What is speech-language pathology? And how does it help recovery from stroke or brain injury? Those are the basic questions clients have for speech-language pathologists at the beginning of care. But the answers to those questions may raise more questions, such as “How long will therapy last?” This post helps patients and caregivers understand the role SLPs play in the treatment of speech, language, and cognitive disorders. It closes with eight questions patients and caregivers may want to ask on their first visit in order to get the most out of treatment.
If you have had a stroke, brain injury or are living with dementia, you may have been referred to a speech-language pathologist (also known as an SLP). You may be wondering, “What is a speech-language pathologist?” or “How will it help me or my loved one with stroke or brain injury or dementia?” Beginning the rehabilitation process can feel overwhelming, and if you’re feeling like you have a lot of questions, you’re not alone.
Speech-language pathologists are highly trained clinicians who assess, diagnose, and treat a wide range of speech, language, social communication, and cognitive issues in children and adults. At minimum, SLPs have master’s degrees. Their studies include coursework in anatomy, neuroanatomy, physiology, genetics, linguistics, psychology, human and language development, and more. So, know that you are in capable hands!
To help you get more out of your treatment, this article shares eight questions to ask your speech-language pathologist at the outset of care.
But first we’ll lay some groundwork on how speech-language pathology can help you or your loved one.
How SLPs Work: The Initial Evaluation
Overall, the job of a speech-language pathologist is (1) to properly diagnose each patient, then (2) to develop an individualized therapy plan to attain the highest level of function possible in areas such as speech, language, cognition, or swallowing.
Patient-centered care is the foundation of the rehabilitation process, so each person’s therapy experience will be different based on your goals and the skills you want to work on. Your clinician will look for your input as she/he develops the treatment plan.
In addition, to help with developing the plan of care, your clinician will do an initial assessment to examine different skill areas. In this assessment, some of the tasks may seem easy and some might be hard. The assessment is very important in understanding what areas should be focused on in therapy.
The evaluation may be comprised of informal and formal assessment measures. Formal assessments are validated through research and normed (standardized), so this can help the clinician identify if there are any cognitive, speech, or language areas that should be worked on in your SLP sessions. Some examples of assessments are:
- Language tests which look at different areas involved in listening, speaking, reading, or writing, such as the Boston Diagnostic Aphasia Examination, the Western Aphasia Battery, or the Boston Naming Test.
- Cognitive tests such as the Cognitive Linguistic Quick Test, the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS), or the Woodcock Johnson Test of Cognitive Abilities, which assess different areas of cognition such as attention, memory, or problem solving.
- Speech tests such as the Frenchay Dysarthria Assessment, which will examine characteristics of speech including respiration, vocal quality, and articulation
- An oral mechanism evaluation, which assesses your articulators (the parts of your mouth that make speech sounds and help with swallowing)
- Swallowing tests such as a clinical swallowing evaluation, a Fiberoptic Endoscopic Evaluation of Swallowing (FEES), or a Modified Barium Swallow (MBS) Study to assess your swallowing function.
From this assessment, your SLP develops an individualized treatment plan. It will be based on evidence-based practice — the integration of clinical expertise, patient values, and the best and most up-to-date research.
How SLPs Work: Regular Therapy
Your treatment with your SLP may involve a number of activities. These activities might be restorative, meaning that the goal is to regain lost skills by forming and strengthening connections in the brain. These activities might also be compensatory, meaning that you are working on building strategies that will help you function in your daily life. Here are some examples:Cognitive:
- Doing exercises to improve memory, such as using a log to improve recall of daily events
- Training in the use of environmental aids to assist with orientation
- Addressing cognitive skills in a functional context, such as preparing a meal or purchasing an item at the store — tasks that require multiple cognitive skills, including planning, and organization
- Learning how to self-monitor in the hospital, home, and within the community
- Activities aimed at strengthening your ability to remember word meanings and link them to the spoken and written forms of words, such as matching words to pictures, sorting words according to their meaning, and judging whether words have the same meaning
- Practicing naming pictures, judging whether words rhyme or not, or repeating words your therapist says
- Listening to or reading sentences or paragraphs
- Using strategies to make speech intelligible, such as practicing word lists, sentences, or paragraphs, or making conversation
- Exercises that improves coordination, range of motion, or strength of your swallow muscles
- Practicing eating and drinking foods and drinks of different consistencies using safe swallow strategies
How SLPs Work: Coordination With Your Care Team
To provide holistic rehabilitation, your SLP may also coordinate with others on your care team, such as doctors, case managers, and occupational or physical therapists.
Your family may also be a part of your support team. In addition to informing your family members of the changes you are going through, your speech-language pathologist may give them ways to more effectively interact with you.
8 Questions To Ask At Your First Appointment With Your SLP
Many clinicians will have you complete a history form before your first appointment. If you can’t fill out the form, they'll go through the information with you in person. Some clinics also request that you send prior testing information along. That might include previous therapy for your disorder or hospital records of the event that led to your disorder. Often it's helpful to bring a family member along who is familiar with your history and current levels of functioning.
The following are suggested questions to ask your SLP at your first appointment so that you get the most out of it:
1. What has the initial evaluation shown? (And can you write down the main points so that I can look at them later?)
2. What will my therapy involve?
3. How will we set goals for my treatment?
4. How can my family be involved in my therapy?
5. How can I practice at home in between appointments, so that I get the most out of therapy?
6. How long will therapy last? How will we decide when to stop?
7. Is there anywhere I can go for more help once this therapy ends?
8. What else can I do to maintain or continue to improve my skills once therapy is over?
Although it may all seem overwhelming, know that you are entering into the care of someone experienced in working with cognitive and communication disorders. Your SLP knows things are hard for you right now, and is there to help you make the rehab process as positive as possible.