Speech Therapy Helps Long COVID

In the spring of 2020, Covid-19 rocked our world as suddenly patients overwhelmed clinics and hospitals in every city. Since that time, patients have relied on providers to support their healing and return to daily function. Outpatient clinics like Therapy Achievements have been involved since that time seeking to provide the most up-to-date interventions to serve our patients’ everyday needs during recovery. Over time, we became aware that patients who became ill with the SARS-CoV-2 might go on to develop Long COVID.

What Is Long COVID?

Long COVID is defined by the CDC (Center for Disease Control) as a chronic condition that occurs after SARS-CoV-2 infection and is present for at least 3 months. Long COVID includes a wide range of symptoms or conditions that may improve, worsen, fluctuate, relapse or be ongoing.

Common symptoms of long COVID include fatigue, shortness of breath, cognitive dysfunction and others. A key feature is that the symptoms generally have an impact on everyday functioning.

Speech Therapy Helps Long COVID Cognitive Changes

Long COVID has come to be associated with several areas of cognitive dysfunction. Brain fog, cognitive fatigue and executive dysfunction have presented as the most commonly reported cognitive impairments within the neurological symptom profile.

Brain Fog:  Of all neurological symptoms, brain fog remains one of the highest reported by patients who experience long COVID.  Brain fog may include:

• severe cognitive fatigue and crashes
• slowed processing
• making simple mistakes
• loss of creativity
• trouble focusing
• trouble making decisions
• lack of initiation on simple tasks
• frequent word-finding difficulty

Cognitive Fatigue:  Cognitive fatigue appears to be another commonly reported neurological symptom.  Cognitive fatigue can be defined as “an increase in mental exhaustion resulting from prolonged periods of cognitive activity". It can range from mild to extreme mental exhaustion and can last anywhere from a few hours to several days (Wylie and Flashman, 2017).

Executive Dysfunction:  Executive functions represent a constellation of cognitive abilities that drive goal-oriented behavior. This type of cognitive functioning is critical to the ability to shift and adjust within our personal environments which are, dynamic; changing moment to moment.  Executive functions can be split into four distinct components including:

Working Memory:  Working memory allows “mental juggling” and is a skill we use during multi-tasking or completing a task with several steps

Inhibition:  Inhibition enables us to keep from doing an action

Shifting Attention:  Shifing attention is the ability to switch between areas of focus

Fluency:  Fluency allow completion of thinking tasks in a reasonable and efficient time frame

When our executive functions are intact, we are able to navigate our complicated world, makie decisions, take appropriate actions and adapt plans as needed. When working as expected, these executive function skills act like the conductor of a symphony who plans, anticipates, times, and synchronizes the actions of many instruments simultaneously. Many things are able to occur at once in harmony and with a positive and reasonable outcome.

When executive function is poor, those affected may feel they are less able to complete organizational tasks, plan their day, have successful conversations and use time effectively. 

Speech therapy helps long COVID cognition by identifying exactly what your cognitive strengths and weaknesses are and helping you develop a treatment plan to target your weaknesses.  Speech-Language Pathologists (SLPs) have unique experience managing other similar medical conditions which impact cognition and communication. This experience, re-framed, can make a significant impact on the long COVID population in helping each person understand and manage their symptoms, including neurocognitive impairment and cognitive fatigue.  Together with their SLP, you can:

• increase your awareness of your own individual strengths and challenges
• learn and practice key strategies based on their specific needs related to cognitive pacing, task modification and compensatory strategies to optimize attention, memory, and organizational skills
• increase resilience and motivation to succeed based on growing sense of control

Speech Therapy Helps Long COVID Voice & Swallowing Changes

Some people with long COVID have problems with swallowing, eating or drinking.  Some report a sore throat or a cough that does not go away.  Others feel like they need to clear their throat.  These changes can happen when long COVID interferes with the normal coordination of breathing and swallowing.

When you eat and drink you automatically hold your breath for a moment so that you do not choke.  Long COVID can cause you to be breathless when you eat and drink or make it hard to hold your breath when you swallow.  This can result in coughing when you swallow.

Speech therapy helps long COVID voice and swallowing changes by identifying problems and developing a treatment plan to deal with them.  Your therapist will complete a swallow and vocal cord assessment  to determine how the vocal cords and swallow structure are functioning.  A Flexible Endoscopic Evaluation of Swallowing (FEES)  may be one of the assessments your therapist uses.  This involves threading a small camera down your throat to look at how the vocal cords and swallow structures are functioning.  Strengthening exercises or Synchrony Dysphagia Treatment may be given if weakness is identified.

Speech Therapy Helps Long COVID Respiratory Changes 

 Respiratory Muscle Strength Training (RMST) uses resistance to strengthen the muscles used for breathing in the same way resistance training strengthens skeletal muscles. 

RMST with your speech-language pathologist specifically strengthens the muscles used for breathing. After doing this training, patients may notice the following:

• improved cognitive function through increased oxygenation to the brain
• maximized respiratory muscle strength leading to better overall endurance
• a stronger voice for communication
• safer swallowing 
• a more vigorous cough to clear the airway

Used in conjunction with traditional cognitive-communicative and swallowing therapies, RMST demonstrates excellent returns in function and quality of life for those who have already endured so much.

Speech Therapy at Therapy Achievements

Speech-language pathologists are professionals specifically trained to help rehabilitate cognitive, communicative and swallowing skills when illness or injury brings on changes in any of those abilities.  Because of this, speech therapists are particularily well equiped to support people living with cognitive, respritory or swallowing symptoms from long COVID.  If you or someone you love has experienced any of the challenges discussed, please contact us. at Therapy Achievements.  We are honored to bring well-researched approaches, knowledge, and hope to your rehabilitation journey.