## 4 Discussion  
Significant efforts have been made to establish multiple guidelines, recommendations, and best practices in managing long COVID syndrome. The importance of a holistic, interdisciplinary care model--delivered by either community-based or primary interdisciplinary teams--has been emphasized for the effective and timely management of the increasing cases of long COVID [94]. However, there remains a significant lack of data on the progression of long COVID in the field of speech pathology, highlighting a notable gap in information and strategies for assessing and managing patients with long COVID by speech therapists [46]. This study examined 19 research articles published up to 31 August 2022, identifying multiple symptoms as risk factors for long COVID. The findings implicated the need for speech therapy interventions and supported the initial research hypothesis linking long COVID syndrome with speech pathology disorders. The eight most frequent symptoms, ranked by their severity index, were as follows: dyspnea (36%), altered mental status (30%), memory problems (30%), attention deficit (29%), communication disorders (23%), pathological saliva (17%), swallowing/feeding disorders (16%), and voice disorders (11%). Dyspnea emerged as the most or second most common symptom related to speech pathology across several studies [13; 15; 36; 47; 76; 77; 78; 79; 81; 82; 83; 84; 85; 86; 87; 88; 89; 90]. Additionally, attention deficit, memory problems, altered mental status, and feeding disorders were frequently documented in the literature. However, communication disorders, pathological saliva, and voice disorders were described in fewer studies, often involving small sample sizes. Figure 6: FCM-DSS output values for four case studies. The graph illustrates the confidence levels (0–1) for recommending specific medical specialties: pulmonologist (black), ENT specialist (red), neurologist (blue), and speech-language pathologist (SLP; green). A recommendation is made when the confidence level for a specialty exceeds the threshold of 0.6. (**a**) Result for Case study 1: pulmonologist, (**b**) Result for Case Study 2: ENT, (**c**) Result for Case Study 3: neurologist, (**d**) Result for Case Study 4: SLP. In most cases, a medical specialty is recommended as the primary referral, with SLP appearing as a secondary response. However, in Case 4 (**d**), the SLP is the primary recommendation, reflecting the severity of communication and attention-related symptoms in that case. Despite the prevalence of symptoms linked to speech pathology disorders, few of the reviewed studies included speech therapists as part of the interdisciplinary team, and even fewer referred patients to these specialists, a finding consistent with earlier research [46, 64]. The second phase of the study was equally encouraging. Using data from the study, a pilot Fuzzy Cognitive Map Decision Support tool was developed in MATLAB. This tool effectively identified four cases with symptoms that speech-language pathologists (SLPs) manage and recommended specialist referrals. SLPs work closely with neurologists, ENTs, and pulmonologists, with many cases from these specialists often referred to SLPs for treatment. This work presents a proposed FCM-DSS (Fuzzy Cognitive Map Decision Support System) developed in MATLAB to assist in the self-assessment of symptoms related to eight conditions associated with potential speech pathology disorders. Designed to be user-friendly, the system can be used without intensive training, making it an efficient tool for the early identification of high-risk symptoms. It helps guide users in determining when specialist help is necessary. This study has several limitations. First, the FCM-DSS is designed to detect specific long COVID symptoms, including altered mental status, memory problems, concentration difficulties, communication disorders, dyspnea, swallowing/feeding disorders, pathological saliva, and voice disorders. The information used reflects data from a specific period (1 June 2020, to 31 August 2022).