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Episode 1 Transcription:
Episode 2 Transcription:
Dr. Pillay: Welcome everyone to our second episode of aphasia speaks. This is our new podcast on all things related to Aphasia which is a common communication language disorder that happens after stroke. Today on our episode, I have Shelley Laitinen with us here in the studio. Welcome Shelley, how are you doing today?
Shelley: I’m doing great thank you for having me on the show
Dr. Pillay: So excited to see you. You’ve done a lot of work with patients with aphasia from a clinical and therapeutic standpoint and I think it’s really important that we include that aspect and perspective when we are talking about things related to Aphasia. So you are a speech therapist here at Froedtert hospital and the Medical College of Wisconsin, can you tell our listeners what a speech therapist is and what are some of the different things that speech therapist do, that are associated with their job?
Shelley: First people usually think of a speech language pathologist as working in the schools with children, so they may not be aware of the medical side of Speech Pathology. I particularly work with people who have had something like a stroke or a traumatic brain injury, or diagnosis like Parkinson’s disease, and speech therapist are responsible for evaluating and treating cognitive communication disorders, swallowing disorders, voice and motor speech disorders. We also work with people who maybe just have a serious medical condition like pneumonia or cardiac event that just deconditioned those systems for speech and swallowing. So usually the first encounter someone has with the speech pathologist in the hospital is for swallowing evaluation. So for most our listeners who had a stroke they probably first met their speech therapist for a swallowing evaluation to make sure they could eat and drink safely, and then speech therapist can work in a variety of settings. So from the hospital to outpatient clinics or skilled nursing facilities and Home Health Care.
Dr. Pillay: wow so you guys do a lot of different things!
Shelley: yes and usually people go but my speech is fine they don’t realize maybe that there’s other things going on to that are under our field of care
Dr. Pillay: So what got you interested in speech therapy as a career choice?
Shelley: It was kind of my love of Science and learning about the brain. I had studied at Indiana University in undergrad in Speech & Hearing sciences and kind of knew right from the get-go that I wanted to work with people with speech and language disorders, and it was then when I was in graduate school at the University of Arizona is where I learned from some of the experts in the field of aphasia and that got me really interested in it. So now after almost twenty years in that field, I’m now solely focusing on aphasia rehab as part of the Intensive program for Aphasia therapy (IPAT) at the Medical College of Wisconsin and assisting with Aphasia research, which is really exciting for me.
Dr. Pillay: that’s great to hear I obviously have a soft spot for all of those things, so you know it’s been wonderful to see how that program has really taken off here at the Medical College, and then how some of the research has been able to dovetail with that. You work with a lot of different kinds of patients and many of them learn skills from you. Right you do the therapy with them and they’re learning those abilities. Is there any one kind of thing that seems to be in common across patients that they seem to struggle with, or is everyone different?
Shelley: that’s a good question. So I look at it as everybody is different and unique, but everybody wants to get better and they want to get better now. Everybody needs to learn some patience and that’s probably the hardest part especially in aphasia rehab is learning some patience, and family members learning some patience. So that the process when there’s been a loss, which having Aphasia can be a loss in a sense of identity and who you are because you aren’t able to communicate your thoughts as clearly as you were before. So everybody that has aphasia I think feels that same way, but someone may not communicate the same way as another person, so they’re still different but they still have that underlying similarity of needing to learn how to be more patient with themselves. That rehab takes time and one treatment that works for one person may not work for another person, so as a speech pathologist you have to think outside the box sometimes and make changes and really dedicate your work with them to meeting their individual needs. So everybody’s different but there is a lot of similarity of having to be more patient
Dr. Pillay: That’s a really good point about being kind to yourself, trying to help manage some of that frustration. You talk a little bit about patience and wanting to get better right now. Do patients continue to get better after a period of a couple of months or how does that change or the course of their recovery change?
Shelley: Yeah that’s the huge question and that is what it is asked all the time. Like they hear things like you only have six months, and then that’s it you have a year, and then its two years, but as a therapist who has worked with people across their care, of course you are going to make the most drastic improvements within those first couple months or the year. So the pace at which the progress is made may be quick in the beginning, and then it yes, it may slow down but there’s this myth of a plateau that people will hear from physicians or in the community, but I think it’s if someone sets their own plateau and isn’t maybe looking for new ways to do an exercise or maybe try out a new therapy app, or maybe even working with a different therapist. That’s totally fine to seek out a new speech therapist if you feel like things aren’t changing much, or seek out new programs like our intensive Therapy Program or a University clinic or get involved in research. So I think if you can find other avenues, and also maybe you just other activities in your daily life. Try something new. I think sometimes people forget that they can look at other aspects of their life that they can continue to grow. So maybe volunteering and trying out something new or an activity that they haven’t done before, or a new hobby or interest. So that maybe progress. Versus feeling more isolated just due to aphasia.
Dr. Pillay: that’s so important. So you talk about finding hobbies and trying out new things, and aspects of that care. I’ve heard this term functional communication and what’s the difference between functional communication and what we just consider communication skill training? Is there a difference you can tell us about?
Shelley: yeah I think sometimes that’s the biggest distinction that people don’t realize is between those two things. So communication skill training is focused on what someone with Aphasia can and can’t do. For example, can the person say a sentence, or can the person write or spell words correctly, and this is more the traditional approach to therapy that focuses on impairments. While of course is it important to work on impairments and approve those skills, therapy also needs to integrate how a person participates in activities that are meaningful to them. So this is considered the life participation approach to Aphasia or LPPA, and this is more how a person does things like order a meal while they’re in the hospital or is a person able to tell someone about their family. So therapy that combines skills training with a functional communication task is the end goal and is really the sweet spot for therapy. For example, I’ll use photos from a person’s phone while they’re naming maybe what actions are happening in the picture or have them practice writing their favorite food words for a grocery list. So trying to combine the skills but with something a little bit more meaningful to them
Dr. Pillay: very cool. Can other people help with speech therapy rehab exercises outside of just coming to therapy visits? how does that work?
Shelley: so it’s very important to involve family from day one and first there needs to be education about what aphasia is. So I know and your last podcast you talked about that, that most people just don’t even know what it is, even though it’s a pretty prevalent disorder in our community. People just aren’t aware, so family members need to be taught how to support communication. You know, what does my loved one understand better – if I show them a picture or write a word when I ask a question. Do I have pen and paper so my loved one can try to write or draw something that they’re expressing. It’s important to always use those supports and to teach friends and people in the community even how to use those supports to involve a person with Aphasia in daily conversations and not feel so isolated. Our society in general needs to do a better job in supporting people with Aphasia and make communication access a human right. So I encourage family and friends to attend therapy sessions where they can learn these strategies from their speech language pathologist
Dr. Pillay: You talk a lot about patients learning from the speech therapist about the therapy process, but is there one thing that you’ve learned from working with people with Aphasia?
Shelley: I find it so exciting to work with people who have Aphasia. What I’ve learned is that it’s important for people with Aphasia to be around other people with Aphasia. So just sitting one-on-one with me in that therapy room, we can work really hard together and make great changes, but it’s important for family friends and people who have Aphasia to meet other people that also are dealing with the same thing. I think I haven’t realized how important that was until starting to work with our intensive program at MCW where we have group therapy. This is where we allow for connection and sharing stories about living with Aphasia and as an all Community groups there’s nothing better than having the opportunity to look another person in who understands exactly what you’re going through. So we honestly have people who just say “this sucks!” and the person can look right at them and say “I know!” and sometimes that’s all they need is just that other person that understands exactly what they’re going through. So I encourage people I work with to check out Community groups or there’s phenomenal online Aphasia resources if you don’t have a group that’s near you. There’s a lot of virtual groups out there and we even had someone from our program go on a cruise with an aphasia group, so I think you just have to find those avenues to allow people with Aphasia to connect with others.
Dr. Pillay: That is really powerful and meaningful as an option. What one thing you with other people knew about Aphasia? Maybe our listeners that don’t know quite as much about it or are less familiar.
Shelley: Kind of like with anything maybe that you don’t know about, I think sometimes people might actually be a little scared to try to talk to someone with Aphasia, because they don’t know how. So it just takes patience and some practice. If you have a friend or a family member that maybe you aren’t spending as much time with as you used to before because you aren’t sure how to communicate with them. You need to put yourself out there and imagine how they might be feeling. I know that they still want to have that connection with their same friends and family members as before. So people with aphasia are at a very high risk for depression and have that loss of social network. Maybe find an activity that you can do with them that isn’t so language focused, something like going to a park in the summer and listening to music together or taking an art class or gardening, going to the zoo. Finding something where it doesn’t require just sitting down and talking to each other as the main focus, but still spending quality time together and enjoying each other’s company.
Dr. Pillay: That’s great – the important thing is finding those activities together to share.
Shelley: Exactly. And making those new memories. The other thing that I think it’s important to to note, is that a lot of people have what’s considered mild Aphasia. So they can easily carry on a conversation or read a book, so maybe most people don’t even think they have that much of a problem. But for my experience people that have what you know, what is labeled as a mild form of aphasia can be very frustrated because maybe they aren’t able to return to their High demanding job. It’s important for even those people who may appear to be doing okay, to still get the therapy they need and the support and counselling that they may need so they also can feel validated and find a new sense of identity.
Dr. Pillay: that’s so important. You talked a little bit about things that you can do with people with aphasia. Are there any tips or tricks you’d like to share with people who have aphasia or their support people in their lives?
Shelley: sure yeah, we touched on this a little bit before, but it’s the sense of having some patience, and always having hope that things will continue to change and progress. You know it may not be as significant as you want to initially with some of the change, like how fast its coming on, but knowing that even little things, you know being able to reply to text with a few words, or feel like you enjoy life a little bit more. Maybe you start to volunteer something. That there’s not really a plateau out there. and also realizing that speech therapy isn’t the end all. So at some point therapy made discontinued and that’s okay. So as you continue to find new things to do in your life, keeping up with your communication exercises on your own, or with family, but you have to find things that are meaningful to you, and you may have aphasia, but that’s not what identifies you as a person.
Dr. Pillay: that’s so important to say. I’m glad that that you said it for all her listeners to hear. So that is it for our episode today. Thank you again to Shelly Laitinen, who is a speech therapist extraordinaire over here at the Medical College of Wisconsin for your time.
Shelley: and thank you Sara for inviting me on as a guest. I really enjoyed our conversation today and I hope your listeners did too.
Dr. Pillay: I’d like to offer a special shout-out to Kat Reinert who wrote and produced the music that you heard on this podcast as well as helping to mix the final episode. Views and opinions are my own. Thank you for tuning in.