adult patients with dysphagia.
Click here for the blog (Facing COVID-19: Impact on swallowing in patients following intubation and tracheostomy)
Click here for the podcast
The American Speech-Language-Hearing Association (ASHA) is a national professional, scientific, and credentialing association for 211,000 members and affiliates who are audiologists; speech-language pathologists; speech, language, and hearing scientists; audiology and speech-language pathology support personnel; and students.
The ASAH Leader is the monthly newsmagazine of the American Speech-Language-Hearing Association (ASHA). It showcases the latest research and practice advances in communication sciences and disorders.
This article, by Nicole Archambault, discusses innovative ways introduced by speech-language pathologists to their clients to help children develop social and communication skills and combat isolation during the pandemic.
RapidInfo4U is part of the Irish Government’s national coordinated research and innovation response to the COVID-19 pandemic. RapidInfo4U is funded by a Health Research Board COVID-19 Pandemic – Rapid response funding award and managed by the Health Implementation Science and Technology cluster at the University of Limerick.