Speech-Language Pathology
The approach for treating patients with dysphagia in the HNC Survivorship Clinic is shifting more to telepractice since the outbreak of COVID-19. Telepractice has been deemed feasible in HNC patients and other adult patient populations, who need continued support by a speech-language pathologist.13, 14 Initially, telepractice was intended to reach patients in remote areas where speech services were not available. Now it is being used to help patients continue with therapy programs in their homes while limiting exposure to COVID-19. It is important to note that each state has its own policies, laws, and professional regulations regarding the provision of teletherapy by speech-language pathologists.
In the HNC Survivorship Clinic, speech-language pathologists are using telepractice with individuals undergoing definitive or adjuvant treatment. This begins after the initial swallowing evaluation has been completed in the clinic and a treatment plan identified. Weekly sessions are held via televideo to promote eating and swallowing exercise programs, with the primary goal to prevent atrophy of the muscles and to help maintain oral diets throughout the course of treatment. We are also using telepractice to engage with individuals who suffer from long-term treatment-related toxicities that impair swallowing function. In addition to implementing a swallowing exercise program, televideo visits allow us to complete a modified version of our typical clinical swallowing assessment to monitor diet tolerance, swallowing function, and use of compensatory strategies to reduce aspiration risk. Without our intervention, these patients may be at risk for developing aspiration pneumonia, malnutrition, or further decline with swallowing function. Individualized treatment programs are established based on patient needs, and close collaboration continues with the physical therapy team.
Speech-language pathologists need to continue to monitor, coach and treat individuals who need our help during and after HNC treatment. COVID-19 has changed the way we are doing things, but we may discover that these new methods will bring added value to what we do.