Speech therapy, rehabilitation

See also Geriatrics and Gerontology Occupational Health Otorhinolaryngology Pediatric Medicine and Surgery Prosthetics Rehabilitation Engineering Speech Therapy and Phoniatrics. 

This classification is a useful distinction that can be applied to the conceptual rehabilitation model and framework (Figs. 4 and 5). The core ICU team undertakes the acute and intermediate phase of nonspecialized rehabilitation. The long-term phase is specialized rehabilitation and again undertaken by the core ICU team but in collaboration with other relevant specialist practitioners, such as speech and language and occupational therapy, to optimize the patients rehabilitation potential. 

Rehabilitation hospitals admit VAIs who require therapy before reentering the community. They must be able to participate in three hours or more of physical therapy per day. Most admissions are from acute care hospitals (85%), and the mean length of stay is approximately 30 days. Many patients (20%) are discharged to a skilled nursing facility (SNF) (30). Patients participate actively, with minimum restrictions and maximum therapy by the multidisciplinary team that often includes physical, occupational, and respiratory therapist, prosthetist-orthotist, rehabilitation nurse, speech pathologist, psychologist, social worker, and vocational counselor (31). 

Few, if any, patients with NMD should be left to develop unexpected ventilatory failure as appropriate assessment, self-management education, and follow-up will identify disease progression and risk of respiratory complications. When ventilatory failure occurs, tracheostomy tubes can be avoided, for the most part, irrespective of the degree of ventilator dependence, with the exception of those with insufficient bulbar-innervated musculature for speech, deglutition, and airway protection. Those with indwelling tracheostomy tubes should be offered decannulation as part of their rehabilitation, irrespective of the extent of their respiratory muscle failure. The only exceptions to this therapy are patients with advanced bulbar ALS or those with rare facioscapulohumeral muscular dystrophy, who lose all bulbar-innervated muscle function and aspirate saliva to the extent of Sao2 remaining below 95% (13). 

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