Becoming a speech language pathologist and cognitive therapist - fast
May 26, 2016 6:21 PM Subscribe
A relative suffered a brain injury and stroke. We want to learn everything there is to know about assessment and treatment of speech and cognition problems after severe brain injury. Researching this, it has been hard to cut through the morass of questionable information coming from companies pushing a product or service. I'd like to get the information that doctors/pathologists/therapists get in their training. Things like textbooks, manuals, class notes, clinical guides, peer-reviewed articles, etc. are great. Free and on the internet is best, but not necessary. Thank you.
If access to journals would help, there is Sci-Hub. In short, it's scientific journal piracy. Science magazine recently published an article about it: Who's downloading pirated papers? Everyone. Before you dig into papers, though, definitely look into what makes a good study.
posted by iamfantastikate at 7:09 PM on May 26, 2016 [1 favorite]
posted by iamfantastikate at 7:09 PM on May 26, 2016 [1 favorite]
Does your relative have access to an SLP at all? Either in the hospital, in a clinic, grad school, whatever. The world of post-stroke/brain injury cognition and language is super complicated, so just being as targeted as possible in what you're researching will be helpful. You'll need to know what the deficits/affects of the stroke were (is it Broca's or Wernicke's aphasia, dysarthria, etc.) You won't be able to diagnosis these things yourself.
I find the field of SLP to still be somewhat of a soft science, with a lot of learning coming from experience working with people with communication/cognitive challenges. There is research, but not as much as there should be frankly. As opposed to reading text books, sitting down with an experienced SLP would be a much better use of your probably limited time right now.
posted by afton at 7:27 PM on May 26, 2016 [2 favorites]
I find the field of SLP to still be somewhat of a soft science, with a lot of learning coming from experience working with people with communication/cognitive challenges. There is research, but not as much as there should be frankly. As opposed to reading text books, sitting down with an experienced SLP would be a much better use of your probably limited time right now.
posted by afton at 7:27 PM on May 26, 2016 [2 favorites]
My Stroke of Insight is a great beginners "Where do I start" place. It's by a brain researcher who had a stroke so has a lot of first person information in addition to a lot of sciencey stuff. It's good reading and it's optimistic and it talks about what you can do NOW that will help. Her resources page has some good starting points for information. Agree with afton, some of this is still being worked out,
posted by jessamyn at 7:49 PM on May 26, 2016 [3 favorites]
posted by jessamyn at 7:49 PM on May 26, 2016 [3 favorites]
I did a bunch of research on exactly these topics at the local university's science library after my daughter's perinatal brain injury. Very little of it ended up being useful, in part because every brain injury is different. (Also because it's difficult to convert subtle clinical knowledge about movement and expression into words on a page. If I was researching this stuff again, I'd definitely look for videos instead of text sources.)
She also did years of OT, PT, speech therapy, and cognitive assessments with professionals. Some of that was helpful. What was most helpful, though, was paying close, careful, sustained attention to what she could do, what she could almost do, and what she might be able to do with some help. None of that is textbook-able, but it's the most important thing. Be calm, creative, observant, and encouraging. The fact that every brain injury is different is what makes creativity and observation so important. You really need to get to know the person and how they're changing. What's helpful one month might be old news next month. (Or it might not be; some skills might take months and thousands of repetitions for someone with a brain injury to learn or re-learn.)
And you'll discover how much context matters. Maybe they can do something or express some knowledge when they're relaxed at home, but when they're exhausted or upset after a trip to a professional, the professional cognitive assessment will show them scoring zero on that thing.
The author's mother in My Stroke of Insight, mentioned by jessamyn, is a good example of helping the right way. She's also a good example of the emotional support needed. The person with the stroke has to do a lot of work to regain skills, and knowing that someone is actively invested in them makes a big difference for motivation and avoiding depression.
In terms of specifics, though I forget if I read this or I was told, I'll mention one thing: The learn-it-backwards rule. If you're helping someone learn a skill, do everything for them except the last step. Once they've mastered the last step, let them do the last two steps. Etc. That has been the single most useful piece of advice I've received.
Some things will be easy for them to learn, and some things will take years, and we don't know enough about the brain to predict which will be which. Enjoy every improvement, whatever it happens to be.
I know this answer isn't what you're looking for, but I hope some of it is helpful anyway.
posted by clawsoon at 9:16 PM on May 26, 2016 [8 favorites]
She also did years of OT, PT, speech therapy, and cognitive assessments with professionals. Some of that was helpful. What was most helpful, though, was paying close, careful, sustained attention to what she could do, what she could almost do, and what she might be able to do with some help. None of that is textbook-able, but it's the most important thing. Be calm, creative, observant, and encouraging. The fact that every brain injury is different is what makes creativity and observation so important. You really need to get to know the person and how they're changing. What's helpful one month might be old news next month. (Or it might not be; some skills might take months and thousands of repetitions for someone with a brain injury to learn or re-learn.)
And you'll discover how much context matters. Maybe they can do something or express some knowledge when they're relaxed at home, but when they're exhausted or upset after a trip to a professional, the professional cognitive assessment will show them scoring zero on that thing.
The author's mother in My Stroke of Insight, mentioned by jessamyn, is a good example of helping the right way. She's also a good example of the emotional support needed. The person with the stroke has to do a lot of work to regain skills, and knowing that someone is actively invested in them makes a big difference for motivation and avoiding depression.
In terms of specifics, though I forget if I read this or I was told, I'll mention one thing: The learn-it-backwards rule. If you're helping someone learn a skill, do everything for them except the last step. Once they've mastered the last step, let them do the last two steps. Etc. That has been the single most useful piece of advice I've received.
Some things will be easy for them to learn, and some things will take years, and we don't know enough about the brain to predict which will be which. Enjoy every improvement, whatever it happens to be.
I know this answer isn't what you're looking for, but I hope some of it is helpful anyway.
posted by clawsoon at 9:16 PM on May 26, 2016 [8 favorites]
I agree with the others that this is much more of an art than a plain science. If you do end up wanting to look at the textbooks I used when I trained, a good comprehensive evidence-based tome is Language Intervention Strategies in Aphasia and Related Neurogenic Communication Disorders
But honestly, you're likely to find that too technical, and without a lot of practical experience it doesn't always translate into what to do.
If you haven't already got a Speech Therapist/Pathologist, I would do that first.
posted by kadia_a at 10:45 PM on May 26, 2016 [1 favorite]
But honestly, you're likely to find that too technical, and without a lot of practical experience it doesn't always translate into what to do.
If you haven't already got a Speech Therapist/Pathologist, I would do that first.
posted by kadia_a at 10:45 PM on May 26, 2016 [1 favorite]
I had/have TIAs and read a lot on strokes. I read the emergency department guidelines, Cochranes and then worked my way through the textbook chapters for neurology slowly to understand what was happening, and had a doctor who was willing to answer questions. I also searched for specific medications and diagnostic terms related to my condition to get related research and just kept the PDFs in a folder, taking note of what referred to what to read next so I could get a reasonable overview of my particular diagnosis.
What also helped enormously was the Stephen Jay Gould's piece on his cancer diagnosis about medical statistics, The Median Isn't The Message which explains how to think about and investigate the very scary statistics you see in your own individual case. I had a doctor shove 50% mortality rates at me that turned out to be closer to 4% when considered with other factors, when pressuring me to make a decision she wanted.
I found the following 3 mainstream articles and books helpful for introductory reading:
Dyer on his stroke.
Where is the Mango Princess for caregivers.
My Stroke of Insight (She goes a bit woo at the end with what her stroke taught her about life, but her description of during the stroke is so so what I experience during my TIAs, it was very helpful. Mine are a fraction of the time and intensity, but it was like hearing someone play the same tune and knowing I wasn't crazy or imagining the experience)
SciHub is great. You can also get most medical student textbooks on torrents pretty easily.
posted by dorothyisunderwood at 4:31 AM on May 27, 2016 [3 favorites]
What also helped enormously was the Stephen Jay Gould's piece on his cancer diagnosis about medical statistics, The Median Isn't The Message which explains how to think about and investigate the very scary statistics you see in your own individual case. I had a doctor shove 50% mortality rates at me that turned out to be closer to 4% when considered with other factors, when pressuring me to make a decision she wanted.
I found the following 3 mainstream articles and books helpful for introductory reading:
Dyer on his stroke.
Where is the Mango Princess for caregivers.
My Stroke of Insight (She goes a bit woo at the end with what her stroke taught her about life, but her description of during the stroke is so so what I experience during my TIAs, it was very helpful. Mine are a fraction of the time and intensity, but it was like hearing someone play the same tune and knowing I wasn't crazy or imagining the experience)
SciHub is great. You can also get most medical student textbooks on torrents pretty easily.
posted by dorothyisunderwood at 4:31 AM on May 27, 2016 [3 favorites]
When you say "speech" problems, do you mean difficulty forming words (due to paralysis, etc), or has the person been diagnosed with a language/communication disability like aphasia (the inability to recall words or produce language)? That's caused by damage in the language centre of the brain, and often doesn't include cognitive damage.
If it's aphasia, there may be information and resources at The Aphasia Institute in Toronto that are useful. I took their classes for family members and they were very helpful.
posted by jb at 4:52 AM on May 27, 2016
If it's aphasia, there may be information and resources at The Aphasia Institute in Toronto that are useful. I took their classes for family members and they were very helpful.
posted by jb at 4:52 AM on May 27, 2016
The Brain Injury Association of America is a good starting spot to gather information. They provide access to articles, webinars and communities of others living with brain injury who can be a wealth of information.
posted by goggie at 7:34 AM on May 27, 2016
posted by goggie at 7:34 AM on May 27, 2016
I'm sorry to hear that your loved one had a brain injury. I am a speech-language pathologist (SLP) and there isn't a fast track to knowing everything. I went to school full time for seven years, then completed a 9 month fellowship before certification, and I am still learning. The best thing you can do is advocate for your family member to have access to qualified rehabilitation professionals, such as speech-language pathologists, occupational therapists and neurologists. After they conduct evaluations, they will each set up a treatment plan. During each treatment session, the family members, care providers and patient will have something to practice until the next session. It takes a skilled clinician to know how much is too much and which skills are safe to practice so go with what he or she advises. Show the clinicians that you are willing and interested in supporting the patient in that way. I'm sure the SLP will go out of his/her way to set you up with practice materials and appropriate education.
posted by coolsara at 7:43 AM on May 27, 2016 [4 favorites]
posted by coolsara at 7:43 AM on May 27, 2016 [4 favorites]
This article, an interview with an experienced rehab nurse, has a good discussion of the flexibility and emotional tools you have to bring to caring for someone who needs rehab. It emphasizes the fact that no two people who need rehab are the same, and you "have to be creative, compassionate, thoughtful and patient."
posted by clawsoon at 9:06 AM on June 2, 2016
posted by clawsoon at 9:06 AM on June 2, 2016
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posted by roomthreeseventeen at 6:46 PM on May 26, 2016