Communication in the context of COVID-19 recovery: A case example

Written By: Rebecca Goodridge, ANCDS Student Member

Starting my clinical fellowship (CF) during a global pandemic has not only impacted the method of service delivery for many of our patients but has also given me the opportunity to work with a patient recovering from COVID-19 firsthand. One of the first evaluations I completed during my CF at a Veterans Affairs Healthcare System was an evaluation of communication in the context of a recent COVID-19 diagnosis.

Given the novel nature of COVID-19, there is only emerging evidence on its effects on speech, language, and cognitive-communication. A review of the literature published in PubMed and the Cochrane Central Register of Controlled Trials between April 8 and May 23, 2020, concluded that there was limited literature on the cognitive sequela of COVID-19 at that time, but existing literature supports and encourages speech-language pathologists’ involvement in this growing number of cases (Ramage, 2020). Documented cases with cognitive symptoms are often related to prolonged mechanical ventilation, intermittent hypoxia, hypercoagulability, or delirium (Ramage, 2020). More literature is needed on the effects of COVID-19 on speech, language, and cognition.

During my patient’s recovery process from COVID-19, the veteran noticed difficulty with speech, word-finding, and memory. His brain imaging was largely unremarkable, without strong evidence of a stroke. Equipped with this information, I prepared for the patient’s initial telehealth evaluation by selecting a broad battery of assessment tasks, including a single-word articulation test, passage reading, a picture-naming test, a picture description task, and a cognitive screener. Each assessment task was adapted for telehealth. I also conducted a telehealth-adapted oral mechanism examination.

Overall, his assessment results were consistent with his self-reported difficulties in motor speech, expressive language, and cognitive-communication. His motor speech presentation, primarily characterized by slow rate, did not suggest a certain type of dysarthria, nor did his brain imaging suggest neurological damage consistent with known types of dysarthria. For expressive language, he presented with word-finding difficulties on the picture naming test, as well as telegraphic speech on the picture description task. The finding of telegraphic speech in picture description was surprising considering he spoke in full, grammatical sentences in conversation. This discrepancy was likely in the context of increased cognitive load during this assessment task. He endorsed new complaints about his memory with onset during his hospitalization, but only mild impairment was noted on his cognitive screener.

These assessment results begged the question of where to go from here. After a discussion with my supervisor, I developed a treatment plan to provide strategies for memory and clear speech, as well as to give exercises for expressive language and script reading. The veteran has shown improvement in his implementation of strategies and performance on exercises in just a few sessions.

We are still in the beginning stages of assessing, treating, and researching speech, language, and cognitive-communication difficulties as a result of COVID-19 infection. More research and clinical case studies are needed. As Ramage (2020) concluded in her review of cognitive-communication impairment in COVID-19, speech-language pathologists play an important role in addressing these concerns and advocating for our patients’ acute and rehabilitative communication needs.



Ramage, A.E. Potential for cognitive-communication impairment in COVID-19 survivors: A call to action for speech-language pathologists. American Journal of Speech-Language Pathology. 2020 Sep 18:1-12. doi: 10.1044/2020_AJSLP-20-00147. Epub ahead of print. PMID: 32946270.

Rebecca Goodridge

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