Traumatic Brain Injury & Speech

Disclaimer: This post is going to be information-heavy. Traumatic Brain Injury is a topic that has been stuck in my mind for a while. These injuries are preventable and can be life-altering. Always be safe and take every precaution you can to protect yourself.

The Traumatic Brain Injury

Traumatic Brain Injury, or TBI, is a serious topic. The Centers for Disease Control and Prevention (CDC) explains, “A TBI is caused by a bump, blow or jolt to the head or a penetrating head injury that disrupts the normal function of the brain (CDC).” TBIs range in severity from mild to severe; it is situational. According to the CDC TBI is a “serious public health problem in the U.S. Each year, traumatic brain injuries contribute to a substantial number of deaths and cases of permanent disability. Every year, at least 1.7 million TBIs occur either as an isolated injury or along with other injuries (CDC).”

There are two main types of TBI — penetrating injuries and closed head injuries. Penetrating injuries involve a foreign object entering the brain and causing damage to every area it touches as it travels through the brain. An example of a penetrating head wound that is regularly talked about in psychology classes is Phineas Gage, who had a railroad tamping iron driven completely through his skull. A closed head injury, on the other hand, occurs when there is a blow to the head without a foreign object entering the brain. An example of a closed head injury is a car accident victim hitting their head on the dashboard or windshield. Closed head injuries result in two types of brain damage — primary brain damage and secondary brain damage.

Primary brain damage is what occurs at the moment of impact, which  may include:

• skull fracture(s)
• contusions/bruises
• hematomas/blood clots
• lacerations
• nerve damage

Secondary brain damage is damage that develops after the trauma over a period of time, which may include:

• brain swelling (edema)
• intracranial pressure (increased pressure inside of the skull)
• epilepsy
• intracranial infection
• fever
• hematoma
• low or high blood pressure
• low sodium
• anemia
• too much or too little carbon dioxide
• abnormal blood coagulation
• cardia changes
• lung changes
• nutritional changes
  (ASHA)

After the Injury

Communication

After a brain injury people often have trouble thinking (cognition) and communicating. “Brain injury survivors may have trouble finding the words they need to express an idea or explain themselves through speaking and/or writing. It may be an effort from them to understand both written and spoken messages, as if they were trying to comprehend a foreign language. They may have difficulty with spelling, writing, and reading, as well… Individuals may seem overemotional (overreacting) or ‘flat’ (without emotional affect)… In general, communication can be very frustrating and unsuccessful (ASHA).”

Behavioral, Emotional, and Personality Changes

People with a TBI experience a lot of changes, externally and internally. In most cases there are emotional, behavioral, and personality changes after the injury. So I don’t completely bore you I will provide you a link to the information, so you could look at it if you’re interested. The Missouri Department of Health and Senior Services and the University of Missouri Department of Health Psychology collaborated in the effort to put together The Brain Injury Guide and Resources. This website has tons of helpful information, but the page I specifically linked to is about the emotional, behavioral, and personality changes a person experiences after a TBI. It also includes strategies for the injured person and for others on how to deal with the changes.

Cognitive Problems

A Traumatic Brain Injury is just like it says — traumatic. Cognitive problems (thinking) are common after a TBI. Each TBI is different in regards to location and severity, therefore the combination of cognitive problems ensuing are unique to each individual. They might include:

• trouble concentrating when there are distractions
• slower processing or “taking in” of new information
• problems with recent memory. New learning can be difficult. Long-term memory for events and things that occurred before the injury, however, is generally unaffected (e.g., the person will remember names of friends and family).
• executive functioning problems. The person may have trouble starting tasks and setting goals to complete them. Planning and organizing a task is an effort, and it is difficult to self-evaluate work. Individuals often seem disorganized and need the assistance of family and friends. They also may have difficulty solving problems, and they may react impulsively (without thinking first) to situations
  (ASHA)

The Speech Therapist and TBI

A speech therapist will evaluate the individual for speech and swallowing difficulties that stem from the brain injury. After the evaluation the speech therapist will develop a treatment plan that is unique to each person. The treatment plan will follow this general progression:

• In the early stages of recovery (e.g., during coma), treatment focuses on:
  • getting general responses to sensory stimulation
  • teaching family members how to interact with the loved one
• As an individual becomes more aware, treatment focuses on:
  • maintaining attention for basic activities
  • reducing confusion
  • orienting the person to the date, where he/she is, and what has happened
• Later on in recovery, treatment focuses on:
  • finding ways to improve memory (e.g., using a memory log)
  • learning strategies to help problem solving, reasoning, and organizational skills
  • working on social skills in small groups
  • improving self-monitoring in the hospital, the home, and the community
• Eventually, treatment may include:
  • going on community outings to help the other person plan, organize, and carry out trips using memory logs, organizers, checklists, and other helpful aids
  • working with a vocational rehabilitation specialist to help the person get back to work or school.
• Individual treatment may continue to improve speech, language, and swallowing skills, as needed.
  (ASHA)

That’s the ramble for now.

Speech Disorders & Language Disorders

When you think of a speech therapist what do you think they do? They treat speech disorders. A Speech-Language Pathologist doesn’t just deal with speech disorders, but also with language disorders. That’s why they’re called Speech-Language Pathologists. Speech disorders and language disorders are not synonyms. There is a difference between speech disorders and language disorders.

(Friendship Circle, “Kids”. Photo. http://www.friendshipcircle.org/blog/2013/05/28/10-ways-a-speech-language-pathologist-can-help-your-child/)

Speech Disorders are “problem[s] with fluency, voice, and/or how a person says speech sounds.” A fluency disorder is present if there are “interruptions in the flow or rhythm of speech characterized by hesitations, repetitions, or prolongations of sounds, syllables, words, or phrases.” An example of a fluency disorder is stuttering. One of the main features of stuttering is the repetitions of syllables, such as “un-un-un-under”. Articulation disorders are “difficulties with the way sounds are formed and strung together, usually characterized by substituting one sound for another (wabbit for rabbit), omitting a sound (han for hand), and distorting a sound (ship for sip).” A child has a lisp when he/she substitutes the “th” sound for the “s” sound – they say “thick” instead of “sick”. Voice disorders are “characterized by inappropriate pitch (too high, too low, never changing, or interrupted by breaks); quality (harsh, hoarse, breathy, or nasal); loudness, resonance, and duration.” Recurring laryngitis is an example of a voice disorder. (ASHA)

Language disorders are “problem[s] with understanding and/or using spoken, written, and/or other symbol systems (e.g., gestures, sign language). The disorder may involve (1) the form of language (phonology, morphology, syntax), (2) the content of the language (semantics), and/or (3) the function of language in communication (pragmatics) in any combination.” The form of language – Phonology is about the combination of sounds; Morphology is about how words are pieced together; Syntax is a synonym for grammar, so syntax deals with forming coherent sentences. Content of language – semantics deals with the meaning of the sentence and the words within the sentence. Function of language – pragmatics is bringing together everything – phonology, morphology, syntax, and semantics – in “functional and socially appropriate ways.” One way to classify language disorders is to divide them into two categories – primary language disorders and secondary language disorders. (ASHA)

There are no known causes of primary language disorders. The category of primary language disorder is further broken down into Specific Language Impairment (SLI), Early Expressive Language Delay (EELD), and language-based reading impairment. SLI has no known causes, and it is an “unexpected and unexplained variation in the acquisition of language (Exceptional Learners p 274).” Difficulties with academic language, specifically in reading and writing, are common for school-age children with SLI. EELD is “a significant lag in expressive language (i.e., a 2 year old does not use 2-word utterances) that the child won’t outgrow (Exceptional Learners p 274).” Some children with language delays catch up with language norms for their age group, however those with EELD don’t catch up to their peers and really struggle with this throughout their academic career. Language-based reading impairment is a language disorder that is undetectable until the child begins to learn to read. “Research of such abilities as phonological awareness, alphabet knowledge, and grammatical speech have helped in identifying children who are vulnerable to this kind of disorder (Exceptional Learners p 274).”

Secondary language disorders occur because of another condition. Intellectual Disabilities (ID), hearing impairment, Autism Spectrum Disorder (ASD), Cerebral Palsy (CP), or Traumatic Brain Injuries (TBI) are some of the causes for secondary language disorders. Each case of secondary language disorder depends on the child and the disability they have. Children with ASD typically lack social interaction because most “lack communicative intent, or the desire to communicate for social purposes (Exceptional Learners p 243).” Since there is a lack of social interaction children with ASD do not have opportunities to develop their expressive language. (Exceptional Learners p 275)

That’s the ramble for now.

Augmentative and Alternative Communication

So far I’ve told you what speech therapy is, but what is Augmentative and Alternative Communication (AAC)?

Augmentative and Alternative Communication “includes all forms of communication (other than oral speech) that are used to express thoughts, needs, wants, and ideas. We all use AAC when we make facial expressions or gestures, use symbols or pictures, or write.” Who needs AAC? People with “severe speech or language problems rely on AAC to supplement existing speech or replace speech that is not functional.” (ASHA)

There are two broad types of AAC: unaided communication systems and aided communication systems. Everyone is different and has certain individual needs, so the type of AAC that is most helpful might be different from their peers. Unaided communication systems sounds like what it is – unaided. There is no equipment or device, it’s just the individual. A person utilizing an unaided communication system uses their body, facial expressions, gestures, etc. to make their message known. An example of unaided communication is ASL (American Sign Language). Unaided communication systems have both pros and cons. Requiring no extra equipment is an advantage, while a disadvantage is that not everyone will understand what the person is trying to communicate. Then there are aided communication systems. Unlike unaided communication systems, aided require extra equipment. Some examples of aided communication systems are pen and paper, picture board, and text-to-speech devices. One disadvantage is that aided communication systems require additional equipment that must go everywhere with the individual. On the other hand aided communication systems are easier for others to understand exactly what the individual is communicating. The pros  and cons don’t matter really, it all depends on what the individual finds most helpful for them. (Communication Matters)

AAC is not meant to be a means for the person to never develop their speech. In some cases it can even help develop the person’s speech. It can help expand their vocabulary, teach proper pronunciation, and serves as a good role model of speech for the individual. Having access to AAC can open up so many doors for the individual, such as academics, social interactions, etc. For those that are in need of AAC but don’t think they can afford it can breathe a sigh of relief. There is funding available to help those that cannot afford it, however it can be a long, drawn out process. For some families it is just easier if they buy it themselves. This way they don’t have to go through the long process of applying for funding, and they can get their hands on the equipment much faster. Some families have relied on fundraising and/or charities to gather enough funds to purchase the AAC.

So where does a speech therapist fit in with someone using AAC? The speech therapist works with the individual to “implement a multimodal approach to enhance effective communication that is culturally and linguistically appropriate (ASHA).” The speech therapist works with the student on language skills, both with the AAC and without it. They also help the student learn how to effectively use the technology. The speech therapist is there to advocate for the child that uses AAC just like any other child they work with.

That’s the ramble for now.

Social Media that SLPs Can Take Advantage Of

When someone says “social media” I automatically think of Facebook and Twitter, but there is so much more than that! There is Pinterest, Google+, and so many more! When I go to these social media sites I don’t expect to see professional material. I expect to see who got engaged or married, how bad or awesome someone’s day is going, etc. So why does someone think that these social media outlets can be used for professional reasons? How can it be done?

“That’s not what they were made for!” – This is what an acquaintance said when she saw a business promoting their business and reaching out to clients/potential clients.

Facebook “is the largest online social network with more than 500 million users.” Everyone and their brother uses Facebook on a daily basis for a variety of reasons ranging from staying connected with family and friends to having a fan page for their business, and everything in between. Personally, whenever I am thinking about using a company for the first time I check to see if they have a Facebook page, and I look for what people are saying about the company or the service they provided. Since people are more willing to be honest on the internet (because of the feeling of anonymity) I use those customer reviews to make a decision about the company. This same concept can be applied to a speech therapist on Facebook. Your business page on Facebook can not only give a description of the services you provide, but also it is a good place to share tips and tricks, photos, success stories (with permission of course), etc. It is also a place to share office news with all of your clients and to promote your business. (ASHA)

When I first heard about Twitter I didn’t think it would be very popular, but I was so wrong! Twitter has “more than 150 million users and counting.” Facebook has friends and fans, while Twitter has followers. It is a quick, easy way to get information out there in 140 characters or less. Speech therapists can really take advantage of this. With the mounds of paperwork, travel, appointments, etc. being able to get information to ALL of your clients in 140 characters or less is ideal. But Twitter is not just for reaching out to your clients – there are other SLPs on Twitter and they all communicate using the hashtag “#SLPeeps”. “On any given day you might find the #SLPeeps exchanging tips on organization, goals, treatment-related applications, industry news – or just offering sympathy or support to fellow professionals having a tough day.” Twitter can be a great resource for SLPs, but only if used appropriately. (ASHA)

What in the world is Pinterest? Pinterest is an amazing resource for business and personal use! It is a “website for sharing virtual links to resources. It is like having unlimited access to a library of bulletin boards, where people have ‘pinned’ their favorite crafts, activities, free resources, blogs, research, and more (SpeechyKeenSLP).” I have already created a Pinterest board dedicated to speech therapy. What makes Pinterest so amazing is: its free, it can be accessed anywhere with Internet access, new pins are added everyday, pins are easily organized, and you can add your own pins. A therapy session should never be boring with the same activities day in and day out. Your therapy sessions can be new and fun with the help of Pinterest and the creative ideas people pin.

Google+ is described as a “more transparent” version of Facebook. It uses “circles, huddle, and hangout”. “Circles” are the Facebook equivalent of private groups that would only be for a very specific group of people. Businesses can create circles for the workers to get updates, ask for a shift cover, etc. Along the same lines, a speech therapist can have a circle for their clients to keep their information from being viewed by every Google+ user. “Huddle” is a function for group chatting over the phone. “Rather than individually sending SMS messages, Huddle can pool them together to make a group chat which is still private to outside viewers, unlike Twitter.” This would be a great way for a speech therapist to send a mass message to all of their clients at once. This is easier versus having to look through their phone contacts and individually select the clients to send a message to. Being able to send mass messages quickly and painlessly can be a big time saver for therapists. “Hangouts” is a video chat and instant message function that is similar to Skype. What makes hangouts special is the option to easily switch between available and invisible. Another special feature of hangouts is being able to make yourself available to some or all of your circles. If a therapy session needs to be done via video chat due to illness, travel, or countless other reasons the therapist can make themselves available to that one client so other clients won’t try to video chat with the therapist at the same time.
(Google+)

One huge, important disclaimer about using any social media outlet, even for personal use, be careful what you post. You don’t know who is going to see it. “In a recent discussion on ASHA’s Facebook Page, an SLP pointed out that she sees other SLPs or SLPAs making comments on Facebook about families they’ve seen for home visits – the conditions of their homes or remarks about the parents, for example – and asked for feedback on this practice. Others weighed in on their concerns about this practice being unethical and a potential violation of HIPPA regulations (ASHA).”  Be smart about what you post.

Ohio State Medical Association posted a very helpful “pamphlet” called “Social Networking and the Medical Practice: Guidelines for Physicians, Office Staff and Patients” (that also applies to SLPs). Some of the guidelines are things that I wouldn’t have thought about. Glad I found it!

That’s the ramble for now.

What in the world is a SLP?

For someone that stumbles on my blog and reads a post or two, they might wonder “what in the world is a SLP?” What do they do? Where can they work, and what kind of people do they work with? Is there a need for SLPs? What do I need to do to become a speech therapist? How much do SLPs get paid? What kind of characteristics does a SLP need? What resources are available for more information? These are all questions that I started asking myself when I decided to turn my life upside-down and change my intended profession. I knew I made the right decision to switch to speech therapy when I shadowed a speech therapist that worked in an elementary school. As soon as I sat down with those kids, my heart melted and I knew I wanted to spend my career working with these kids.

What exactly is a SLP? SLP stands for Speech-Language Pathology, sometimes they are called speech therapists. What does a Speech-Language Pathologist do? According to the University of Redlands, Speech-Language Pathologists “assess, diagnose, treat, and help to prevent disorders related to speech, language, cognitive-communication, voice, swallowing and fluency.”

Speech therapists can work in a variety of settings and with a variety of people. According to the United States Department of Labor in 2010, 44% of speech therapists worked in elementary and secondary schools; 15% worked in offices of physical, occupational and speech therapists, and audiologists;  13% worked in hospitals; 4% worked in nursing care facilities; and 3% worked in home health care services. Speech therapists also work in rehabilitation centers, private practices, state and federal government agencies, and research labs (ASHA).

According to Josephine Chen, M.S., CCC, LLC a speech therapist works with a variety of patients including, but not limited to:

• Infants with feeding/swallowing difficulties
• Toddlers with delayed language development
• Preschoolers and school age children with articulation and phonological disorders, language delays/disorders, delayed play skill development, delayed pragmatic language skills
• Children with Autism or other syndromes
• Children with language processing disorders and language-based learning disabilities
• Individuals who stutter
• Individuals with voice disorders
• Individuals with difficulty swallowing
• Hearing impaired individuals
• Individuals who have a stroke, head injury, or neurological disorders that affects speech, language, cognition, or swallowing
• Individuals who wish to modify their accent

Is there a need for speech therapists? According to the United States Department of Labor “employment of speech-language pathologists is expected to grow by 23 percent from 2010 to 2020, faster than the average for all occupations. As the large baby-boom population grows older, there will be more instances of health conditions that cause speech or language impairments, such as strokes and hearing loss.”

What do I need to do to become a speech therapist? It is not completely necessary to have an undergraduate degree in Communication Sciences and Disorders. However, the college might have you take some undergraduate courses before beginning your graduate classes. A master’s degree is necessary in order to become a speech therapist. It is also necessary to be licensed by the state and be certified. The certification you can get is the Certificate of Clinical Competence in Speech-Language Pathology (CCC-SLP) (US DoL).

The average salary of a speech therapist depends on the state. The average annual salary for a speech therapist in Georgia is $96,000. Hawaii is the state with the lowest average annual salary at $63,000. New York and Mississippi are tied for the states with the highest average annual salary at $104,000.

A speech therapist works with people with different needs and abilities. For these reasons, and many more, speech therapists need to have:

• a sincere interest in helping people
• above-average intellectual aptitude
• the sensitivity, personal warmth, and perspective to interact with a person who has a communication problem
• scientific aptitude, patience, emotional stability, tolerance, and persistence
• resourcefulness and imagination
• a commitment to work cooperatively with others
• the ability to communicate both orally and in writing
  (According to ASHA)

By this point I’ve convinced you that being a speech therapist is the best job in the world and you want to become one too! But you have questions. Where can you find more information? Never fear, the Internet is here! There are numerous resources for Speech-Language Pathology. This is just a small list of those I’ve found to be helpful:

• The American Speech-Language-Hearing Association (ASHA) is a great resource for all-things Speech-Language Pathology!
• ASHA also has a blog – the ASHAsphere – that is updated regularly with tons of information about interesting topics.
• The Georgia Board of Speech-Language Pathology and Audiology has information about being a speech therapist – laws, how to become certified, etc – all specific to Georgia.

That’s the ramble for now.

(Cafe Press, “Funny Speech Therapist Tote Bag”. Photo. http://www.cafepress.com/jobtees/7376996)