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

Rabinowitz, Liat; Winters, Elana; Abrams, Darcy

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.