Speech and language therapy service provision in spinal injury units compared to major trauma centres in England: Are services matched?

Abstract

Background: National UK guidance makes recommendations for speech and language therapy staffing levels in critical care and rehabilitation settings. Traumatic spinal cord injury patients often require admission primarily to critical care services within a major trauma centre prior to transfer to a specialist spinal injury unit but may not receive similar levels of care. Dysphagia and communication difficulties are recognised features of cervical spinal cord injury; however, little is known about access to speech and language therapy services to provide rehabilitation and improve outcomes. Aims: The aim of this study was to compare the workforce and clinical practices of speech and language therapy services in eight spinal injury units and four major trauma centres in England through an online survey. Methods & Procedures: An online survey was created with 26 multiple-choice questions across seven sub-sections, with options for free-text comments. These were sent to a named speech and language therapy contact at each of the specified units. Responses were uploaded into Excel for analyses, which included descriptive statistics and analysis of themes.Outcomes & Results: Responses were received from 92% (11/12) speech and language therapy services invited, which included seven out of eight spinal injury units and all four major trauma centres. No units met national staffing recommendations. Staff in spinal injury units provided an average of 27 h per week input to the unit compared to 80 h in a major trauma centre. Despite caseload variations, speech and language range of therapy involvement and prioritisation process were equivalent. Access to instrumental assessment varied, with less use of Fibreoptic Endoscopic Evaluation of Swallowing in spinal injury units despite its clinical value to the spinal cord injury caseload. Conclusions & Implications: Speech and language therapy services delivering post-acute and long-term rehabilitation to spinal cord injury patients are limited by their resources and capacity, which restricts the level of therapy delivered to patients. This may have an impact on clinical outcomes for communication and swallowing impairments. Further evidence is needed of the interventions 6

Oropharyngeal Dysphagia in Acute Cervical Spinal Cord Injury: A Literature Review

“…FEES enables evaluation of secretions and airway patency, facilitating clinical decision making for a patient's ability to tolerate oral trials. Clinical settings can vary in their access to these instrumental assessments and the availability of SLP services, affecting dysphagia diagnosis and development of swallow rehabilitation programs [94].…”

“…Despite this there are currently no recommendations for levels of SLP staffing required for an optimal service to those with cSCI. A recent service evaluation in UK has highlighted that services in spinal units have limited staffing provision compared to those in major trauma centers, which reduces the range and intensity of therapy [94]. In the UK, a collaboration of professional bodies have proposed a minimum standard for SLP service provision to SCI rehabilitation to be delivered as part of a team approach [139] (Table 5).…”