Speech therapist Sam Rees explores the role of speech therapy in spinal cord rehabilitation
Working as a speech therapist in the multidisciplinary team in a neurological rehabilitation unit, I was often met with quizzical looks upon introducing myself to the newest admission. What could a speech therapist have to contribute to my rehabilitation for spinal cord injury?
When most people hear “speech therapist”, they think of school children learning to say “r” properly. Rarely do people picture us working alongside physios and OTs in a gym, doing spinal cord rehabilitation. So, what value can we add to this team?
Speech therapy is about much more than just speech. It’s about communication, cognition and swallowing. In spinal cord rehab, it is most importantly about breathing. After a spinal cord injury, especially one sustained higher up the neck, the muscles that control breathing and swallowing may be affected.
Breathing isn’t just about your lungs. It is about the muscles that move air in and out. We have our diaphragm (innervated by the phrenic nerve at levels C3 to C5), which is the star of inhalation; intercostal muscles (from T1 to T11) that expand our rib cage and help you to take a deep breath and project your voice; and abdominal muscles (from T6 to T12) that are essential for forceful exhalation, coughing, and voice projection.
Injuries sustained above these levels can weaken these muscles and affect these important functions. Without a strong diaphragm or abdominal support, the air pressure generated beneath the vocal cords is reduced. Less air pressure means a weaker cough, difficulty clearing your throat and a softer, breathier or easily fatigued voice.
This is why many people with higher-level spinal cord injuries may struggle to clear their throat, complain that others can’t hear them in a noisy room, or they run out of breath mid-sentence.
A speech therapist assists with respiratory muscle strength training (RMST) – gym for the muscles that control breathing. Using specialised devices, you can learn to engage and strengthen the muscles involved in breathing.
Over time, this strengthens the diaphragm and respiratory muscles to improve cough strength (keeping lungs clear and infections at bay), support longer, louder speech and boosts endurance for everyday tasks, like chatting to a friend without pausing for breath every couple of words.
After cervical spinal cord injuries, or certain spinal operations, the muscles that control swallowing may be affected, leading to coughing, choking, or food “going down the wrong way”. Speech therapists provide clinical swallowing evaluations and rehab exercises to improve swallowing function. We might recommend muscle-strengthening drills, safe-swallowing postures, or texture modifications to make mealtimes safe, enjoyable and social again.
Recovery after a spinal cord injury is about regaining as much independence as possible and quality of life. Being able to breathe deeply, laugh loudly, sing along to your favourite song and eat without worry is essential. Speech therapists work alongside your rehab team to help make that possible. In the end, rehabilitation isn’t just about movement, it’s about finding your voice again.
