10/2/2018. Behind the Ventilator: An SLP Finds Her Voice as a Patient with Guillain-Barré Syndrome

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1 Behind the Ventilator: An SLP Finds Her Voice as a Patient with Guillain-Barré Syndrome New Mexico State Convention 10/20/18 Carly Stoltenberg, M.S., CCC-SLP EBS Healthcare, Regional Director Adjunct Professor, Rio Salado College Biography Carly Stoltenberg, M.S., CCC-SLP, has been a speech pathologist for 23 years. She is currently a Regional Director for EBS Healthcare and an Adjunct Professor for Rio Salado College. She is a former Clinical Associate Professor at Arizona State University. Financial Disclosure: I have no relevant financial or non-financial relationships in the products or services described, reviewed, evaluated, or compared in this presentation. Learner Outcomes/Objectives Participants will identify strategies and characteristics that facilitate resiliency in their patients, clients, and students Participants will be able to describe the main signs and symptoms associated with Guillain- Barré Syndrome 1

2 Learner Outcomes/Objectives Continued Participants will be able to describe the feeding and communication limitations associated with Guillain-Barré Syndrome Participants will be able to state important features to include for documentation purposes Take 3 minutes to write down challenges/trauma: (Ongoing or within the past year) Challenges Trauma Stress Illness (personal or family related) New Job New House Work Drama Death in the Family Divorce Mental Health New baby Etc. Resiliency or re sil ien cy [ri-zil-yuh ns, -zil-ee-uh ns or ri-zil-yuh n-see, - zil-ee-uh n-see] noun 1. the power or ability to return to the original form, position, etc., after being bent, compressed, or stretched; elasticity. 2. ability to recover readily from illness, depression, adversity, or the like; buoyancy. 2

3 Cultivating a Resilient Disposition Positive Mindset/Optimism Meditation Perspective Taking Meltdowns/Shattered Beliefs about the future I get knocked down, but I get up again. Talk About It Fears Experiences Find Purpose in Your Trauma Signs and Symptoms of Guillain-Barré Syndrome What is Guillain-Barré Syndrome? Autoimmune condition (body attacks itself) 1 in 100,000 Immune system attacks myelin sheaths of the nerves in the Peripheral Nervous System (PNS) These nerves are located outside of the brain and spinal cord Weakness, tingling, and paralysis occur, starting in the toes and feet and working up GBS = Gradual Block of Sensation Multiple Sclerosis (MS) affects the Central Nervous System (CNS) 3

4 Review of the Peripheral Nervous System Which part of the nerve is being attacked? Dendrites Soma Axon Myelin sheath Axon terminals Image retrieved from The SLP in the Acute Care Hospital Setting **Important to get treatment as soon as possible! SLP consult for swallowing, feeding, and speech Lines, Leads, and Tubes IV: Hydration and medicine Heart Rate Monitor: ANS O2 Sat Monitor: ANS Suction: Airway Management Ventilator: Airway Management NG Tube/G Tube: Swallowing Rectal Tube/Foley Catheter: Bathroom Management Port for IVIG/Plasmapheresis 4

5 The SLP & GBS: Communication Limitations Barriers to Communication Dysarthria (often Flaccid, but Ataxic Dysarthria can occur in Miller-Fisher Variant Breath Support (important for phonation, vocal loudness, and speech endurance) Ventilator: Cognitively intact, but can t speak Double Vision/eye patch Coordination/Finger Isolation Fatigue The SLP & GBS: Feeding & Swallowing Limitations Barriers to Feeding/Swallowing Dysphagia due to weakness and decreased sensation and motor coordination that could put the patient at risk for aspiration Fatigue Respiratory Muscle Weakness (weak or absent cough reflex and poor respiratory reserve) Decreased or absent gag reflex Obstructed Intestines: Listen for Bowel Sounds Prior to Starting Feedings Weight Loss: Dangerous for a Patient During Recovery NG tube vs G tube The SLP & GBS: Post-Acute Hospital Care Patients with GBS benefit from transferring to facilities that specialize in providing intensive rehab therapy Skilled Nursing Facilities (SNFs) Home Health Agencies Long-term Care Hospitals Hospital-based Rehab Units (i.e., inpatient rehab units that are part of acutecare or critical access hospitals) Freestanding Inpatient Rehab Hospitals (i.e., rehab facilities that are not managed as units within other hospitals). Patients with GBS need intense rehab in order to recover. This intense therapy is not offered in long-term care hospitals, SNFs, or via home health. 5

6 Important Features to Include: Documentation The coverage criteria that Medicaid and insurance companies use is that patients, at the time of admission, can be reasonably expected to actively participate in, and benefit significantly from, an intensive rehabilitation therapy program. Intensive therapy differs from the therapy provided in other settings for post-acute care in that it generally requires: substantial time (at least 3 hours of therapy per day, 5 days per week) a coordinated, interdisciplinary approach among multiple therapies (e.g., physical therapy, occupational therapy); and rehab physician supervision In addition, a case review found that physician reviewers identified several additional factors affecting the patients ability to participate in and/or benefit from therapy. Pre-existing physical limitations Unresolved health problems (e.g. inadequate recovery from a prior illness or surgery Uncontrolled pain Altered Mental Status Age Motivation Murrin, Suzanne, Case Review of Inpatient Rehabilitation Hospital Patients Not Suited for Intensive Therapy Q & A 6

7 Thank you...for helping your clients to move their own mountains. You Have Been Assigned This Mountain Contact Information: to Show Others it Can Be Moved. FACEBOOK: GBS Carly Recovering Like a Champ and Looking Good Doing It! 7