Forums » Smalltalk » AMA: I am a rehabilitation therapist

What is says on the tin. I'm a therapist who specializes in cognitive rehabilitation. My certification is as a speech-language pathologist. I have had my license for five years. Previously, I've worked with birth-3 in early intervention programs for children who were having trouble learning to speak or eat on their own. I have also worked in outpatient rehab settings for teenagers with rare genetic disorders. I currently work in geriatrics. Most of my current patients work on memory: dementia, Parkinson's disease, and post-stroke or post-traumatic brain injuries (falls, motorcycle accidents, etc). We work to restore daily functioning ranging basic skills such as orienting to person, place, and time all the way up through preparing an individual ideally to return to work or school after an illness or injury.

I cannot answer questions that might divulge patient information. Also, since I am only licensed and insured in one state in the US, I cannot provide personal advice. I can, however, answer the following types of questions:

►Daily routines in various settings: home-visits, outpatient, and residential
►What it's like being non-neurotypical in a field dominated by neurotypical therapists
►Questions about education and attaining a license in this field (in English speaking countries)
►Exactly how young therapists can be taken advantage of and how to avoid this
►The good, the bad, and the ugly of navigating private insurance and various federal and state programs
►For the purpose of creating more accurate characters, general questions about aphasia, dysphagia, dysarthria, stuttering, speech sound disorders, common neurological disorders, recovery from traumatic brain injuries, etc. (Please give a specific scenario.)

What it's like being non-neurotypical in a field dominated by neurotypical therapists?

What was your biggest "win"?

Have you ever worked with anyone who was hard of hearing or deaf in some way?

brain plasticity: i don't have any questions, i just think it's neat.

what do you do to decompress or compartmentalize from your job? (other than rpr hahaa)

Think I doubled this so I'm deleting it. Forgive. I don't usually respond in forums.

What it's like being non-neurotypical in a field dominated by neurotypical therapists?
When I was in school, I was told it wouldn't be possible for me to provide therapy, because everyone who is a therapist in the field should be able to provide a "perfect" (typical) model for the client. But that viewpoint is changing, slowly, especially now, for example, that more people are listening to with autism who are speaking out against rigid therapy such as ABA (applied behavior analysis) which can use the removal of positive stimuli as punishment. Preferred therapy methods within the associated fields are changing with that input. I still don't disclose my status to employers or coworkers. Although, I am now completely comfortable with some of my own mistakes as learning opportunities for clients. I invite them to modify or comment on their behavior in the same way I do theirs. It helps to create self-awareness and independence.

What was your biggest "win"?
Honestly, I feel like a million bucks anytime anyone tells me they appreciate my help.

Have you ever worked with anyone who was hard of hearing or deaf in some way?
I've never worked with anyone who was deaf, or hard of hearing with that as a primary therapy target. But hearing status is a question I ask every new client. Sometimes people just need a little push to use assistive devices, or to have them tailored to better suit their needs.

Brain plasticity is neat.

Honestly, sometimes, it's hard to compartmentalize. If I have a patient I'm particularly concerned about sometimes I will have a very hard time not circling my thoughts back around to them repeatedly. So, I just sort of have to acknowledge those anxious thoughts and let them go, just like any other anxious thought. But, I have a million things I do to decompress: an unhealthy obsession with Lush, a ton of horror movies and riffed B-movies, listening to music, burning candles, hanging out with my cat, cooking, and recently diamond painting. Also, I love roleplaying. Nothing special. Super basic.

no such thing uahaha

How do children from birth-3 end up in these programs? What signs are their caretakers/doctors looking for?

Have you noticed any changes in how you view media tackling certain disorders after working in cognitive rehabilitation? Is there a trope that's particularly annoying or you wish wasn't so prevalent?

1. If someone was writing about an elderly character losing their voice due to muscle weakness in the muscles of the mouth and throat, what helpful interventions might another character who is a therapist do with them to help them regain their voice?

2. Does singing songs help kids who have trouble speaking or who speak few words learn to speak?

I love language development, so I could go on forever. But, I'm going to keep this brief and focus on how to find help if there are concerns.

Since the critical period from birth to three is so important, every child in the United States, including territories and commonwealths, is entitled to free or low-cost in-home intervention if they qualify. Most of these children will be referred by their pediatricians. If they are diagnosed with failure to thrive or a genetic disorder, they will likely be referred immediately from the hospital. What caretakers and doctors should look for depends on the child's age. So, pediatricians are recommended to screen at 9- 18- and 30- months. However, a doctor's referral is not needed. Families can contact their state's program independently for an evaluation.

In general, if your child is visibly frustrated because of their difficulty expressing their basic needs (for example: unable to point, unable to answer yes/no, unable to put two words together by 2), or if you notice they're having trouble playing with their toys or other people (for example: not answering their name, not playing trial/error, cause/effect games, not playfully copying or playfully showing objects by 1, not pretending, not using two related toys together by 2) then it's time to ask a professional. Early intervention can also be useful to help children learn to walk, feed themselves, use their hands, and play to learn.

If you are at all concerned about your baby, talk to your doctor or schedule an evaluation appointment through your state's program. A list of these programs and more information about EI including how to schedule screening appointments can be found here. Here is a tool to for families to self-screen.

tl;dr: If you have any concerns about your baby's development, there are a ton of resources most people don't even know exist.

My big gripe is that when people have aphasia (cannot speak/understand after a stroke) they somehow miraculously understand sign language or picture symbols. They play it as though their mouth has just been sewn shut. But, sign language is a language. Picture symbols have semantic meaning, and can have grammar if you string them together. People with aphasia also have difficulty using symbols other than words. So, present them with sign or picture cards and chances are they'll have trouble with those too.

That one gets on my nerves but, I don't think it bothers me that people don't get that instinctively. Aphasia can be messy and difficult to understand.

1: Voice is not my area of expertise. However, I will say that a majority of age related vocal changes are normal and do not impair daily functioning, which is a criteria needed to provide therapy. If I evaluated a patient who was aphonic due to atrophy, I would be alarmed. I would refer out to a neurologist and ENT to rule out structural and neurological disorders. I would also refer out to a therapist who specializes in voice for therapy. If I were to provide therapy for related disorders such as dysarthria or apraxia, I would need more information to structure a treatment protocol.

2: That depends completely on the context. Songs can help elicit joint attention and reciprocal engagement. But, those are only one small step on the way to functional language.

Hi I don't have a question that this thread is very cool and informative, thank you for opening up about what you do :>

Thank you so much for this thoughtful answer! I got a LOT out of it.

Oh oh nevermind I have one.

Have you worked with folks who will not "get better" so to speak -- you said that you have a focus on helping people return to daily activies like work and school, but also that you work with patients with dementia.

Can you spend a little bit of time talking about how those two things are different in approach?

I feel like our systems hyper-focus on the "getting better and returning to 'normal' life" part. What happens when the definition of what normal life is has to change? That might be way too open ended. Sorry if it is 😅

For example when I was young my mum and I spent time as permanent live-in caregivers to a lady with Alzheimer's. Our day to day focus was mostly just on making her happy. For a while we tried to bring her to us, to talk about what was happening in the moment. But she was never going to get better. So she was happier, day to day, if we met her where she was, in whatever memories she was experiencing at the time.

I know you focus on rehabilitation, which is by definition trying to help people recover. So maybe this isn't a great question. Idk.

That's a great question, not too broad at all. I just recently started working in an assisted living facility, and progressive illnesses like dementia are a bit different. Overall, the key word to think about is functional. What's functional is determined by the patient and the clinician on the outset of therapy and is based on the patient's desires as well as how far their illness may have progressed. So, functional for dementia might be knowing what day it is, or remembering the names of the important people in their lives. It might be organizational practices to help remember appointments. It could be making a memory book with photographs to remember the story of their own lives, or it could be a social group discussing music or movies from points in their lives they can remember well. This general outlook is used with most neurodegenerative diseases, although the treatment goals would be different.

Generally, it's good practice to council the patient that the purpose of therapy in their particular case might be to keep them going living the lifestyle they want for as long as possible, and not to 'cure' them. There may come a point where therapy is doing more harm than good. They may not have the mental or physical stamina, and at that point, it will be time to end the sessions. This can be scary to hear! But, it's best to be honest at the outset. Having said this, insurance companies in the United States really hate paying for any type of dementia treatment because they like to see progress back to baseline, even if that is neither possible nor appropriate for all patients. So, dementia is rarely billed as a patient's primary illness. Therapists tend to choose more "treatable" co-occurring illnesses on paperwork.

Thank you so much for this answer! That's super interesting. How frustrating it is that the insurance system works that way. I suppose it's one of myriad things that are terrible about dealing with insurance.

I love that approach, where the goals and definitions have patient buy-in. I'm pleased to know that there are folks working hard to recognize people's dignity and self-determination.

OFF TOPIC: Yes there is. Did you know that there's a new box subscription for Lush? I can't. They release a list of possible items for the box the month before and then everyone votes on the ones that the want Lush to make special for the boxes. It's stuff they don't sell in stores. It's $56/month. I'm going to spend WAY TOO MUCH ON THIS.