SCIRehab Project Series: The Speech Language Pathology Taxonomy

Abstract

Introduction: Outcomes research for speech language pathology (SLP) interventions for acute traumatic spinal cord injury (SCI) rehabilitation in the US is difficult because of the lack of a treatment classification system (taxonomy). Objective: To describe a taxonomy developed by speech language pathologists (SLPs) to examine the effects of SLP interventions on SCI rehabilitation outcomes. Methods: The SCIRehab study uses practice-based evidence, a rigorous observational methodology that examines treatment processes without specifying or requiring specific therapeutic interventions. Speech language pathology lead clinicians and researchers at 6 US SCI centers developed a detailed SLP taxonomy documentation process that is comprehensive of SLP interventions for patients with SCI. Results: The SLP taxonomy consists of 7 intervention categories that address deficits (speech production for patients with artificial airway, motor speech and voice, swallowing, cognitive-communication, and communication) and the associated exercises and tasks that patients perform. Time is recorded for each category, and supplementary information focuses on cueing needs and family involvement that helps to describe and guide intervention selection. The SCIRehab project is enrolling 1,500 patients with acute traumatic SCI at 6 inpatient rehabilitation facilities. Conclusions: Speech language pathology taxonomy information is being captured for the SCIRehab patients who are referred for SLP services; this may be the first attempt to document the many details of the SLP rehabilitation process for patients with SCI in the US.

New Approach to Study the Contents and Outcomes of Spinal Cord Injury Rehabilitation: The SCIRehab Project

“…The paper by Gassaway et al (4) in this issue describes the electronic data capture applications and methods, along with the process that was used to develop the discipline-specific POC documentation (4). Specifics for each discipline's POC are described in the remaining papers in this series (5)(6)(7)(8)(9)(10)(11).…”

“…The second article in this series by Gassaway et al (4) describes how representatives of rehabilitation disciplines at 6 centers developed a taxonomy for categorizing rehabilitation interventions and a documentation system suitable for capturing detailed treatment information prospectively and provides information on documentation elements that are common to the information collected by most disciplines. The remaining papers in the series describe the interventional taxonomies developed by 7 disciplines and the unique elements of their documentation; they also place the information collected on SCI rehabilitation against the background of issues in the disciplines involved (5)(6)(7)(8)(9)(10)(11).…”

Relationship of speech-language pathology inpatient rehabilitation interventions and patient characteristics to outcomes following spinal cord injury: The SCIRehab Project

“…Speech-language pathologists often are consulted to evaluate and treat swallowing, motor speech-voicing, and cognitivecommunication functions. 14,15 It can be particularly challenging to differentiate the type and severity of CCLs and to identify and adapt appropriate cognitivecommunication interventions for individuals with SCI. Fig.…”

“…Clinicians were trained in the use of the documentation system and entered data into handheld personal digital assistants after each encounter with a patient. The SLP treatment taxonomy has been described previously 14 and includes activities commonly employed in an SCI rehabilitation setting: initial assessment, cognitive-communication treatment and the deficit addressed (orientation, attention, memory, organization/sequencing, processing speed, problem solving, pragmatics, safety/ insight, and executive functioning), swallowing exercises (e.g. pharyngeal strengthening exercises, use of neuromuscular electrical stimulation), swallowing evaluations for oral-intake recommendations, communication treatment, motor speech and/or voice therapy (for patients with or without a tracheostomy and/or ventilator), and patient-family education.…”

“…The SLP taxonomy is comprised of eight activities delivered during individual or group sessions. 14 In the second stage of SCIRehab, analyses were conducted to better understand the type and amount of interventions that are provided in inpatient rehabilitation. Brougham et al 15 reported a significant difference in time spent in each SLP activity among different neurological groups.…”