Brought to you by Encompass Health
Working in inpatient rehabilitation as a speech-language pathologist (SLP) is an amazing opportunity to experience the best of all worlds in the assessment and treatment of adults with communication and swallowing disorders.
We serve on a specialized interprofessional care team. We treat cognition, language, and dysphagia resulting from a wide variety of neurologic diagnoses including:
The typical length of stay for these patients is approximately 2 weeks, depending on functional status and diagnosis. This allows time to evaluate, build rapport, experience meaningful improvements, and prepare patients and their families for their road to recovery ahead.
Although the inpatient setting can be demanding, you will never have a boring day—and you’ll never experience the same day twice.
Follow along for a glimpse of a day in the life of an inpatient rehabilitation SLP!
I complete chart reviews for evaluations and any new patients on my schedule, prep materials for treatments and family training, and try to get a head start on discharge documentation, if applicable.
I treat a patient who has dysphagia. I use neuromuscular electrical stimulation (NMES) to target his swallowing delay.
At the same time, I implement free water protocol to optimize hydration and provide therapeutic trials of thin liquids.
If time allows, I’ll continue with expiratory muscle strength training (EMST). The goal is to gradually increase independent use of the EMST device for carryover of the regimen after discharge.
The team is evaluating a new patient who is recovering from a stroke. I receive an order to assess cognition, language, and swallowing on every patient admitted for a stroke, when appropriate. My assessment consists of several key strategies:
Motivational interviewing. I aim to make treatment goals person centered and meaningful to their specific routine and chosen activities. Therefore, this technique is important for any patient starting on Day 1.
Providing education to help build rapport, manage recovery expectations, and provide hope to the patient and their family. For some patients, this is the first time during their hospitalization that they’ve been told what a stroke is, what regions of the brain were affected, and the role that the affected lobes play in our daily functions.
I teach a brain health education group to up to six patients. It’s an interactive session where we discuss the various pillars of brain health. We review the patients’ existing routines and achievable and accessible modifications to promote brain health and optimal recovery. We also discuss principles of neuroplasticity, expectations for future levels of care, and recommendations and resources for ongoing cognitive stimulation.
I attend a team conference for a patient on my caseload. I meet with the patients’ primary interprofessional team, which includes a physical therapist (PT), an occupational therapist (OT), a registered nurse (RN), a rehab physician, and a case manager. We discuss barriers to home discharge, recommend possible solutions, and set target dates to transition the patient to the next level of care.
I conduct a 30-minute treatment session with a patient who has mild cognitive impairment. We’re targeting executive functions and implementation of external memory devices through a medication management simulation.
To prepare, I reference the patient’s medication summary in their chart. Then, trial using a pillbox with their specific medications, doses, and instructions. This makes the task personally relevant and optimizes the patient’s success.
Lunch and documentation time! It’s time to catch up on my charting.
I participate in family training for a patient with moderate expressive-receptive aphasia. I encourage family members to participate in and attend as many family training sessions as possible. I also provide verbal and print education regarding the patient’s cognitive and communication disorders; model caregiver communication and cueing strategies to best promote the patient’s recovery, autonomy, and life participation; educate the family on community resources for ongoing therapy and support groups; provide home exercise programs; and, if applicable, issue low-tech augmentative and alternative communication (AAC) devices, aphasia identification wallet cards, and more. I find it helpful to illustrate on a piece of paper (via a hand-drawn staircase) where the level of language breakdown occurs in each of the brain’s four language domains. By doing this, I show family members where in the brain their loved one’s language is accessible—and what level of support they may require. Lastly, I make concrete recommendations for what types of tasks will require assistance at the time of discharge and answer any questions.
I have another patient with dysphagia on my schedule.
Our rehabilitation hospital partners with a local hospital to conduct modified barium swallow studies twice a week or more. We also contract with a mobile endoscope clinician who performs fiberoptic endoscopic evaluation of swallowing (FEES) once a week, as needed.
During the FEES, the contracted clinician operates the scope while I (a) provide trials of various texture/viscosity of food and drink and (b) educate the patient. During and following the examination, the clinician and I collaborate on what we’re seeing (i.e., live interpretation) and engage in problem solving to guide the patients’ treatment plan.
After the examination, I disseminate results and recommendations to the patient and their authorized care partners.
I complete my daily documentation with the goal of leaving work at 4:00 p.m., hanging my hat on another busy and rewarding day!
About the Author
Haley Richter, MA, CCC-SLP, graduated from the University of Cincinnati with a bachelor’s degree in communication sciences and disorders and from The Ohio State University with a master’s degree in speech-language pathology. She completed her Clinical Fellowship at Mount Carmel Rehabilitation Hospital in Westerville, Ohio—an affiliate of Encompass Health—and has been a part of their therapy team for the past 6 years.
About Encompass Health
Encompass Health is the nation’s leading provider of inpatient rehabilitation, with more than 160 hospitals in 37 states and Puerto Rico. We strive to exceed expectations as we serve our patients and communities through customized rehabilitation. Our care teams are committed to achieving the best possible outcomes to get our patients back to what matters most to them.