You sit down at the bar and notice a girl sitting on the other side. You catch each other’s eye and exchange smiles. You get up and go sit next to her, buy her a drink and each take a sip, introduce names and start a conversation. What does this have to do with speech therapy? Everything.
Oral motor skills that give your smile symmetry and musculature to produce clear speech, without drooling or slurring.
The ability to produce a variety of sounds, linked together, to make your speech fluent and able to be understood by your listener.
Pragmatic skills that allow for appropriate socialization so you can start a topic, maintain appropriate eye contact, give personal space and continue taking turns conversing.
Stating words without that “on the tip of your tongue” feeling, formulating sentences and understanding what the other person is saying.
Being able to pay attention, remember the information you’re hearing, process that information and calculate how much you owe at the end of the night.
Having a voice to speak at all.
Swallowing that drink without it pouring out of your mouth or making you cough with every sip.
These are all areas speech-language pathologists (or SLPs for short) assess and treat. I give this example, because this blog is geared towards PT students, so I wanted to give a familiar setting, such as a bar, and because most of the areas of speech therapy are never thought of until something goes wrong. Talking, thinking, and swallowing: these are aspects of our lives we take for granted. But let’s get back to the point, what does this have to do with PT?
First of all, we are therapists dealing with muscles and nerves; anatomy and physiology to produce movement.
For example, a young female is admitted to acute care and diagnosed with Guillian-Barre including bilateral facial weakness and changes in her sensation causing significant difficulty to produce speech and some trouble eating. Try talking or eating without moving your face or lips. Not easy, right? What can we do to address this weakness? Assess what movement is currently present, initiate therapeutic exercises for increased and improved function, providing feedback (keying in on the slightest movement) and adjust the exercises’ frequency and duration as appropriate. For this patient, I was able to compare her speech therapy sessions with her knowledge of training for a marathon. Slow, steady progress and “work outs” to reach the goal, which was to return her speech and ability to eat to normal.
A 50-year old woman enters your outpatient clinic with right-sided weakness and facial droop with a diagnosis of a left middle cerebral artery CVA. She speaks a handful of words in total and frequently does not follow your directions. When she does speak it is slurred, muffled and hard to understand. She produces a word that does not make any sense, but she points and repeats that non-sense word. She is asking for some water. Once you figure that out, you give her a cup and half the water pours out the right side of her mouth, without her awareness, and then she starts coughing like crazy. She has aphasia, apraxia, dysarthria, and dysphagia. You may or may not come across these words, but let’s talk about them so that you can one up those other PT students. Aphasia is the interruption of language, a block of communication. Language is a two way street, you express it (expressive) and understand it (receptive). This patient is demonstrating expressive and receptive aphasia, as she has difficulty producing the words she wants to say (such as I want some water) and is not following any of your directions. Dysarthria is a motor speech deficit interfering with the production of speech/articulation in regards to how it sounds (i.e. slurred, slow, quiet, etc). Think about what you sound like when you leave the dentist after having Novocain or after you finish a few of those drinks at the bar. Apraxia is a motor speech deficit that inhibits purposeful movements, such as your lips and tongue do not get the right message to move. I want to say the “m” sound, but my lips won’t come together. Dysphagia is any deficit impacting swallowing whether it be inability to chew, pocketing food on that weak right side, choking on solid foods or slow and weak muscles that allow that sip of water you gave to the patient to go down her throat into her airway. So you get through your session and wonder, how am I going to communicate with this person and why is she coughing so violently when she drinks water? This is your moment to walk down that clinic hallway to see your friendly speech therapist. You get the chance to collaborate, discuss and work as a team to help this patient get better. Maybe this patient has recently started using an app on her iPad that allows her to touch icons that produce speech, for example, “Water.” Or maybe she does best with simple yes/no questions. Let’s be real, some of the directions you PTs give to complete an exercise are quite complex. This patient may need one-step, simple directions, with a model and THEN she can do it. Oh, and there’s that problem with drinking water. The patient might need to drink thicker liquids that go slower so she can manage without aspirating.
In my mind, there is nothing better than putting a variety of therapists in one room to talk about the patients they share. You will find a moment, a patient, a clinical setting that inspires you and gets you excited. Some of my favorite moments have been during co-treat sessions when we put our heads together addressed the patient’s goals and made the most out of the therapy experience. There’s no “I” in team, and when we work as a team our patients get better. We can get people back to home, back to school, back to work, back to their lives. That’s why we are therapists, right!?
So let’s not forget cognition… how we think. A 20-something year old male is wheeled into the acute rehab gym a few days or weeks after being in a car accident. He has a brain injury. He squints because the lights are too bright and immediately he has a headache, but then there’s all that noise of people talking, gym machines clanking, music and a TV blaring the news. His mind overwhelmed by stimuli the moment he entered and he can’t hold his attention to what you are saying. His eyes dart every which way because he is so distractible. You’ve seen him all week, but he can’t remember your name. Once you start therapy he can’t remember what you tell him to do. His brain does not remind him he can’t get up, but his impulsive behavior says go, so he tries to stand and falls. Normally our brain filters all that stimuli out, we attend to what we need to, we remember general information and details, we know our limits and can reason through problems; but, after this gentleman’s head got knocked around, his brain isn’t doing those things. He needs us to help him limit the stimuli, talk quietly and slowly, give him time to process what you are saying, write notes or reminders in his memory log so he can do his exercises later without forgetting, and start to have him understand why some movement and actions he would typically do are not safe right now. You find out this patient loves to cook. How can PT and SLP come together here? How about a co-treat session in the rehab kitchen. You get to work on standing, balance, transitioning from different positions, proprioception, and much more and I get to see how this patient maintains his attention to the task, sequences the steps to making his dish, remembers and understands what he just read from the recipe, maintains good judgement, insight and safety awareness, communicates his wants/needs, and much more.
On a similar, but different note, let’s talk concussion. A prime time for our worlds to come together. Any age, a plethora of stories as to how the concussion occur, but often very consistent deficits. There’s that mother of two that normally multi-tasks like no other and now can’t write an email while the kids are playing in the background. She is struggling with balance and cognition so you put her through some balance activities while I have her complete some mentally challenging tasks. Maybe her balance is affected by concentration or maybe her lack of balance is making it hard for her to think. Either way, we have something to go on or we can work on real life functioning.
To be honest, if I was not a speech therapist I would be a PT. I have a vast interest and praise for the practice. But I love what I do. There is no better feeling than helping a person say their own name or their children’s names, or I love you, or simply, “I want water.” We have ways to make you talk, a tag-line you might see on a t-shirt or bag of a SLP used to get people’s attention, but it’s true.
So be the brave PT to break through the walls and go check out what the SLP is doing. We just might be able to team up!
Katherine De Noyelles, MS, CCC, SLP