Joey Wahler (Host): It addresses a wide range of issues, from communication problems to swallowing difficulties. So, we're discussing Speech-Language Pathology. Our guests from Silver Cross Hospital, Beth Parisi, Clinical Manager, Acute and Inpatient Therapy Services; and Maggie Pensinger, she's a speech-language pathologist.

This is Silver Cross Hospital's IMatter Health podcast, where medical experts bring you the latest information on health topics that matter most to you and your family. Thanks for joining us. I am Joey Wahler. Hi there, Beth, Maggie. Welcome aboard.

Beth Parisi, MS: Hi, Joey.

Maggie Pensinger, MS: Hello.

Host: Great to have you two with us. So first, for you, Beth, simply put, for those that aren't as familiar, what exactly does a speech and language pathologist do?

Beth Parisi, MS: Oh, we do a lot of different things. Like you touched on in the introduction, speech-language pathologists do a wide range of assessments and provide interventions for patients across the lifespan from birth through end-of-life decision-making in terms of speech, language, cognitive communication, voice and swallowing disorders.

Host: When you mention speech and language, as it relates to what the two of you do, what's the difference between the two?

Beth Parisi, MS: Speech would refer to how your articulation is, how you're enunciating, how those words are sounding when they come out. And language would be the content of all of that. So, does your sentence structure make sense? Are you staying on topic? Are you understanding accurately somebody else's message?

Host: Gotcha. So, Maggie, talk a little bit more, if you would please, about the general scope of what the two of you do in terms of the age range, which can be pretty much right throughout the spectrum of life, right? And also, the most common specific issues that you treat.

Maggie Pensinger, MS: Yeah. So, you're right, we can treat really the entire lifespan. So from birth to death in a sense. And the different location and kind of type of services would depend, right? So with birth and more Pediatrics, you're going to focus more on like feeding and swallowing. What you kind of think about when you hear speech therapy is those kids in schools working on saying their certain sounds and pronouncing their Rs.

But then, more of that adult and geriatric population is where you're going to see a little bit more of that speech and language, but then also cognition. Things like attention, memory, problem-solving, how your brain is working in those everyday tasks that you're doing.

And then, another large area that we work on is dysphagia. So, that difficulty swallowing and making sure that patients are on a least restrictive diet, that they're safe to eat and drink on, and not having potential complications from that.

Host: Yes. Swallowing, which is something most of us, I'm sure take for granted on a daily basis, don't even think about having the ability to do it. There are conditions later in life where it becomes a big challenge, right?

Maggie Pensinger, MS: Yes, I spend most of my day in the inpatient acute side of Silver Cross, and that pretty much is my caseload, is looking at swallowing, assessing patient's swallowing, helping with modifications of diets, and helping to educate families on how that can change with different neurological things going on, but also just stability and age-related changes too.

Host: So Beth, some may think of speech therapy oftentimes as basically helping kids with pronunciation. So, what are some lesser known but equally important roles that SLPs play in rehab and in healthcare? What are some of the things that the two of you and yours do that maybe most people don't realize?

Beth Parisi, MS: Especially in the inpatient rehab world, a lot of focus is on cognitive functioning. Patients come to the hospital independent. And then, for whatever reason, they are going to have trouble or can have trouble with executive functions. So, planning things out, staying on task, organizing information. A lot of things that we just go about doing while we're multitasking throughout the day. So, we do a lot of cognitive function and retraining and then, as Maggie had touched on, the swallowing aspects.

So, there are exercises that we can do to target different impairments of swallow function. So, we're doing a lot of exercises, a lot of different trials with textures and liquids for eating and drinking, and getting our patients as close to baseline as we can before they're discharged.

Host: So, having said that, Maggie. Naturally, before any of this occurs, you've got to evaluate a patient, see where they're at, find that baseline, as Beth just mentioned. So, can you walk us please through what an evaluation with an SLP typically looks like to assess a patient's needs?

Maggie Pensinger, MS: Yeah. So, again, kind of the like location and kind of where you're at in things is going to vary a little bit on what that evaluation would look like, whether that be an evaluation in a school with a kid or in an outpatient clinic versus an acute care hospital versus inpatient rehab. But regardless, the similarities are you're going to get that order from a doctor and that's going to kind of help drive what things they're looking to assess, whether it be just a swallowing issue, whether it be a speech-language, cognition issue. You're going to take like a case history. So, chart reviewing things that you know before you're seeing the patient. What information are you getting from the doctors? What's going on? You know, in the acute side of things, I'm looking at any sort of relevant imaging that's been done for patients to see is there a stroke that happened? Is there an injury to something? How does their chest imaging look if we're looking more at swallowing?

And then, when you're seeing the patient, you're going to kind of start with that personal interview, get that information and that background of what's happened with the patient. Why are they coming to see you from their end of it? What things are they noticing as challenges? If family's there, asking families opinion on thing to get that information. And then, it kind of leads into what does that assessment look like? Looking at a dysphagia and swallowing assessment, we're going to try doing an oral motor exam. We're going to look at specific trials, giving them things to eat and drink to see how they respond. If we're going to look more at speech-language, cognition type things, we're going to do some more formalized, standardized assessments that are going to target specific areas that then can help us compare two peers of similar age to kind of see what is that normative, where are they falling, how severe are their deficits? And then, we write that up and kind of create a plan of care, whether, how often we want to see them, what our goals, what things are we going to work on to help them to reach their essential goal, right? Hopefully, that's to return to their baseline or be as independent as possible.

Host: Absolutely. And Beth, speaking of reaching goals, that's a big part of what the two of you do, right? So what are some of the biggest changes or improvements you've seen in your patients after consistent speech and language therapy where you've been able to meet those goals?

Beth Parisi, MS: So, I've been very fortunate to work across the continuum of care with the adult population from the acute inpatient areas to inpatient rehab and outpatient. And I mean, the best is when you can follow a patient through the whole continuum. But really, in that inpatient and outpatient setting, you can see really big changes. And inpatient rehab, the average length of stay is about 12 to 14 days. So when you're seeing a patient every day for over an hour, getting somebody with severe aphasia to say their spouse's name, through articulation speech and language therapy to get them to tell you about their dog and their face lights up, that the dog, you know, maybe tripped them and that's why they fell on their rear, but that's their buddy. And then, of course, more long-term patients that we see that might have feeding tubes because of their swallowing impairment. And their goal is to go out to a restaurant with their friends, like they do dinner every Friday night. So, working on that swallow function so they can go to their favorite restaurant and be able to order something, modified or not, but be able to have that interaction, that quality of life. The social component is really important to us too, as it is with everybody. So, those are some instances that I've been really lucky to be a part of.

Host: And then, Beth, you've mentioned the two of you, the term aphasia. We should be clear for those that are unfamiliar, that basically means that between the brain and the mouth, if you will, for simplicity purposes, that thoughts basically get stuck or jumbled, and a person knows what they want to say, but they just have trouble getting it out, yes?

Beth Parisi, MS: You got it. Absolutely.

Host: So, Maggie, how do SLPs-- you kind of touched on this a little bit earlier-- but how do they collaborate with those other healthcare professionals, the doctors, the occupational therapists, teachers perhaps, to create that complete care plan where everybody is involved?

Maggie Pensinger, MS: Yeah. There's a lot of collaboration in our job, really across the continuum too. So, speaking from like a medical side of things, you're going to have access to a lot more notes from just the electronic medical record system. So, I'm going to see a lot more communication just by reading notes of other disciplines, whether that be physicians, nursing, occupational therapy, physical therapy, case management.

But then, we also, you know, can have that constant messaging through things, whether it be through like a messaging system or seeing them in the halls and having that conversation. But we really, you know, are constantly getting everyone's opinion on things because we want to treat everyone with a whole approach and everyone be on the same page. So, it's really a multiple times a day, multiple attempts every day with each patient for things. And even thinking about in like a school setting with teachers that, as a speech therapist, you're going to be getting the teacher's input. They're going to be the ones with the kids more than you are. So, what are they seeing in the classroom? What are they doing? And I think it's just as important to have that collaboration with family members too, because they know these patients a lot more than we do. We're only seeing snapshots of things, so including them in their plan of care and in those conversations to help collaborate to meet the patient's goals, but also the family's goals.

Host: Gotcha. Just a couple other things. In summary here, Beth, for those joining us to think they or a loved one might benefit from speech therapy, what should they be looking for in a provider in the first place?

Beth Parisi, MS: All speech-language pathologist will have graduated and earned the certificate of clinical competence from ASHA, the American Speech-Language and Hearing Association. Definitely ask your primary care provider if they have a recommended center or clinician that they refer to, and a lot of clinicians specialize. So, going to the ASHA website, the American Speech-Language and Hearing Association, you could actually search for different specialties in your area. And then, calling clinics and asking about your particular concerns or diagnoses would be a great way to start.

Host: And then, following up on that, Maggie, for those interested in connecting with an SLP, like the two of you at Silver Cross, how can they take that first step?

Maggie Pensinger, MS: Yeah. So, I think that, you know, if they're in the hospital and they're going to be an inpatient stay, just having that conversation that they have concerns about things to the nurse or the doctors when they're coming in. And then, we'll get those steps kind of rolling while they're in the hospital. You know, if they're looking more from an outpatient, they're at home, but noticing things, reaching out to that primary care physician and just kind of saying, "I would like to go to Silver Cross to have these services." We offer outpatient therapy here as well on site, so we'd be able to kind of get connected with it. And I always like to say, if you call the main hospital number and ask for Speech Therapy, they tend to kind of direct you to someone in the department that might be able to help direct your needs and answer your questions a little bit more.

Host: Excellent. Well, folks, we trust you're now more familiar with Speech and Language Pathology. Beth, Maggie, keep up all your great work. I'm sure it's very rewarding and thanks so much again.

Beth Parisi, MS: Thank you.

Maggie Pensinger, MS: Yes. Thank you, Joey.

Host: Absolutely. Thank you two. And for more information, please visit silvercross.org/slptherapy. Now, if you found this podcast helpful, please do share it on your social media. and thanks so much again for being part of Silver Cross Hospital's IMatter Health Podcast.