Giving COVID-19 patients their voices back

Speech-language pathology, Milva Venditti, Mélissa Bouchard, Milana Schipper, Catherine Booth Hospital
Speech-language pathology, Milva Venditti, Mélissa Bouchard, Milana Schipper, Catherine Booth Hospital

Speech-language pathologists assist COVID-19 patients after intubation

Imagine winning the battle against COVID-19 but losing your ability to speak or swallow.

During the coronavirus crisis, some patients arrived at the Jewish General Hospital in such acute respiratory distress that they needed a ventilator to help them breathe. The tubes could be removed once they recovered, but these patients’ stories weren’t over—they were just beginning.

Patients often required help to regain some of the most essential human functions:  eating, drinking and using their voice. And the team of speech-language pathologists at the JGH were by their side, supporting them on their journey to recovery.

Milana Schipper, a Speech-Language Pathologist in the JGH Intensive Care Unit, recalls an elderly man who’d had a tracheotomy, a procedure in which a tube is inserted into the windpipe through an opening in the front of the neck. These patients lose their ability to speak, and speech-language pathologists can help them recover their voice with intensive therapy and the use of a speaking valve.

When the patient heard his voice for the first time in weeks, his eyes widened. Then he said, “Hello, hello,” as if testing an old instrument for the first time. Finally, he turned to his daughter, who was at his bedside, and said the words, “I love you.”

These moments of first speech are described as some of the most rewarding parts of a speech-language pathologist’s job.

“It’s extremely moving,” Ms. Schipper says.

Though largely overlooked, the speech-language pathology team was a critical part of our CIUSSS’s frontline coronavirus response. Ms. Schipper, like her colleagues, often began her work with fundamental communication. This could mean offering intubated patients a picture board, for example, so they could convey a simple message such as, “I’m cold.” In some cases, patients’ only means of communication was to move their eyes.

While respirators saved lives, the breathing tubes that were inserted into patients’ throats risked damaging their vocal cords and surrounding muscles, affecting their ability to speak and swallow. The longer a patient was intubated, the more likely the damage.

Regaining one’s voice has deep significance to recovering patients. Speech-Language Pathologist Mélissa Bouchard recalls a woman in her early 30s who sang in her church choir and, after time on a respirator, was desperate to speak again.

“Our voice is our identity. It’s unique to each of us, as much as our face,” Ms. Bouchard explains. “When anything alters it, ­it’s like we aren’t ourselves.”

Ms. Bouchard gave the woman exercises and practised with her, helping her produce a voice while minimizing strain on her vocal cords. Once the woman was discharged, she was given additional exercises to perform at home while waiting for follow-up care in the speech-language pathology out-patient voice clinic. “She felt there was something she could do. It gave her back control over the situation,” Ms. Bouchard says.

Speech-language pathologists also evaluate swallowing disorders, known as dysphagia, and offer strategies for recovery. Intubation can weaken the muscles used for swallowing, and the team helped recovering COVID-19 patients take their first sips of water or first bites of food after prolonged periods of intubation.

“To be able to help somebody communicate, swallow and start eating by mouth again feels incredible,” says Gina Mills, Chief of Speech-Language Pathology at the JGH. “These are basic abilities we take for granted until we no longer have them.”

Working conditions were demanding for the speech-language pathologists, especially during the first wave of the coronavirus in 2020. Their work involved getting up close to patients infected with COVID-19 to assess their capacity to swallow. They also offered services to COVID-19 patients transferred to the JGH from the Catherine Booth Hospital—patients who would not otherwise have had access to these specialized interventions.

In addition, the speech-language pathologists maintained coverage on all of their regular care units, as well as uninterrupted out-patient services. For a small team of just eight people, it meant taking on extra workloads and stretching themselves to their limits.

“At the beginning of the pandemic, we didn’t know what we were up against,” says Ms. Schipper. “It was challenging, but we always knew we were making a difference.”

Ms. Mills says that while conditions were challenging, the team had a positive outlook.

“They really rallied together and supported one another,” Ms. Mills says. “I am very proud of the dedication and commitment to excellent patient care that my team continues to demonstrate during these trying times.”