Speech Language Pathologists (SLPs) focus on far more than sounds and words.
SLPs assess, diagnose and treat conditions related to the fundamental aspects of human function. This can include thinking, swallowing, communicating — and the ability to connect with others during moments of vulnerability.
At UHN, SLPs care for patients across a range of specializations, from supporting cognition after a brain injury, to preserving safety in the ICU and fostering transitions back to daily life.
Supporting ICU patients when it matters most
In the ICU, the goal is survival.
When patients are put on ventilators and life support machines, they may undergo a tracheostomy and lose something they didn't expect: their ability to speak and swallow.
That's when Gabrielle Carrier comes in. Her goal is to help patients find functional ways to eat, drink and communicate during one of the most critical times of their lives. Sometimes, she helps patients get their natural voice back too.
"Almost all patients who come to us with a tracheostomy started in the ICU and have been unwell for a long time," says Carrier, an SLP with the intensive care unit and tracheostomy team at
UHN's Toronto Western Hospital.
"My role is to make sure their communication and swallowing needs are met as early as possible."
A tracheostomy is a life-saving procedure where a surgical opening is created in a patient's neck and a tube is inserted into their trachea to help them breathe.
When a patient has a tracheostomy, air doesn't flow to their voice box and their vocal cords don't vibrate. This physically prevents them from speaking. It also makes it much more difficult to swallow.
Carrier uses advanced imaging techniques, such as an X-ray called a video fluoroscopic swallow study, to assess the patient's ability to swallow. She also uses fiberoptic endoscopic evaluations of swallowing, a camera that goes through the nose.
These tests allow Carrier to see what's happening inside the throat.
She determines if it's safe for them to eat or drink on their own, and gradually reintroduces oral intake with safe dietary textures and strategies.
She also helps patients find alternative ways to communicate by using picture boards, mouthing words, writing and providing referrals to get high-tech, computerized devices when needed.
For those who may be ready to start speaking, she works with a respiratory therapist to assess when the patient can begin using a speaking valve. It's a device placed on the tracheostomy tube that allows air to move back up through the voice box.
The ultimate goal of the tracheostomy team is to enable patients to once again breathe, speak and swallow on their own, and, when possible, get the tracheostomy tube removed.
"We deal with things people don't think about until they're gone — eating, drinking, communicating," she says. "Being able to help someone regain even one of those at such a difficult time in their life is incredibly rewarding."
Helping people find themselves again after a brain injury
At first glance, most of Steve Wilcox's patients seem fine. They speak clearly. They answer questions. They smile.
But minutes into a conversation, their memories become jumbled, they tell stories that didn't happen and the conversation slips off track.
Symptoms like these are some of the many invisible communication issues that can happen after a brain injury. Wilcox finds creative ways to help patients reconnect neuropathways in the brain that are damaged and affecting both language skills and cognition.
"Being able to have relationships, shared jokes and humour, to pick up on wit and sarcasm, to participate in social settings — everybody does that every day without thinking," says Wilcox, an SLP on the
Inpatient Acquired Brain Injury Unit at
UHN's Toronto Rehab.
"But when you've had an injury and those things are no longer efficient or appropriate, the impact is huge."
Depending on the area of the brain that's injured — it could be from a concussion, tumour, lack of oxygen or stroke — Wilcox first determines what type of communication impairment the patient may have.
Many patients experience aphasia, a language disorder that affects a person's ability to speak, read, write or understand speech. Patients know what they want to say but can't access or express the language to do that. They often have difficulty naming words and forming sentences because word processing becomes disorganized.
"In a grocery store, apples are all in one bin and oranges are in another," says Wilcox. "After a brain injury, those words can become mismatched. If you're looking for a specific orange, you can't find it very efficiently because it's sitting with the apples."
He helps patients rebuild their neuropathways by guiding them through structured conversations, triggering long-term memories and working with everyday objects and tasks.
"What we're trying to do is reorganize where things are stored so they can be retrieved more efficiently by challenging the brain to reconnect through neuroplasticity."
Sometimes the best tool to do that is a pen.
He asks patients to describe what it looks like, what it's used for and where you may find it.
"A lot of it is figuring out what their strengths are and finding ways to play into that," he says.
Providing dignity and quality of life after acute care
Before a patient leaves acute care, health care professionals assess whether they have regained the essential abilities needed for independence, such as eating on their own or communicating their needs.
Chanel McKenzie answers those questions every day as an SLP in transitional care. She helps patients find functional ways to swallow and communicate, ultimately identifying the support they will need to maintain their quality of life long after discharge.
"We need to make sure they have the ability to connect with family, to enjoy a meal and to help future caregivers understand how to support them," says McKenzie, who works at
UHN's West Park Reactivation Care Centre.
She says the trick is meeting patients at their cultural and cognitive level, while taking the time to understand their values, goals and what holds meaning for them in the next stage of their life.
McKenzie works with patients to achieve these goals. Often, that looks like helping them balance safe swallowing while still enjoying meals.
For example, for patients with dementia, what used to be simple and enjoyable can feel confusing or create risk of food or liquid going down the wrong way.
"They might look at a sandwich and not know what it is," says McKenzie. "They'll take it apart, eat it with utensils, or not understand how to start."
Part of her role is identifying when cognitive changes in patients are interfering with safe swallowing — such as visual agnosia, the inability to recognize objects — and collaborate holistically with occupational therapists, staff and families to support and adjust the environment.
That can mean narrating what's on the tray, offering one food item at a time, using teaspoons instead of large utensils, or providing supervision at meals.
"Sometimes it's as simple as someone saying, 'This is your sandwich. Take a bite,'" she says.
McKenzie may be the first clinician to formally assess a patient's communication after an acute hospital stay. She works to create practical, personalized ways for them to express themselves and their needs through communication boards and strategies.
For one patient, a man with significant communication barriers, that meant designing a board that reflected what was important to him and his feelings, such as his cultural foods, his favourite devices and the music he liked.
Since the patient could not use letters but recognized numbers, McKenzie adapted the board accordingly. He could point to a number and then to an item — two cups of water, for example — restoring a sense of control in daily interactions.
"If someone can't tell you what matters to them, you have to find another way to learn it," she says.
