16 Most Common Home Health Speech Therapy Diagnoses

ASHA’s Diagnosis Codes Related to Speech, Language, and Swallowing Disorders lists almost 1000 diagnoses. It can be overwhelming for Adult Home Health SLPs to even know where to begin as they prep for their patients.

But don’t worry, we got you!

First, we put together a list of the most common diagnoses of referred patients. Then we describe each diagnosis and how to treat them.    

Hundreds of worksheets, handouts, and therapist treatment guides.

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The Top 16 Most Frequent Diagnoses Referred for Home Health Speech Therapy

* The most frequent diagnoses may vary depending on your facility or unique situation.

1. Dementia

You’d best get comfortable with this diagnosis because you will probably be seeing it a lot!

What is it?

Dementia is an umbrella term for memory loss plus impairments in one or more of the following areas: judgment, abstract reasoning, visuospatial, executive functioning, and language.

Alzheimer’s Disease: The most common form of dementia. Alzheimer’s is caused by beta-amyloid plaque buildup and tau protein tangles which result in neuronal death. It usually starts in the hippocampus (memory center of the brain). It’s a progressive disease with no cure, although medications and therapy may help slow the process of memory loss.

Lewy Body: The second most common form of dementia. It’s caused by abnormal plaque buildup in areas called Lewy bodies. It usually causes visual hallucinations and Parkinson’s-like tremors and rigidity. It is also progressive with no cure, although medications and therapy may reduce symptoms.

Speech Therapy Interventions:

Evaluate and treat Memory Loss and Executive Functioning Disorders. These folks may also need Language and Swallowing treatment.

2. Dysphagia

What is it?

Dysphagia is a swallowing disorder that affects the oral cavity, pharynx, esophagus, and/or gastroesophageal junction. It is caused by an underlying medical condition, including CVA or Parkinson’s disease. Patients with dysphagia are at increased risk of malnutrition, dehydration, aspiration pneumonia, chronic lung disease, choking, and even death (ASHA).

Speech Therapy Interventions

Evaluate and treat underlying symptoms, recommend swallow studies as needed (MBSS or FEES). Provide swallowing exercises, oral-facial exercises, compensatory swallowing strategies, and diet changes.

3. Falls

What is it?

This one is pretty self-explanatory. Patients who fell are usually referred to speech therapy to address potential cognitive deficits that result from the fall. 

Falls have become increasingly common in the aging population, especially for those with other underlying issues including chronic disease, dementia, or even hearing loss. Many patients have a history of falls and often receive PT and OT to increase strength, balance, and safety while transferring.

Speech Therapy Interventions

Evaluate and treat Cognition, including Visuospatial, and Executive Functioning. Provide safety training, including when to use the call light, and visual aids to remind patients to avoid transferring without help.

4. Acute cerebrovascular accident (CVA)

What is it?

Otherwise known as a stroke, a CVA is caused by a blockage of blood flow to the brain or by a blood vessel rupture. The fastest recovery occurs during the first 3-4 months post-stroke, although stroke recovery can happen for years.

Speech Therapy Interventions

Evaluate and treat Language, Motor Speech, Voice, Swallowing, and Cognitive Impairments

5. Chronic obstructive pulmonary disease (COPD)

What is it?

According to the World Health Organization, COPD is a lung disease characterized by chronic obstruction of lung airflow that interferes with normal breathing. Many of these folks fatigue easily while eating. Some may develop hypoxic brain damage secondary to sleep apnea.

Speech Therapy Interventions

Evaluate and treat Swallowing. Provide compensatory strategies for energy conservation during meals. Possibly evaluate and treat Cognition.

6. Pneumonia

What is it?

Pneumonia is an infection of the lungs caused by bacteria, viruses, and/or fungi. Dysphagia, reduced pharyngeal sensation, and an impaired cough reflex are major risk factors for pneumonia. Many patients develop aspiration pneumonia secondary to oropharyngeal weakness.

Speech Therapy Interventions

Evaluate and treat Dysphagia. Provide compensatory swallowing strategies, oropharyngeal exercises, postural techniques, and diet changes. Provide training in the use of incentive spirometer, deep breathing, and directed cough.

7. Congestive heart failure (CHF)

What is it?

Congestive Heart Failure is a type of heart failure in which the heart muscle doesn’t pump blood as well as it should. These folks may show signs of laryngeal penetration or aspiration, including demonstrating wet coughing during meals, chest congestion after meals, and a history of pneumonia. However, they may not necessarily have dysphagia. Differential diagnosis is key!

Speech Therapy Interventions

Education about signs and symptoms of aspiration and red flags for when to call the doctor, diet changes, energy conversation during meals, and compensatory swallowing strategies.

8. Coronary artery disease (CAD)

What is it?

Coronary Artery Disease develops when the coronary arteries (which supply the heart with blood, oxygen, and nutrients) become damaged or diseased. These folks tend to fatigue easily during meals.

Speech Therapy Interventions

Typically dysphagia treatment.

9. Gastroesophageal reflux disease (GERD)

What is it?

GERD is the frequent flow of stomach acid back into the esophagus. Although GERD is not in itself a treatment area for home health SLPS, the symptoms can mimic or mask more serious conditions including Dysphagia and Esophageal Strictures. Again, differential diagnosis is key!

Speech Therapy Interventions

Rule out Dysphagia/Aspiration or other conditions, refer to ENT or GI doctor to rule out structural issues, provide training in the use of GERD precautions.

10. Parkinson’s disease

What is it?

Reduced dopamine levels result in tremors, bradykinesia, and rigidity. It is a progressive disease with no cure, although medications, surgeries, and therapy may help improve functioning and reduce symptoms.

Speech Therapy Interventions

Evaluate and treat Dysarthria, Dysphagia, and Cognitive Impairments. LSVT LOUD can treat dysarthria and dysphagia.

11. Amyotrophic lateral sclerosis (ALS)

What is it?

ALS, also known as Lou Gehrig’s disease, is a progressive disease that kills nerve cells and eventually leads to death (usually via suffocation). Medications and therapies can slow the disease and increase quality of life. Dysphagia, motor speech, and voice/resonance disorders are common.

Speech Therapy Interventions

Evaluate and treat Dysphagia, Motor Speech disorders, and Voice/Resonance disorders (avoid strengthening exercises). Find and train in the use of an appropriate AAC system. Provide compensatory swallowing strategies and diet changes.

12. Encephalopathy

What is it?

According to the National Institute of Neurological Disorders and Strokes, Encephalopathy refers to any diffuse disease of the brain that alters brain function. Common neurological symptoms are progressive loss of memory, cognitive ability, and ability to concentrate. Other symptoms may include dysphagia, dementia, and loss of ability to speak. Encephalopathy is usually temporary, with some people experiencing symptoms for just a few hours and others for several weeks.

Speech Therapy Intervention

Evaluate and treat Cognition. Rule-out lasting cognitive impairment. Refer to a neurologist as needed.

13. Esophageal strictures

What is it?

An esophageal stricture is a narrowing of the esophagus. Symptoms include difficulty swallowing, reflux, and cough (particularly at night), dehydration or weight loss. The narrowing can be caused by scarring, esophageal webs, tumors, or cancer.

Speech Therapy Interventions

Evaluate and treat Dysphagia. Recommend swallow studies as needed. Refer to ENT and GI doctor for medical/surgical intervention as needed. Provide compensatory swallowing strategies, swallowing exercises (e.g. Shaker), and diet changes.

14. Head and neck cancer (HNC)

What is it?

According to ASHA, Head and Neck Cancers include malignancies of the nasal cavity and paranasal sinuses, oral cavity, pharynx, larynx, and salivary glands. Functional symptoms of HNC can include reduced intelligibility of speech, dysphonia/aphonia, hyper/hyponasality, and swallowing problems.

Speech Therapy Interventions

Evaluate and treat Speech, Language, Resonance, Voice, Cognition, Feeding/Swallowing.

15. Traumatic Brain Injury (TBI)

What is it?

A TBI is an injury to the brain caused by a sudden and violent blow to the brain, such as by a fall, car accident, blunt force trauma, etc. Mild TBIs show the greatest recovery while moderate to severe cases usually require prolonged and intensive therapy and medical intervention.

Speech Therapy Interventions

Evaluate and Treat Language, Motor Speech, Voice, Swallowing, and Cognitive Impairments.

16. Sjogren’s Syndrome

What is it?

According to the National Institute of Health, Sjogren’s syndrome is an autoimmune disorder in which immune cells attack and destroy the glands that produce tears and saliva. Common symptoms include dry mouth and nose, amongst others.

Speech Therapy Interventions

Evaluate and Treat Swallowing impairments. Encourage water intake and OTC dry mouth products (e.g. Biotene spray). 

There you have it!

To summarize, the most common diagnoses you can expect to see when getting a referral for home health speech therapy are Dementia, Dysphagia, CVA, Falls, COPD, CHF, CAD, GERD, Parkinson’s Disease, ALS, Encephalopathy, Esophageal stricture, HNC, TBI, and Sjogren’s syndrome.

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