In Honor of Better Hearing & Speech Month: An Inside Look at the Job of a Speech-Language Pathologist

May 22, 2020

When Candace McGarry, MS, CCC-SLP, introduces herself as a Speech-Language Pathologist, or speech therapist, many people don’t know what to expect. Often assumed that her main role is to help with clarity of speech, patients and family members inquire why they need her help.

An integral part of the Physical Medicine and Rehabilitation world, speech therapy often goes misunderstood and underplayed. While medical SLPs do assist with articulation in patients with dysarthria (weakness in speech muscles), cognitive deficits, and aphasia (loss of language comprehension and ability to speak) – caused by a number of illnesses and procedures – some SLPs in the hospital setting, like McGarry, actually deal more with dysphagia, or difficulty swallowing.

Why would SLPs help with dysphagia? What’s unique and largely unknown about an SLP’s background, McGarry says, is their expertise in neurology, as well as the anatomy and physiology of the head, neck, and thorax. Also, their lack of specialty, during initial education and training, allows them to work with patients of any age. “Once I explain to patients how we know swallowing is actually intertwined with voice, they have a better understanding of why we’re part of their care team.”

Dysphagia often occurs from damage to the nervous system, and can be seen in patients recovering from stroke, as well as patients suffering from neurological impairments caused by ALS, Parkinson’s disease, or oral/pharyngeal/esophageal cancer.

In the inpatient setting, McGarry, Clinical Director of Speech Services at Jefferson Health New Jersey, assesses her patients’ vocal cord function, oral and pharyngeal muscles, and swallowing capabilities. These assessments are either done clinically, at the bedside, or during a Videofluoroscopic Swallow Study in the Medical Imaging Department. She then modifies their diet and creates a treatment plan.

“We want to protect them from aspiration, or food entering the airways by accident, which can result in pneumonia and other complications,” explains McGarry. “Some patients need thickened liquids – which move a lot slower than regular liquids like water – while others may need their foods modified to a puree-consistency.”

To improve their swallowing, McGarry introduces oral motor exercises, pharyngeal and laryngeal exercises, modified head and neck positioning, and different methods of drinking and swallowing. Depending on the severity of the dysphagia, improvement can take anywhere between a few days to several weeks.

Aside from diagnosis and treatment, McGarry’s other primary responsibility is education for both the patient and their care team. McGarry says it’s essential to inform the nurses and doctors about the best ways to communicate, so that time spent with the SLP isn’t the only time the patient feels heard.

Intubation is also a common cause of dysphagia, and since the outbreak of COVID-19, McGarry’s career, like most of her colleagues’, has been flipped “upside down.” In one day, she saw 14 patients, 10 of whom were hospitalized due to COVID-19. She has had to visit patients draped in PPE – cautiously disinfecting before and after, again and again.

“Every morning is a surprise,” says McGarry. “While we do our best to go about business as usual, the extra safety precautions and uncertainty of the infection are undoubtedly stressful.” 

In addition to helping COVID-positive patients with dysphagia, she’s also worked with some of them on communication and cognitive improvement. McGarry explains that the virus, and the intensive care they undergo, have left a cognitive impact. “It’s completely unexpected, but people are coming out of this disoriented and unable to communicate.”

In her 30 years of practice, McGarry’s experienced nothing like it. However, what gets her through the tough times are the fleeting moments of success – the strides patients make in both swallowing and communicating.

“It can be as simple as a facial expression, a smile, or sigh of relief, when they realize we’re on the same level. I understand what they’re going through, and I’m going to help them through it,” says McGarry. “These are the most impactful moments.”