Q&A: Speech Therapy

speech-therapyEvery May the American Speech-Language-Hearing Association spreads awareness about communication disorders during Better Hearing and Speech Month. Communication disorders affect individuals of all ages, from children who can’t speak yet to adults suffering from strokes. To help these individuals, speech language pathologists, often referred to as speech therapists, create treatment plans customized for each patient and their disorder to help restore them to their fullest lives.

This month, to highlight and celebrate the incredible work they do, we’ve interviewed several PT Solutions SLPs to raise awareness about speech therapy and what it entails.

Can you briefly describe what a Speech Language Pathologist (SLP) does on a daily basis?

Scott – Acute Care – New Orleans, LA: Per the American Speech-Language-Hearing Association, our profession can be described as the following: Speech-Language Pathologists (SLPs) work to prevent, assess, diagnose, and treat speech, language, social communication, cognitive-communication, and swallowing disorders in children and adults.

Josi – Inpatient Care – Bolingbrook, IL: In my specific role, I evaluate and treat speech, language, cognitive, voice and swallowing disorders in patients with neurological diseases like stroke, Parkinson’s disease, multiple sclerosis, dementia, Alzheimer’s disease & brain injury, along with head & neck cancer.

Claudia – Acute Care –  New Orleans, LA: SLPs work with a variety of ages and settings; from newborns to geriatric populations, in schools to skilled nursing facilities. SLPs in a hospital evaluate and treat patients experiencing feeding, swallowing, and communication difficulties. For patients experiencing feeding and swallowing difficulties, as a result of strokes, heart attacks, accidents, head and neck cancer and many other etiologies, we evaluate them to determine whether it is safe for them to eat by mouth. If so, we determine what diet is most appropriate, what maneuvers/postures are best for feeding, and what exercises can rehabilitate their feeding/swallowing. We work with patients who have undergone a tracheotomy to restore vocalization through a speaking valve and cleaning and caring for the tracheoesophageal puncture. We evaluate and rehabilitate communication for patients who have suffered from a stroke that resulted in different types of aphasia. We also work with patients who suffer from different types of motor speech disorders and dysarthrias that affect their speech.

Kimberly – Pediatric Care – Flagler, FL: A common misconception about speech and language pathology in the pediatric population is that we are teachers, or tutors, and spend the day playing games. While we try our best to disguise our treatment sessions as fun and games to engage our patient, a speech and language pathologist has extensively studied the brain, muscles of the head, neck, chest, and back, and the unique way that all of these components work together, to remediate or develop speech and language skills. Our population of patients includes more than people might think! In any given day we could have evaluated or treated children who: aren’t yet talking, are stuttering, have memory deficits, have behavior concerns, can’t pronounce some speech sounds, have difficulty swallowing, or have difficulty using correct sentence structure, and that doesn’t even graze the surface of our scope of practice.

What inspired you to become an SLP?

Claudia: I actually started college as an engineering major because I was good at math and science and thought it was a natural fit. Boy, was I wrong! I thought I wanted to build airplanes, so I worked at Miami International Airport for two summers and soon realized it was not the career for me. In high school I always participated in clubs like Best Buddies and Special Olympics because I enjoyed helping others achieve goals they set for themselves. My mom then suggested I shadow the speech language pathologist at her school. The saying “mothers know best” couldn’t be more right. After one day, I fell in love and knew right away that this is what I wanted to do.

Scott: When I was young I went to an SLP for articulation difficulty which was my introduction to the profession. When I was older and thinking about a career I could use to help people that lined up with my interests becoming a SLP was at the top of my list.

Kimberly: I actually started college with the intent to become a physical therapist. The reason for my change of heart was a combination of 3 things: organic chemistry, my school teacher aunt who highly regarded the SLP at her school, and my mother’s own experience with speech pathology as she was born with a cleft palate. Once I began my studies in the field of communication disorders and speech and language, I fell in love and knew I had finally found my calling.

What is the biggest realization you’ve had while working in speech therapy?

Claudia: Never stop learning. The speech language field is relatively new and its research (and our practice) is ever-changing. There’s new information and research coming out all the time and we need to make sure we keep up with it so we can provide the best quality assessment and treatment possible.

Scott: It wasn’t until I was in my first clinical rotation in an acute setting that I realized how integral Speech-Language Pathology was to so many functions that everyone of us use every single day.  In my own personal life, I often think about what if I couldn’t eat my favorite food or couldn’t tell my wife that I love her every morning.  If I couldn’t do this my quality of life would be greatly impacted so I always consider this when I am working with patients.  Anyone who has a deficit within the areas speech-language pathologists provide intervention for, it’s tough for them. Having a positive mental attitude and providing support/education are just as important as the intervention we provide as clinicians.

Kimberly: I have learned that you can never predict the impact you can have on a family.

Josi: Education of, communication with, and listening to the patients and their families are some of the most important things I can do for them

What’s your favorite thing about being a SLP?

Claudia: My favorite thing is hearing from patients about how excited they are about their progress and how grateful they are for the support they received.

Scott: It’s the patients.  The work we do as Speech-Language Pathologists can be difficult.  You become very close with patients and families.  It’s only human to empathize with their difficult situations and you feel their burden. When you are able to guide an individual to meet their goals and enhance their quality of life it’s as great of a feeling as anything you can experience.

Josi:  Helping others and watching their reaction when they succeed in therapy.

Kimberly: The uncertainty of each evaluation, you never truly know what to expect.

What are some challenges you face as a SLP?

Kimberly: The uncertainty of each evaluation 🙂 and the not-so-pretty-side of therapy: the constant tug-o’-war with various insurance companies to cover services for our deserving patients.

Claudia: We often times find ourselves advocating for our profession and informing others about what we do, which isn’t a bad thing, but it can pose a challenge when others are not receptive to it.

Scott: In general, I feel that lack of education regarding what our profession does results in most challenges I see.  This can come from patients/families, coworkers, and even physicians. When you are able to educate others on what SLPs do as well as our objectives, you find that our goals are the same as everyone else.  We are here for the advancement and wellness of people.  It’s a simple concept but I believe when others understand what we do our role becomes much more of a collaboration with multiple professionals working together to improve another person’s quality of life.

Josi: People often think all we do as speech-language pathologists is treat speech, which is in fact, only a small portion of what we do.

Are there any hot topics in the hearing and speech world right now? What should we know about them?

Claudia: Medicare moving from a quantity (volume of services) to focusing more on quality and efficiency of care. This is really important because many facilities focus on seeing large numbers of patients in one day, but sometimes the quality of the assessment or treatment suffers because of that.

Josi: Right now, I feel there is a shortage of referrals to outpatient speech-language pathologists prior to a patient undergoing surgical resection or radiation treatment for head and neck cancer patients.  Without this visit, patients do not receive the necessary extensive education they need regarding what changes to expect after surgery/radiation treatment in regards to their speech, voice and swallowing function.  This often sets them up for unrealistic expectations.

Scott: In my years of practice I do feel there has been a growing emphasis on making therapy intervention applicable to an individual’s daily life.  It’s a mindset that helps to improve overall function in the patients we see.  There are so many different types of intervention within the areas of Speech-Language Pathology but the more meaningful, for example, a communicative interaction is for a patient the more carryover and learning you see in their recovery.

Tell us about a memorable moment, recovery or advancement you’ve seen during your time as a speech therapy.

Claudia: During one of my clinicals, I had a 4-year-old patient who had a tracheostomy tube and his only form of communication was making a clicking sound to gain attention, gesturing, and sometimes using his speech-generating device. After working with him for a semester, he was saying phrases like “more bubbles please” and using spoken language as his primary form of communication. His mom was great to work with as well. You could tell she listened to our recommendations and implemented them at home.

Josi: I successfully treated a woman with vocal cord dysfunction.  Prior to speech therapy, stress and environmental odors would cause her to begin coughing.  She could not stop this coughing and it ended up having to call paramedics many times.  It had begun to affect her everyday functioning and caused her great anxiety.  I taught her how vocal cords normally work and educated her on what vocal cord dysfunction is.  I helped her realize she had control over her vocal cords, we identified the triggers of her vocal cord dysfunction and I trained her on rescue breathing to do during these attacks.  She was successful in that she stopped having these attacks because she learned to avoid the triggers and became confident on how to manage the attacks with the rescue breathing.  This was a very memorable moment for me because she was so appreciative and she was one of the first patients I treated with vocal cord dysfunction.

Kimberly: A personal victory was the establishment of AbleNet, Inc augmentative communication devices as a provider for PedICare Insurance holders. After 9 months of test case reports, physician correspondence, language evaluations, and data collection; PedICare will now cover Augmentative and Alternative Communication devices furnished by AbleNet Inc.

A remarkable recovery: In February of 2015 we began treating a young man that suffered complications from a routine surgery and was ultimately resuscitated after 14 minutes. He arrived at our facility in a stroller and non-verbal. After months of working with our pediatric team, he is walking and talking with incredible accuracy and is close to age-appropriate for speech and language skills. It is this kind of miracle that can only be witnessed in a small number of professional fields. Being a part of these kinds of stories is truly priceless.

Where do you see the profession of speech therapy in 10 years?

Claudia: The number of speech language pathologists has been on a steady incline, so I anticipate continued growth in the field. With more and more SLPs entering the workforce, I see us being more prevalent members in the workplace and continuing to further our scope of practice. For example, seeing more SLPs specializing in certain areas (i.e. specializing in voice and working solely for an ENT). This is happening now, but it is not as common.

Scott: Hopefully awareness and education will increase so the general public knows what it is that SLPs do.  This would lead to our profession being able to help and improve the lives of more people.  I’m not sure I can say where I see my profession in 10 years but only what I hope it will become.  A greater resource for people we can provide services to.

Kimberly: I imagine that the format in which speech and language services are provided will be greatly impacted by the ever-changing insurance companies and their authorization process. Our field will need advocates across all populations and diagnoses for evidence supported treatment conditions especially validating those settings outside of the school system.

What’s the most important advice you give your patients?

Claudia: Practice, practice, practice. I always insist that they will see significantly quicker progress if they practice outside of our therapy sessions and carefully follow all recommendations.

Scott: As cliché’ as it is I always ask my patients to work as hard as you can.  Unfortunately with many of the patients I work with who have neurological injuries it’s difficult to determine what their long term return of function may be. I always tell them while we can’t know exactly how much they will improve but in time the one thing that is certain is if they don’t try they will never reach their full potential.  So, even if the long term recovery isn’t to the patient’s previous level of function I would hope they can recognize their accomplishment in making themselves the best person they can be.

Josi: When the patients with speech, language, or cognitive disorders become frustrated in therapy, I educate them to slow down, stop to regroup and return to what they were working on at a later time.  If they do this, they will have a better chance at thinking more clearly and successfully completing the task.

Kimberly: For the families of children with language delay: Narrate everything. Label and repeat. If you feel like you’ve said it enough- say it again.

Anything else you want people to know about occupational therapy?

Kimberly: As in many aspects of the rehabilitation world: Early diagnosis is good but early intervention is even better. If you can treat the deficits without “labeling” a child unnecessarily early then do just that.

Scott: We are here to help.