What does a speech pathologist do? A day in the life of speech pathologist Grace Whittaker
Monday 20 August 2018
Grace Whittaker is in her third year of practice as a speech pathologist. Working in the Princess Alexandra Hospital’s Geriatric Assessment & Rehabilitation Unit (GARU), Grace helps Queenslanders who have been seriously ill or injured to recover some of the most basic functions for their independence: communication and swallowing.
We spent a day watching Grace at work, to find out what a day in the life of a speech pathologist is really like.
Speech pathology for all ages
One of the biggest misconceptions about speech pathology is that it’s a therapy just for children with speech disorders like lisps or stutters. However, speech pathology includes assessment, diagnosis and treatment, and can be applicable to people of any age - as Grace found out during her university study.
“I didn’t realise how broad speech pathology was,” says Grace. “I had barely thought about how it would involve adults, but throughout my study I realised that was the area I was passionate about.”
Grace’s current work involves adults of any age with a variety of complex health issues. After an early morning ward handover to get patient updates from the weekend, Grace’s day begins.
Layers of learning
Part of learning to be a speech pathologist is getting practical, hands-on experience, and Grace has two final year university students joining her at the hospital. In the morning, she supports them to co-facilitate a joint Speech Pathology / Occupational Therapy high level cognitive language group therapy session.
Seven adult patients of varying ages attend the therapy session, each with a different reason for being in hospital. Within this group, Grace’s patients are recovering from conditions such as stroke, neurosurgery and critical cardiac events. Conditions like these can affect the parts of the brain responsible for language and cognition.
Held in one of GARU’s three dining rooms, this group therapy session is designed for patients who will be returning home, with tasks focused on practising functional skills and utilising cognitive and communication strategies that patients will be required to use in the outside world.
The patients warm up with a word search. The speech pathology students and Grace assist the patients with strategies to find the words. “Can you find just the first letter?” they ask. It is strategies such as this, as well as highlighting, visual aids, scanning, checking off and double checking that patients are encouraged to independently use in preparation for returning home.
Next, they move on to a real-world, problem-solving task. Given a scenario, the patients have to create a detailed meal plan for the week, which is then further complicated by having to cater for unplanned guests. To complete the task as they would in the real world, the patients must then write a quantified shopping list to complement the plan.
Functional tasks such as these stretch the patients’ high level cognitive and language skills, and are designed to help the patients practise skills such as auditory and reading comprehension, memory, problem solving, verbal explanation and reasoning and written expression. Tasks like these give Grace, her students and the occupational therapist an idea of the level of support each patient may need to complete daily tasks when they return home.
While Grace assists the patients when they get stuck, or prompts them if they get confused or their concentration begins to wane, she’s also observing their ability to interact and work within a group setting, paying attention to how they converse with other patients, whether they are open to other people’s opinions, and whether they perform better in a group or individual setting.
At the end of the session, the students write progress notes in the patients’ digital charts using the hospital’s integrated electronic Medical Record, which Grace then reviews before uploading. She also provides written and verbal feedback to the students about their facilitation of the therapy session, including strengths, weaknesses, and considerations for next time.
Individual therapy sessions
Every day, Grace has individual therapy sessions with the patients assigned to her. Given the seriousness of their conditions, most of the patients Grace works with will come to her for many months before they are discharged from hospital, and will see her every weekday for a therapy session.
Like the group therapy sessions, the patients Grace works with individually can have a variety of different conditions and be working to overcome different challenges caused by their illnesses or injuries. While Grace’s current caseload is mostly patients who have suffered a stroke, as a speech pathologist Grace also works with patients with traumatic brain injury, neurodegenerative diseases, brain or head and neck cancer, patients recovering from orthopaedic injury, and patients with any variety of respiratory, cardiac, gastrointestinal and dermatological conditions which have impacted on their communication and swallowing functioning.
Grace can provide swallowing rehabilitation to patients experiencing difficulty swallowing their saliva, food or drink. She can also re-teach a patient how to create the correct lip, tongue and jaw movements for speech sounds, and help them recover basic and high-level language skills, ranging from being able to say their own name, to the skills and strategies they will need to successfully return to work or study.
The joy of returning home
Grace’s first one-on-one patient is a man named Mark, who she has seen five days a week for 10 months. When Mark came in after a large stroke on the left-hand side of his brain, he was only able to make occasional voluntary sounds in his attempts to communicate. Now with the help of Grace and the multidisciplinary team, he’s recovered basic reading, writing and speaking skills.
Mark has aphasia, which means his language skills are impaired as a result of damage to his brain. Aphasia commonly affects both comprehension and production of written or spoken language. Grace describes Mark’s particular type of aphasia as constantly feeling like words are ‘on the tip of the tongue’; Mark knows the word he wants to say, but he can’t quite get it out.
Grace shows Mark a sequence of pictures, asking him to tell her in basic sentences what is happening while she writes the words he says on a whiteboard. Some words come easily, while others require some prompting from Grace. “What do you use to clean your teeth?” she asks. “A toothb-”, she makes the sound, prompting him to remember the correct word. “A toothbrush,” he answers, confident now he’s found the right word.
Sometimes the words Mark says aren’t quite correct, and Grace writes them on the whiteboard then asks him if he thinks the sentence is right when she reads it back to him. “Is that how you’d say it?” she asks. “No,” he answers, then works to think of the words to add or change.
Mark is nearing discharge, with only three weeks left before he gets to go home. Grace says that getting patients to a point that they can return home is a highlight of her job. “Seeing patients improve and regain function, seeing the joy that brings them and their family, is very rewarding. Where it’s realistic, we aim to get people home with appropriate community supports.”
While Mark has not recovered completely – reading, writing and speaking is hard work, his speech is still halting, and he uses a wheelchair to get around – with the help of Grace and the multidisciplinary team at the GARU, he has made huge progress and can now get back to life at home with his family.
Finding pride in making progress
Like Mark, Grace’s second patient, Don, had a large stroke on the left-hand side of his brain. As a result of his stroke, he has aphasia, as well as apraxia of speech, which is a speech disorder that makes it difficult for Don to plan the shapes and movements he requires the different parts of his mouth to make, in order to make the sound he wants for speech.
Grace starts his session with a reading aloud exercise focusing on ‘consonant clusters’ or words with two consonants together like plane or blame. Don begins by reading words with a consonant blend at the start, “plane, plate, ply, play”, before moving on to words with the consonant cluster in the middle: “explain, complain, deplete.”
Though the exercises tire him, he works hard, with Grace encouraging him. Even when she pushes him hard, he continues to do everything Grace asks. “I’m a pain, aren’t I!” she says, when she asks him to repeat a word. He smiles and nods at her joke, but it’s clear how grateful he is for her help.
Throughout the exercises, Grace gives Don strategies to help make his speech clear as well as correct. For some words he separates the first consonant to make the sound distinct: “puh-lay, puh-lease”. Grace often reminds him to take deep breaths before he speaks and to speak slowly.
At the end of his session, Grace has Don practise his verbal reasoning skills with a cause and effect exercise. Here Don’s sense of humour starts to shine through. “What could cause a friend to give you a call?” Grace asks. “They won the lotto!” Don says happily.
Sprinkled throughout his session are moments of ease for Don. What would cause a cheque to bounce? “Insufficient funds,” says Don, without a pause. Don’s progress is clear to see in moments like these, when speech is easy, even of complicated words and ideas, and he can make a joke or showcase his point-of-view.
After his session, Grace assists him out of the room in his wheelchair. He turns and delivers one last smile for the camera. “I’ve come a long way,” he says proudly.
A job that goes deeper than it first appears
Grace finds that even among her patients, there can be confusion about what a speech pathologist actually does.
“It’s not only about helping people with their speech,” explains Grace, “it’s a much broader practice. I frequently have patients arrive at our initial session quite confused as to why they are receiving speech pathology intervention. They will say to me, ‘My speech is fine!’”
Speech pathology is about more than just the way a person’s speech sounds. Particularly within the sub-acute rehabilitation setting, a lot of Grace’s work involves trying to understand the brain of the patient and how their illness or injury has impacted their ability to swallow, comprehend and express language and produce intelligible speech and voice.
“The human brain is a mysterious wonder,” she says. “To see how it can bounce back after such a traumatic injury is amazing. The change I’ve seen in some patients, coming in without the ability to even make sound, to now talking in full sentences, is remarkable.”
Grace’s day ends like that of many medical professionals: with paperwork and administration tasks. She has to write notes in patient charts after each therapy session, as well as mark assessments and plan future therapy sessions. Contributing to the ongoing education of the multidisciplinary team is also of high priority, as Grace prepares to present an in-service to the Occupational Therapy GARU team later that week about confidently creating texture modified meals for patients with swallowing difficulties within their meal preparation groups.
While Grace admits that sometimes it’s hard to leave work at work – “You wonder about the patients who have left, what happened to them?” – she loves what she does and where she works. “I feel very privileged to work within both the speech pathology team and the broader multidisciplinary team here at PAH. It’s such a skilled and supportive workplace,” says Grace.
Every day, patients at the Princess Alexandra GARU and across Queensland benefit from the work of passionate speech pathologists like Grace, who help them to overcome great challenges to be able to communicate with their loved ones, eat and drink, and share their own passions with the world once again.
Thank you to Grace and the speech pathology team at Princess Alexandra Hospital GARU for allowing us to share your stories.