ABSTRACT
Research Objectives To investigate the impact of provider mask wearing on communication during wheelchair education. Design A voluntary survey designed by physical therapists and speech language pathologist to question perceived impact of mask wearing on communication and communication strategies. Setting Urban nonprofit rehabilitation hospital. Participants Sixty-six physical and occupational therapists from inpatient, outpatient, and day rehabilitation participated. Interventions Not Applicable. Main Outcome Measures Clinician perceived impact per survey response. Results Clinicians identified that mask wearing impacted communication at least some of the time as it relates to clarity (80.3%), efficiency (78%), and ability to establish rapport (60.6%). Clinicians reported a variety of strategies to limit communication breakdowns, at least some of the time repeating statements (84.8%), raising their voice (78.8%), increasing patient proximity (78.8%), using nonverbal cues (75.8%), conducting sessions in an alternative location (68.2%) using pictures or video supports (47.0%), and using written communication (40.9%). Clinicians would like further training in printed resources (68.2%), ways to integrate communication tools (51.5%), nonverbal communication techniques (31.8%), and vocal hygiene strategies (30.3%). Conclusions Results indicate clinicians used a variety of communication strategies to reduce communication breakdowns while wearing a mask. Clinicians reported their communication remained effective for wheelchair education activities, though multiple strategies were utilized to minimize the impact. Staff identified additional training and resources necessary to support effective patient-provider communication while wearing a mask. Author(s) Disclosures There are no conflicts to disclose by the authors.
ABSTRACT
OBJECTIVE: To investigate dysphagia in patients recovering from SARS-CoV-2 admitted to acute inpatient rehabilitation by summarizing clinical swallow evaluation and videofluoroscopic swallow study findings. DESIGN: Retrospective cohort study. SETTING: Urban inpatient rehabilitation hospital. PARTICIPANTS: The first inpatients admitted with SARS-CoV-2 (N=40) who participated in a videofluoroscopic swallow study. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Patient characteristics upon admission (duration of intubation, tracheostomy status, comorbidities, videofluoroscopic swallow study (VFSS) completion at previous level of care); admission International Dysphagia Diet level (IDDSI); Mann Assessment of Swallowing Ability (MASA), Functional Oral Intake Scale (FOIS), dysphagia severity rating; penetration aspiration scale (PAS) rated during VFSS; and IDDSI level recommended after completion of VFSS. RESULTS: Twenty percent of patients had been evaluated by videofluoroscopy in acute care. Nineteen of 37 (51%) individuals were upgraded to IDDSI level 7 regular diet with level 0 thin liquids and achieved a FOIS of 7 after the completion of the VFSS. Five individuals (13%) received a diet downgrade or remained on the same diet recommendations from their admission. Total numerical score (TNS) of less than 170 on the MASA predicted presence of aspiration in 27% of patients (6 of 22). Seventy-two percent of the sample (16 of 22) had a TNS less than 170 but did not demonstrate any instances of aspiration. The odds of patients having a PAS of 3 or greater increased by approximately 15% (odds ratio, 1.15; 95% confidence interval, 1.03-1.27; P=.013). Thus, with each additional day of intubation during acute care stay, there was a 15% greater likelihood of having airway invasion. CONCLUSIONS: Instrumental swallow evaluations are imperative to diagnose and treat dysphagia in the post-coronavirus disease population. Because of the heterogeneity of this population, high incidence of prolonged intubation, and limitations of the clinical swallowing evaluation, instrumental assessments need to be performed on a more consistent basis as infection prevention protocols evolve.