The General Council of Colleges of Speech Therapists has pointed out "shortcomings" and "inequalities" in the rehabilitation of people who have suffered a stroke, a process that includes the treatment of speech, language, communication, and swallowing disorders. In view of this situation, the organization is calling for the presence of speech therapy professionals to be ensured in the care of these patients throughout the entire care pathway.
The spokesperson for the General Council of Colleges of Speech Therapists, Ana Bistuer, made this call on the occasion of World Stroke Day, which is celebrated this Thursday. "The rehabilitation of communication and swallowing continues to be unequal depending on the autonomous community and the hospital, despite the advances of the Stroke Code," she stated.
For this reason, she reiterated the need to integrate Speech Therapy "effectively and in a coordinated manner in healthcare" and to "guarantee" the presence of speech therapists in "Stroke Units and rehabilitation and neurorehabilitation teams, as well as the continuity of treatments to improve the safety, communication and autonomy of patients".
Along the same lines, the General Council of Colleges of Speech Therapists calls for sufficient provision of professional resources and the implementation of clear protocols for evaluation, referral and follow-up between hospitals, primary care, homes and health and social care centers, in order to ensure homogeneous and continuous care.
Bistuer explained that stroke "can damage the brain networks responsible for language, speech, voice and swallowing". She also emphasized "the importance of intervening early when the clinical condition allows it", although she noted that improvements can appear "even in the chronic phase".
In this regard, she indicated that recovery "depends on the severity, location and extent of the injury, the sequelae, the premorbid state, the timeliness of rehabilitation, therapeutic continuity and support from the environment".
Likewise, she stressed that "discharge should not be established solely based on the time elapsed, but according to the evolution, the objectives and the support needs", insisting that the duration of speech therapy intervention must be adapted to each case.
Consequences of stroke in communication and swallowing
Among the most frequent sequelae of stroke, Bistuer has mentioned aphasia, "which affects approximately a third of patients and can make speaking, understanding, reading, writing, and even calculating difficult".
He has detailed that this disorder of the ability to communicate does not manifest itself the same in all people. While "some people speak with effort and broken phrases", "others use wrong words or have difficulty understanding, although they may retain their knowledge, preferences, and decision-making ability".
He has also differentiated dysarthria, "which alters the motor execution of speech and can affect articulation, voice and rhythm, from apraxia of speech, which makes it difficult to plan the movements necessary to pronounce, although the muscles function".
According to what he has indicated, both alterations "can coexist and require individualized treatments, from breathing and articulation exercises to structured practices with visual and rhythmic supports", adapting the intervention to the specific needs of each patient.
In this context, he has advised the families and the close environment of the affected person to "speak clearly, allow time to respond, use supports and avoid infantilizing the language directed at the patient". Likewise, he has asked for more specific training for caregivers, improvements in communicative accessibility and the backing of associations and conversation groups.
On the other hand, he has emphasized that dysphagia, or difficulty swallowing, "requires especially early attention". According to what he has specified, "it affects between 37 and 78 percent of people in the acute phase, depending on the evaluation method, and can cause choking, malnutrition, dehydration and respiratory complications".
In his view, it is essential to carry out a screening before the first oral intake and ensure a specialized assessment when there is suspicion of risk. Along these lines, he has explained that "the intervention includes the modification of textures, liquids, postures and oral hygiene. The use of thickeners or the removal of an alternative feeding route must be decided according to the evaluation and evolution".
Lastly, Bistuer has reminded that "if there are sudden difficulties speaking or understanding, deviation of the mouth or sudden loss of strength, 112 should be called", and has recommended "going to a registered speech therapist in the presence of communication, language, speech, voice, or swallowing sequelae", underscoring the importance of specialized and continued care after the stroke.