• Anna Samuel


Two Interviews with Speech and Language Therapists


By Anna Samuel

I sat down to chat with two of my family members who are Speech and Language Therapists working in very different environments. The first provides rehabilitation to adults with acquired brain damage, and the other works with children with speech and language disorders.

Interview 1: Speech and Language Therapy in Community Neuro-Rehabilitation

A.S.: Can you tell me about your role as a Speech and Language Therapist?

T1 (Therapist 1): I’m a clinical lead Speech and Language Therapist working in a community neuro-rehabilitation setting. I manage a small team of 7 speech therapists who are part of the multidisciplinary team consisting of Occupational Therapists, Physiotherapists, Dieticians, Psychologists and specialist Nurses. We provide rehabilitation to people who have acquired neurological conditions, such as strokes and brain injury, as well as degenerative disorders like Parkinson’s, Motor Neurone Disease and Multiple Sclerosis. We facilitate communication and swallowing which can be impaired after neurological change. We are based in an outpatient clinic, but also visit people in their homes and nursing homes, as well as providing inpatient rehab beds in a community hospital, where they receive intensive input for a 6 week period.

A.S.: How does neurological damage impact communication and swallowing?

T1: Neural damage can cause swallowing impairments (dysphagia) which puts people at risk of aspirating (particles of food and drink enter the lungs and cause aspiration pneumonia). Swallow rehabilitation works on muscle strengthening or compensatory procedures such as diet modification, postural changes and environmental changes. The location and size of the lesion determines how severe the communication deficit is. Aphasia is a language impairment. Receptive aphasia is difficulty understanding others, whereas expressive aphasia is a difficulty producing language. This can be affected across modalities, including both reading and writing. Apraxia of speech is the difficulty in planning of speech and disruption of neural messages to the articulators (lips, teeth, jaw, and tongue). Dysarthria occurs when the patient is unable to correctly place articulators to produce intelligible speech.

A.S.: What are the psychological impacts on the patients?

T1: There are cognitive impairments such as memory and attention which pose a challenge to rehabilitation. We commonly see changes in mental health such as low mood, depression, anxiety, and emotional lability.

A.S.: What about the psychological effects on you and your team?

T1: There is a huge emotional load on therapists. We have a strong, cohesive team which helps manage that as there are always people to communicate with during stressful times. Patients and family members have high demands of us, and we must be realistic that we may not be able to meet all their expectations. It is particularly emotionally challenging working with patients with degenerative conditions. We get to know them and their families, whilst dealing with the knowledge that they will deteriorate and eventually pass away. I think this is especially daunting for junior therapists, so I tend to allocate these patients to more experienced therapists.

A.S.: How are family members involved in the treatment process?

T1: Family members have a choice to be involved as much as they want. We plan family meetings to involve them in goal setting and discharge planning. Family members are useful when getting to know a new patient in communicating their hobbies and interests so that their therapy can be tailored to them uniquely. When the patient is severely cognitively impaired, we provide indirect therapy which involves educating the family with techniques such as speaking in short, simple sentences and using visual and written cues to facilitate communication.

A.S.: What role do the Psychologists play?

T1: The Psychologists conduct cognitive and mood assessments which highlight specific areas of deficits to enable more targeted and efficient rehabilitation. The rehabilitation process requires cognitive effort and patients suffering from depression or anxiety will lack motivation to participate in therapy. Some patients lack insight into their impairments and are unaware that they need therapy, so the team provides education to facilitate their understanding.

A.S.: What is the main challenge of your job?

T1: The restraints of the NHS mean that there is a huge pressure on resources (staffing and funding). There is a long waiting list, so we have to prioritise according to need.

A.S.: What are the benefits of your job?

T1: I love working within a multi-disciplinary team as we collaborate to provide the most effective treatment. It is very satisfying to see the patients’ progress and to be involved in helping them achieve their goals.

A.S.: Can you give me an example of when you feel as though you have significantly benefitted the life of a person?

T1: I worked with a man who had a stroke which caused severe Apraxia of speech. We started with vowels and added consonants, slowly building up from scratch. When he was discharged, he was able to produce full sentences and was so grateful.

I also treated a lady with motor neurone disease. We set up an AAC (augmentative and alternative communication) device which allowed her to use an app on her iPad to communicate. She used it to voice bank phrases of affection for her family such as “I love you” so that as her speech deteriorates, she is always able to hear her voice.

A.S.: What was the career path that led you to this job?

T1: I have always loved languages. When I was younger, I babysat a child who was hearing impaired and became interested in how she acquired speech. I completed my degree in Speech and Language Therapy as a mature student.

A.S.: How has COVID-19 impacted your work (for you and the patients)?

T1: We have been working remotely. It has been difficult for the elderly patients to overcome the technological challenges of online appointments. It can be challenging with video calls because it is hard to pick up on non-verbal and environmental cues.

Interview 2: Speech and Language Therapy for Children

A.S.: Can you tell me about your role as a Speech and Language Therapist? What kind of language disorders do you deal with?

T2: I work with children, parents and teachers to assess and provide therapy for children with language and speech disorders. Lots of children have Developmental Language Disorder (DLD) which is a difficulty in the understanding and/or use of language. It often presents as difficulty using pronouns, tenses or syntax, making their language difficult to understand by others. They can have difficulties understanding in the classroom. DLD affects around 2 people in every classroom. Some children have language disorders that are associated with Autism Spectrum Disorder (ASD). They can have a range of difficulties with social communication, as well as receptive and expressive language impairments. We help to improve their functional use of language, such as initiating play with their peers to enable them to form friendships. I also see children who stammer and have speech sound disorders.

A.S.: What are the psychological impacts on the children?

T2: Children who are unaware of their impairment are often not psychologically impacted. However, the children who are aware of their difficulties may be particularly shy and reluctant to make friendships. Children who stammer and have speech sound disorders find it particularly difficult because their impairment is very obvious to themselves and other children. Some of the children I treat are also being seen by CAMHS (Children and Adolescent Mental Health Service) as they are suffering with mental health issues. I work in a deprived area of London, so these issues may also be a result of difficult home lives. Children with language disorders often have lower academic achievements because sometimes teachers don’t adapt their language enough for them.

A.S.: What about the psychological effects on you and your team?

T2: I work in a large team of Speech and Language Therapists. Unfortunately, some children with severe learning difficulties pass away which is emotionally challenging for the therapist who has worked with them over time. Other therapists work with neonates who are born prematurely so require help feeding, and these babies are also very vulnerable. However, in general my job is very rewarding. It makes me very happy to see children becoming more confident by using strategies we have worked on.

A.S.: How are family members and teachers involved in the therapy?

T2: Throughout a child’s episode of care, we have lots of contact with families, updating them on their progress and providing resources to use at home. We phone parents to understand how they communicate at home, as we only get the opportunity to see them at school. Some children have Selective Mutism in which they talk confidently at home amongst their family but become unable to talk at school. Families can also provide useful information about a child’s likes and dislikes which we can use to motivate the child during therapy. During lockdown, we have worked closer with families and this has highlighted the benefits of involving the parents as they can implement strategies when we are not there.

It is equally important to communicate with the teachers. They provide information about the child’s attention skills, friendships and their understanding in the classroom. We may also train teachers to provide therapy to individuals or small groups.

A.S.: Do you work alongside Psychologists?

T2: If I suspect a child has cognitive impairments or memory deficits, I will advise that they are referred to the Educational Psychologists who will provide further assessment.

A.S.: What is the main challenge of your job?

T2: It is challenging when parents of children don’t want to engage in therapy. This may be because a parent doesn’t understand their child’s language disorder. It is important for us to educate them about this.

A.S.: What are the benefits of your job?

T2: My job offers lots of variety as I work with multiple children at a range of schools throughout the week. I enjoy being part of a team because everyone is willing to offer help and share knowledge, so I am always learning. The positive impact on both the children and their families is extremely rewarding, and I especially enjoy working with children who have lots of character!

A.S.: Can you give an example of when you have significantly benefitted the life of a child?

T2: I am currently working with a girl who has DLD. She was very aware of her difficulties and would cry when a Speech and Language Therapist attempted to work with her. I initially had some relaxed conversations with her and discovered that she loved reading, so we read her favourite book together. She enjoyed coming to therapy with her friend so that they could do the activities together. I have now worked with her for the past year. She has gained lots of confidence and now loves coming to therapy.

A.S.: What was the career path that led you to this job?

T2: I always wanted to work with children and doing work experience with a Speech and Language Therapist inspired me. I did a Masters in Speech and Language Therapy and then went into paediatrics afterwards.

A.S.: How has COVID-19 impacted your work?

T2: We have been able to provide assessments and therapy on video calls throughout the pandemic. Most children were very receptive to this and enjoyed using the technology.

Anna Samuel is in her 2nd year of studying Experimental Psychology at Corpus Christi College.

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