An April 2016 Military Medicine report on Dysphagia in a military treatment facility suggests that up to 20 percent of military active duty service members traumatically injured during deployments who were admitted to Walter Reed National Military Medical Center  and the former Walter Reed Army Medical Center  exhibited difficulty swallowing and eating, a condition called dysphagia.

According to Dr. Nancy Pearl Solomon, a research speech pathologist at WRNMMC who served as principal investigator for the report on dysphagia management in a military treatment facility, difficulty eating and swallowing can have significant health care implications including aspiration pneumonia, dehydration, malnutrition, and in severe and prolonged cases, death.

The researcher and her team designed the WRNMMC Dysphagia Database, to harness clinical data by clinician-investigators to inform best practice patterns for patient referral, prognosis and management.

A staff of 10 speech-language pathologists (SLPs) at the WRNMMC Audiology and Speech Pathology Center provides evaluation and treatment for pediatric and adult patients with speech, language, cognitive-communication to voice and swallowing disorders, according to Laura Cord, a speech-language pathologist.

She said SLPs are incorporated into a variety of multi-disciplinary teams including the Traumatic Brain Injury clinic, cleft and craniofacial clinic, pediatric high risk clinic, as well as the voice clinic with ENT [Ears Nose and Throat]. Partnering with their team members at the Brain Fitness Center, SLPs use computer-based programs to work on attention or memory goals for patients.

They also work with the Assisted Technology team to help patients reach therapy goals using devices or apps. In addition, Cord said she works with music therapists to improve speech clarity, as well as both the dental and prosthetics teams when working to improve speech production for wounded warriors or other patients with craniofacial injuries.           

“Given the drawdown with [Operation Enduring Freedom] fortunately, we have not seen as many wounded warriors on the inpatient side recently. Most of our wounded warrior care at this time is on the outpatient side,” Cord explained.

Speech-language pathologists often build relationships with injured service members while they are inpatients at the medical center with acute needs such as swallowing and communication.

As these patients recover, the SLPs follow them through their journey, which may involve outpatient services, such as those provided at WRNMMC’s National Intrepid Center of Excellence, offering cutting-edge evaluation, treatment planning, research and education for service members and their families dealing with the complex interactions of mild traumatic brain injury and psychological health conditions.

Speech-language pathologists at the NICoE, like Judy Mikola, evaluate and treat service members with attention, memory, processing speed, executive function, and speech/language difficulties.

“At this time, a large percentage of our patients are from [Special Operations Command]—those service members that have served in Special Forces through the Navy, Army, Marines, and Air Force. Typically, these service members have been deployed on a yearly basis since 2001, and consequently exposed to numerous concussive events secondary to blast exposures, blunt forces, motor vehicle crashes or hard parachute landings,” Mikola said.

Most of the service members evaluated at the NICoE experience speech-cognitive problems related to decreased memory, like forgetting previous conversations, as well as attention and concentration deficits, according to Mikola. She said some patients may become easily distracted, find it hard to stay focused, and difficult to respond or think as fast as before the injury. These service members may also struggle to find words during conversation.

Speech-language pathologists may consult with the WRNMMC complimentary alternative medicine team to determine which relaxation technique may be incorporated into speech-cognitive treatment.

“I had a service member who benefited immensely from using a deep breathing relaxation technique while attempting to complete a verbal discourse task,” explained Mikola. “Prior to implementing the relaxation technique, he was unable to effectively present oral briefings to his command.”

She said each service member discharged from the NICoE receives an ongoing treatment plan recommendation list which includes possible recommendations for ongoing speech-cognitive therapy near their home base.  The speech pathology department at the patient’s home base is routinely contacted by NICoE SLPs to forward therapy recommendations, plans or to answer any questions the department may have about the patient’s care at NICoE. Research follows patients to check on their progress.

“Providing education to each patient and their spouse about cognitive changes associated with mild TBI and co-existing physical and psychological symptoms is a big part of our job,” Mikola said. She indicated she appreciates the opportunity to meet the service member’s spouse and hear their point of view of their loved one’s cognitive challenges.

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