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Communication is the process by which people exchange information. Language is the process by which thoughts, feelings, and emotions are generated using a recognizable verbal or written system. It includes both receptive and expressive skills. Speech is the process of creating sounds and combining them to form words that are understood by a listener. It requires the integration of cognitive and neurologic abilities along with the musculoskeletal skills that support respiration, phonation, and articulation. Cognition refers to mental processes, including attention, memory, auditory processing, problem solving, and executive function. Some of the cognitive skills that are important for communication include processing speed, concentration, self-monitoring, thought organization, and memory. Verbal communication, the most common form, involves the use of speech, language, and cognitive skills, augmented by facial expressions and gestures.


Speech, language, cognitive, voice, and swallowing problems are key issues for patient management in acute rehabilitation settings. Speech–language pathologists (SLPs) assess and treat impairments in each of these domains. During the initial stages of a patient’s diagnostic workup, a speech and swallow evaluation is warranted, especially if caregivers and family members report changes in communication, cognitive, or swallowing ability. During the rehabilitation process, the SLP, along with other members of the multidisciplinary team, provides quality care to help the patient reach his or her fullest physical, psychological, social, vocational, and educational potential.

The main areas to be tested in patients undergoing evaluation include speech, language, voice, cognition, and swallowing. All parameters are assessed or at least screened using formal tests or informal measures. The primary objective is to determine the presence of impairment, classify the type, and determine the level of severity. Based on the results, recommendations and functional prognoses are made, a treatment plan is formulated, and measurable therapy goals are developed. The information from the initial assessment provides an important baseline for measuring change.

The goal of speech, language, and cognitive-based therapy is to improve communicative effectiveness, efficiency, and naturalness. Three main therapeutic approaches, outlined by Duffy, can be used to achieve these goals. The first is to restore lost function. This effort aims to reduce impairment and targets deficits directly. Achieving success with this approach depends on the etiology and course of the disease, as well as the type and severity of the disorder. The second approach is to promote compensatory abilities and the use of residual function. Compensation can take many forms; for example, a patient might be instructed in speech-enhancing strategies or the use of augmentative devices or alternative means of communication (gestures, functional communication board, etc). A third approach encompasses strategies to reduce a patient’s need for lost function by modifying the environment and facilitating more effective speaker–listener interactions. Through education and counseling, SLPs also help patients and their families adjust and cope.

The primary objective for swallow rehabilitation is to ...

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