Focus On: Speech/Language Therapy

(Living Beyond Disabilities/May 2014) - Pippa Siguenza and Paula Sobel bring a combined 63 years of speech/language therapy experience to their MossRehab patients. Both work with outpatients at the Main Campus in Elkins Park.  Siguenza, MS, CCC, SLP, and Sobel, MA, CCC, SLP, answered questions about their work for this month’s focus on speech/language therapy.

What is speech therapy?

The term “speech therapy” does not clearly reflect the extent of our profession. “Speech therapy” implies addressing how clearly one speaks. We go beyond that. We are speech/language/swallowing therapists: We do a lot of work with language (how one comprehends and expresses wants, needs, ideas and opinions), swallowing and cognition (executive functions, memory, judgment, problem solving, divided attention, reasoning, etc.)

Can you explain how speech/language therapists at MossRehab typically spend their day?

We evaluate and treat patients and educate families. We meet with colleagues to discuss patients and share ideas. We work as a team with physical therapists, occupational therapists, psychologists, physiatrists and other professionals to provide optimal treatment for our patients. We provide in-services to share information about continuing education classes. Documentation is a key component of our day to ensure quality care and ongoing insurance authorization. We negotiate with insurance companies to get coverage for our patients. Those are just a few of the things we do. We also work together to develop and market our program both within the network and in the community.

Who are the typical patients that you work with?

Most of our patients are recovering from a stroke, but we also work with individuals with brain tumors, traumatic brain injury, multiple sclerosis, Parkinson’s disease, voice disorders, etc. Generally, our patients are people who have neurologic disabilities.

How is the work of a speech/language therapist at MossRehab different than speech/language therapists that work at schools or other facilities?

Siguenza and Sobel discussing patient caseThe main thing is that we work with adults facing traumatic injuries and conditions—people who are aware of what they have lost.  They are looking at a return to roles—work, leisure activities, family functions. Our patients have experienced an acquired event in their adult years. Communication difficulties stem from medical rather than developmental causes.

You are dealing often with patients who face major obstacles. What are some of the toughest challenges to providing speech/language therapy in that environment?

Patients are usually referred to outpatient rehabilitation after an inpatient hospital stay or a traumatic event that affected their communication, their cognition and/or their swallowing. These are such basic human activities—the most significant challenge is to help them regain their skills and cope with their disability.

We have a lot of young stroke patients now. In the past when you heard that someone had a stroke you thought of someone who was older—in their 70s, 80s, 90s. Now we have stroke patients in their 20s, 30s, 40s. Many of the people on our caseloads are between 30 and 60 years old. One challenge is incorporating role reversals. Those are great challenges. People’s life goals have been totally altered. 

Does the level of impairment among MossRehab patients affect how you deliver speech/language therapy?

In terms of long-term goals, level of impairment does not affect how we deliver therapy.  We see everybody as a whole person—pulling everyone (professionals, family, friends, etc.) in that we need to make sure the patient’s long-term goals—even beyond rehab—are taken into consideration. As outpatient speech/language pathologists, we are often the patient’s last step—helping them make the final moves to go back to work or school or home.

What are the most rewarding aspects of this work?

Rewards are many in this environment. The most rewarding is when someone tells you, “I used that strategy when I was out with my friends and it worked.” Or, “I signed up for a cake decorating class at the local art supplies store, and I could actually use my strategies to ask the woman to help me understand what she was saying.” It’s those things that go beyond a thank you. It’s knowing that what you are doing is making a difference in a patient’s life. It’s getting patients back to interacting with their family, their friends, their community.

Do any stories come to mind of patients that inspired you?

There was a young patient who had a stroke that resulted in a severe communication impairment. She was unable to speak, read or write. She had worked in the field of journalism, so this was a major challenge for her. We worked together intensively, and she was ultimately able to successfully return to her prior job. She was determined and motivated and followed through on all therapy strategies until she had mastered them.

What are the changes you have seen over the years with speech/language therapy?

We are much more focused on function now, real life activities. Inpatient stays are shorter now due to changes in health care coverage so we are seeing people in outpatient much sooner than we used to. We get them earlier in the process of recovery. Our course of care in outpatient is also shorter due to insurance limitations.  We are certainly seeing the introduction of more computer-based exercises and apps. We are using this technology to practice the therapy strategies that we provide.

Looking ahead, is there anything you see on the horizon that you are particularly excited about?

Our relationships with the Moss Rehabilitation Research Institute and the MossRehab Aphasia Center give us a connection to the up and coming research and strategies that can support our clinical treatment. That, combined with the advances in technology, point us toward exciting future developments.

How did you get into speech therapy?

Paula: When I was 15 years old, I had a young cousin, age 4, with whom I spent a lot of time. Her speech was unintelligible except to a few close family members. We later learned she wasn’t hearing correctly because of fluid in her ears and this had affected her ability to produce many speech sounds. One day I realized she couldn’t produce the “sn” sound in “sneaker”. She could say the “s” and the “n” in other words, but she couldn’t put them together to say “sneaker.” So I worked with her briefly—not knowing anything about speech/language therapy—and she got it. I think it was the rush of reward and success that “caught” me. While in graduate school, I had been planning to be a speech/language therapist working on articulation with children in the schools, but while doing my last practicum at MossRehab, I changed my track. I became totally immersed in the MossRehab milieu —the patients, the work, and the rehab team.

Pippa: I was actually interested in deaf education in high school and then moved into speech/language therapy in college. In graduate school I really found my niche with brain injury and continued down that path. When I came to MossRehab, I shifted over to stroke.

What drove you to take on such a challenging area of speech/language therapy?

The academic/intellectual stimulation, and, most of all, the patients, their progress and the ability to move them along the stages of rehabilitation so they can reenter their community and enjoy life. We get feedback from patients about how their treatment has made a difference—that’s the key—making a difference in somebody’s life. It’s a rewarding job to take somebody who seems so broken and so devastated by a life-altering injury and really be able to help them to a level where they can enjoy greater independence and contribute to society.