SPEECH THERAPY MAKES FOR LASTING MEMORIES
By Claire Markey
Much of a speech language pathologist’s work in a hospital setting is centered on language and cognition. In the past the population served was primarily geriatric patients who had strokes or brain injuries from illnesses such as brain cancer or dementia.
Presently, the adult population includes more adults at a younger age who either have had accidents at work or have suffered a head injury doing some of the more adventurous activities that people like to do, such as snowmobiling, downhill skiing, horseback riding, etc.
A brain injury can manifest itself differently in each individual. More and more we are discovering how language is connected to memory. As a result, the role of a speech pathologist has involved using cognitive therapy to help patients recover their communication abilities.
Imagine getting off a plane in a country where you don’t know the language. Someone can teach you to memorize and repeat the correct sounds to ask for the restroom or restaurant. But you don’t really know the words, grammar, syntax or the structure that bring the words meaning.
That’s kind of what it’s like for people who have difficulty speaking following a stroke or brain injury. People often maintain their intellectual capacity but communication can be compromised.
Recovery can be equally unpredictable. One patient, for example, couldn’t talk or read but she could spell what she wanted to say. Her therapy centered primarily on teaching her to be able to read aloud what she spelled. Once she was able to do that she started to talk. Finally after months of therapy her brain made the connection.
Speech and cognitive therapy begins with a referral from the patient’s doctor. This is followed by an evaluation of the patient’s abilities and deficits. Based on the results of the evaluation and the patient’s goals, a therapy program is set up using a variety of approaches to reach desired goals. Sometimes this can be like finding the right key on a key chain full of them to unlock a door. For example, one patient was referred for memory issues. He had already developed a variety of successful strategies and accommodations for his memory in his workshop but was frustrated by forgetting which cupboard housed his cereal bowl for his morning routine. His goal was to be able to independently complete his morning routine without having to open every cupboard. We decide to attach a post-it note with the word cereal on the correct cupboard. This was a temporary strategy which worked. Then one week the post-it fell off but the patient automatically went to the right cupboard. The brain re-trained and re-learned over time and repeated exposure to the written word. This was more ideal.
Therapy methods have changed over the years. Repetition was popular but fell out of favor for awhile. Today it is considered an important part of therapy. The use of iPads, smart phones and modern technology make it possible to create images that help people retrieve memory and communicate. In therapy, making meaningful associations is important. One patient had a head injury affecting his ability to remember people’s names. He devised a system in his address book to categorize his contacts based upon how he knew them. Years after we worked together I saw him downtown and he said, “Just a minute.” He pulled out his notebook from his pocket and went through it for a minute before looking at me and saying, “It’s Claire, right?”
It’s gratifying to work with patients in need of speech therapy. At BMH’s Rehab Department the staff works well as a team to facilitate a patient’s progress since many patients have physical or occupational therapy needs as well as speech needs. This strong support system increases successful therapy outcomes. Another critical aspect of speech therapy work is the support and collaboration from a family member or friend. Working as a team, more progress is often seen and it is often motivating to have the extra help. Often patients and family members have developed successful strategies and accommodations themselves but lack the confidence that they are doing the right thing. I often tell my patients: you are the expert because you know yourself best. Always remember that.
Claire Markey, SLP, CCC is an ASHA certified Speech/Language Pathologist in the Rehab Services Department at Brattleboro Memorial Hospital. Swallowing/Dysphagia/Voice therapy is also provided by Chris Hotchkiss, SLP, CCC. Both SLP’s can be contacted through the Rehab Department at 802-257-8255.