EPISODE 65

[INTRODUCTION]

[00:00:05] MBH: Thanks for joining us at Keys for SLPs, opening new doors for speech-language pathologists to better serve clients throughout the lifespan, a weekly audio course and podcast from SpeechTherapyPD.com. I'm your host, Mary Beth Hines, a curious SLP who embraces lifelong learning. Keys for SLPs brings you experts in the field of speech-language pathology, as well as collaborative professionals, patients, and caregivers to discuss therapy strategies, research, challenges, triumphs, and career opportunities. Engage with a range of practitioners from young innovators to pioneers in the field as we discuss a variety of topics to help the inspired clinician thrive.

Each episode of Keys for SLPs has an accompanying audio course on SpeechTherapyPD.com, available for 0.1 ASHA CEUs. We are offering an audio course subscription, special coupon code to listeners of this podcast. Type the word KEYS for $20 off. With hundreds of audio courses on demand and new courses released weekly, it's only $59 per year with the code word KEYS. Visit speechtherapypd.com and start earning ASHA CEUs today.

Welcome to this episode of Keys for SLPs, Keys to Supporting Conversation Partners and People with Aphasia. I am your host, Mary Beth Hines. Before we get started, we have a few items to mention. We encourage questions from our participants. You can put your questions in the chat box for our guest to answer throughout the episode, as well as at the end of the episode.

Here are the financial and non-financial disclosures. I receive compensation for hosting Keys for SLPs from SpeechTherapyPD.com. No relevant non-financial relationship exists. Katherine Wolf is an employee of Encompass Health Rehabilitation Hospital. She receives compensation from SpeechTherapyPD.com for this episode. No relevant non-financial relationships exist. Here are our learning objectives for today. One, explain three recommendations for supporting people with aphasia and their families from the perspective of a person with aphasia. Two, describe supported conversation techniques to use when working with people with aphasia, and three, integrate communication partners into supported conversation.

Now, we welcome our guest today, Katherine Wolf. Katherine is a clinical fellow at Encompass Health Rehabilitation Hospital of Bakersfield in Bakersfield, California. As a stroke survivor herself, she prides herself on helping people with aphasia and their families communicate. She joins us today to share her story and the beauty of supported conversation for adults with aphasia with other therapists. 

[INTERVIEW]

[0:03:00] MBH: Welcome, Katherine.

[0:03:02] KW: Hi, thanks for having me. I'm so excited to be here.

[0:03:05] MBH: Well, we are just delighted that you joined us and I think you met Yumi from SpeechTherapyPD.com at CSHA. What does CSHA stand for? California Speech and Hearing Association?

[0:03:16] KW: Yes. ItÕs the ASHA of CSHA Ð of California

[0:03:21] MBH: Of California, yes. Yumi came back from that conference, and she said, "You have to meet Katherine Wolf." I'm so happy that she met you and that you're joining us tonight. Your story is so unique and I would love for you to just tell us about your journey.

[0:03:39] KW: Yes. When I graduated college, I was a middle school English teacher. That's all I wanted to be my whole life and I was excited to do it. Then, I had my first child and had strokes when he was seven weeks old, not related to the pregnancy, but soon after. I ended up having 10 strokes over the past several years, and turns out that I have a brain condition that causes strokes, and it's an incurable brain condition. But they gave me two brain surgeries, one on each side that helped to kind of alleviate the problems that come from that. Thankfully, I haven't had a stroke since October of 2021. Fingers crossed that continues.

[0:04:32] MBH: Absolutely. That is a huge feat after having 10. 

[0:04:36] KW: Yes. That's 10 that were all significant strokes. I also had countless TIAs. We didn't even keep up with that number, because they were constant, it feels like. So all of those 10 strokes were entirely big and I lost a lot, but I had really great therapists. After my eighth stroke, the neuropsychologist said that I couldn't go back to teaching, because just the deficits that I continued to have were too much or too many to go back to teaching. Which I've totally agreed because teachers, especially in inner city middle schools need a lot of processing and a lot of multitasking ability. Those were two of the things that I no longer had at that time. I talked with my own SLP, who became a very good friend of mine. She said, "Why don't you become a speech pathologist? You have a really unique perspective that, thankfully, most people don't have." Because I would never wish this on anyone, but it gives me a different perspective that allows me to really connect with my patients.

[0:06:01] MBH: Absolutely. So you had 10. Were you in therapy, outpatient therapy for a number of years or did you do inpatient therapy? Can you tell us a little bit about your journey as far as rehabilitation? 

[0:06:13] KW: Yes. I was in the acute care hospital for about three months. I actually had really severe aphasia at that time, and couldn't walk, couldn't hold a pencil, couldn't hold my son, couldn't feed him with a bottle because my hands just no longer worked. I spent three months in the hospital, had dysphasia, I was on a modified diet for about three weeks. I was also getting some speech therapy. Our acute care SLPs, they do so much, and they don't have as much time. I didn't get as much as I would have liked in the acute care setting. But then, I went to the inpatient rehab hospital, I was there for about six weeks because I'd be there, I would have a stroke, they would send me back to the hospital. Then, I would flip back and forth, do I was there for about six weeks.

Then, I went to this intensive neuro rehab, that was technically an outpatient, but it was like a full day, five days a week, eight hours a day. Where I got occupational, physical, and speech therapy. Then from there, I went to outpatient therapy that was the typical outpatient therapy, like one to two times a week. Yeah, that whole process was a good full year or so. Then, unfortunately, my insurance was like, "Okay, yes. We're done paying for this." It's unfortunate because I feel like we see so many patients with that same issue of the insurance company. It's like, "Okay, we're not paying for this anymore," even though they could probably still really benefit from it. After my outpatient, benefits ran out. I just started using the strategies that I learned in all of those therapies to just kind of continue reteaching myself. I was a big reader, and so I would read for fun, even though I could only read children's books. But I had a son who was one, and I had somebody to read to, and I Ð yeah, it was a good long chunk of my life.

[0:08:35] MBH: Wow. So that whole year, you had a newborn baby, that was his first year of life.

[0:08:41] KW: Yeah.

[0:08:42] MBH: Since then, you've had another baby?

[0:08:44] KW: Yes, I have. Yes. My son is now five and my daughter is three. It was actually after her birth was when I had Ð after that was when I had my other two strokes.

[0:09:00] MBH: Okay. Then you had the surgery after that?

[0:09:04] KW: No. My first brain surgery was two weeks after my first stroke. It took them two weeks to kind of figure out what was going on with me because my disease is really rare. It doesn't usually present in people my age, I was 25 at the time, and it usually presents in people who are either really young, or really old, and not in people who are in their 20s. I had my first brain surgery then. But because it took six to eight weeks for the brain surgery to really take in my head. I was still having consistent strokes after that. Then, my second brain surgery was in 2020, which to have an emergency brain surgery in 2020, it was a whole crazy thing because we're still at the very beginning of the pandemic, or not the very beginning, but it was in September so everything was shut down. I was in the hospital ICU for five days, and my husband couldn't come and visit, and just a lot of Facetime. It definitely was quite a journey.

[0:10:18] MBH: Absolutely. Okay. Then you had Ð then, in October of Õ21, so about a year after that, then you had the surgery that has stopped the strokes?

[0:10:30] KW: The September 2020 surgery is the most recent surgery I've had, and then October 2021, was when I had my last stroke. 

[0:10:42] MBH: Okay.

[0:10:44] KW: Yes. I'd like to stop at 10. I'd like for that to be like my limit.

[0:10:51] MBH: That sounds like a good plan. 

[0:10:52] KW: Yes.

[0:10:53] MBH: So far so good, you're holding on.

[0:10:56] KW: Yes. Yes.

[0:10:58] MBH: What a whirlwind, especially during COVID for this to be happening. Along the way, you had a lot of speech-language pathologists, right? Who was this speech-language pathologist, or who Ð was it one or was it several who encouraged you to go back to school?

[0:11:15] KW: There were two of my speech pathologist who really encouraged me that I kind of talked to them about it, and they were like, "Yes, you should absolutely go for it, I think you would be great for it." Then there was a third speech pathologist who was not mine, but she just knew me from all of my time in the rehab hospital. She was like, "No, Katherine. You really need to do this, I think it would be really good for you." So I finally said Ð I talked to my husband about it, ad nauseam. So I was like, I don't know, you know, because my neuropsychologist said, "You'll be disabled for the rest of your life, your deficits are not improving the way we would hope for them to improve." I was still living with aphasia, I still deal with it on a daily basis, even now. My processing speed is a lot slower than it used to be. He was like, "You are going to be disabled. I don't recommend working or anything. I wasn't okay with that. I was a 25-year-old and I love to learn, so I wouldn't take that as an answer. 

[0:12:30] MBH: Good for you. Good for you.

[0:12:32] KW: Yes. So I went back to school, I went online to Utah State University and got my second bachelor's in Communication Disorders and Deaf Education. Then I started grad school in August of 2020, a month before I had my second brain surgery.

[0:12:52] MBH: Wow.

[0:12:54] KW: Yes. Then graduated with a 4.0 from grad school. I really want to just go back to that neuropsychologist and be like, "Here."

[0:13:05] MBH: That is amazing. So your graduate degree, did you also get that online, or was that?

[0:13:10] KW: No. So it was an in-person graduate program. I went to Rocky Mountain University of Health Professions in Utah. It's a graduate-only school, so they only do graduate programs, and then they do all medical programs. PA, NP, physical therapy, occupational therapy, speech therapy, a whole bunch of healthcare-related fields. My graduate program was really focused in on the medical side of being a speech therapist, which is what I really wanted. Because based on my time as a middle school teacher, and my time in the hospitals, I was able to come in with pretty good certainty of what I wanted to do, and why I wanted to get this degree. I actually finish my CF in two weeks, and I'm so excited.

[0:14:05] MBH: Wow. Well, I am so impressed that you did all of this while you had two small children, and dealing with your own recovery. Yumi was right, I had to meet you. You are amazing.

[0:14:19] KW: Thank you. I appreciate it.

[0:14:21] MBH: Well, you are welcome. How did you go to Utah for graduate school?

[0:14:26] KW: We were living in Texas, which is where I taught, and that's where I met my husband, had my kids. When I was applying for graduate school, I applied to 17 different schools because I was like Ð there are a lot of people who don't get into graduate school the first time. To me, there was no option. It's either I get into grad school this time or I have to find something else to do. I applied to 17 different schools and got into a number of them, and waitlisted on all the rest of them. So, my husband and I just kind of had to whittle it down to where are we willing to live, and what's going to be best for our family and for my husband.

One of his important things is to have beautiful nature. He grew up in the outdoors, he grew up in Northern California, and so we chose Utah, and moved there in April of 2020. Amidst pandemic where we knew no one, so we just went on walks all the time. It was just kind of a random choice because I got in and it was the program that I wanted. Then, like I said, my husband is from California, and working in a rehabilitation hospital is my dream job. When I got the offer to come here, it was a no-brainer to me. My in-laws live in Orange County, so we're close to our kids' grandparents, which has been phenomenally important for us. And yes, and Bakersfield just feels like home, and we feel Ð we bought a house, and we Ð weÕre starting to really feel settled here, so I don't plan on moving anytime soon.

[0:16:20] MBH: Well, I don't blame you. It's so wonderful that you have now found your home, and that speech-language pathology helped you do that. You were able to move your family to graduate school as well as to follow your career paths. So, it's so exciting. Well, thank you for sharing that. Yes, so inspiring, and we have a participant who's also saying, "Thank you" and so inspiring on so many levels. Yes, I agree. You are a person with aphasia. If you're just listening or if you are Ð when this is live, we can see the video. The average person would probably not pick up on the fact that you are living with aphasia. Can you talk a little bit about what is hard for you right now?

[0:17:06] KW: Yes, so I still get very overstimulated easily. Anytime there is a significant amount of noise going on, I have a really hard time focusing. I have to Ð I keep my therapy sessions in as controlled environments as I can because I want to be able to focus on my patient and I'm not always able to do that. I found that when I have patients who need to work in the more complex environments where they want to go back to work or whatever. I take them to the therapy gym where everybody's working, it's a little crazy, it's good for me too. It's good practice. That's one thing that I definitely still struggle with.

When it comes to my aphasia, anytime I get tired, or frustrated, or overstimulated, or even put on the spot sometimes, itÕs like your words just go poof, and they just kind of disappear. Thankfully, I've learned really, really good strategies, not only from my speech therapist but also from my studying to become a speech therapist. To be able to kind of circumlocute or to be able to use my semantic feature analysis to kind of get my words going again. Sometimes I just have to tell people, okay, give me a second. I'm processing what you're saying, and I need to repeat it back to you to make sure that I've understood what you've said. I just Ð I really have to advocate for myself and just also give myself a lot of grace because it can be really frustrating. Especially as a previous Ð see, it's happening again. 

[0:19:12] MBH: That's okay. We have a lot of time, you just take your time.

[0:19:15] KW: Especially as a previous Ð oh, gosh. What's the word? Like professional who Ð I was a middle school English teacher. Speaking, and writing, and reading were my job and not just things that I enjoyed. It can still be really frustrating sometimes to get stuck or to get overstimulated by things that I feel shouldn't be overstimulating or hard. That's something that I had to really deal with through graduate school because graduate school was the first time after my strokes that I was working professionally, even if it was like semiprofessionally. But learning to work professionally with aphasia, and learning that, even though, for example, I got really, really good at circumlocuting and semantic feature analyzing. I don't even know if that's a word. But around my daily life, around my house, or around when I'm with my kids, or whatever.

But doing it in the professional setting, you have to be a little bit more careful, because when you go to interviews, or when you're working with a kid, or you're talking to a coworker, it becomes a lot different because it's a different level of requirement from your brain. I have a very distinct memory in having an aphasic moment, and not feeling understood, because I saw a patient with dysphagia, actually. I was like, he was on a diet, but he was really struggling with it. I called my supervisor in, and I was like, I really think that we should put him back NPO. He's really struggling with his diet. The nurse has said that he's really struggling with it. "What do you think?" She was like, "Yes, I agree." I was like, "Okay, great." Then she left and I finished everything. Then I went out to the nurse, and I was like, "Hey, we're going to keep his diet the same, but like not even realizing that I was misspeaking, not because I didn't know what I wanted my recommendations to be. But because I was Ð my brain was so overstimulated, and stressed out about like, "This patient is not safe." So then, I sat down to write the note at the nurse's station, realized, "Oh, crap, I told her the wrong thing. I need to go back and tell her the correct thing." It was like two minutes later. Thankfully, the patient was safe, it was fine. 

But when I told my supervisor that that had happened, she got very, very upset with me, and basically said, you don't have good clinical judgment? I said, "No, it honestly wasn't my clinical judgment. It was my aphasia. You know that I've been really open, and honest, that sometimes I have communication errors." I felt like, if you're expecting perfection from me, how are you treating your patients? At that point, I realized, I have to be different, and I have to show my patients that it's okay to have communication errors even in your real-life settings. You have to learn to advocate for yourself to get the quality of life that you deserve. That's Ð I don't even remember what we're talking about. Sorry, I just kind of went off on a tangent.

[0:23:04] MBH: Such good advice, though. Such good advice. Yes, yes. Thank you for sharing that, and thank you for sharing the things that you still struggle with, because as I said, this is a video podcast right now, in the future. Only audio is recorded, but the average person would not pick up on that. Thank you for sharing, and such good advice about advocating for yourself, and having that lived experience really makes you a good therapist.

[0:23:33] KW: Thank you.

[0:23:33] MBH: Well, you're welcome. Let's talk about based on your experience as a person with aphasia and your expertise as an SLP clinical fellow, almost a full CCC SLP. What recommendations do you have for speech-language pathologists working with people with aphasia?

[0:23:53] KW: Oh, I feel like I could talk about this for hours. I could talk about all of this for hours. But I think one of the big ones is just giving people enough wait time. And the way I kind of tell people is like, if you think that you've given them enough wait time, wait about 15 seconds more. Just give them the time without talking to try and get what they're trying to say out. It's different for each person have what they need, because SLPs are pretty good at picking up on cues. You can tell when people are like, "Oh, I need more wait time or "Oh, that was too much wait time." They don't say it to us, but you can read their face and their body language. 

Sometimes, if they are trying to work on it, and then about 30 seconds go by, and they're like, I just, I can't." I know what I want to say, but I can't get it out. That would be the point to kind of step in and help them out. Another one is, "If they ask you to tell them, like ask the question again, I always tell people to ask the question exactly the same. This kind of goes against what we believe as humans, because normally if somebody asks us to repeat the question, it's because they didn't understand it, or they need you to rephrase the question. But a lot of times, people with aphasia, they don't need you to rephrase the question, they need you to repeat it. Because, maybe, the question is, "Do you want coffee?" They got the first part the, "Do you want?" But then if you say, "Do you want some coffee?" or "Would you like some coffee?" They now have to restart all of their processing time to figure out what those new words mean. Does that make sense?

[0:25:56] MBH: Absolutely. That makes sense. 

[0:25:58] KW: So, if they say, "Oh, will you repeat the question?Ó Or look like deer in the headlights, like, repeat the question, say it the exact same way. Because what you're allowing them to do is, essentially, they verify that they understand the first part that do you want, and then they can process the end of this question. They can process coffee. So it takes a lot of time. Another one would be to listen to them actively. One thing that I tried to do in my evaluations is I tried to find out more about them than just their stroke or their injury. What is important to them? What do they like to do in their free time? What are their goals? What did they want to get back to? Is it their goal to go back to work? What did they even do for work? Do they have kids at home? Are they retired? Are they married? Because all of those things are going to play into your therapy sessions.

Knowing that information is really, really important because, yes, it's important to know what type of aphasia they have, or that they have aphasia. But how you treat a patient who is 90 years old, and lives alone is very different than how you're going to treat a 25-year-old who has a kid. Making sure that you're listening to everything and treating the whole patient. Then, the last one is just to remind them that you're on their team, that it's okay to be angry and frustrated at your situation. Because having a stroke of any kind, big or small, is an immense, huge, ginormous change in your life. It can be a really overwhelming time, it can be a really frustrating time.

I remember it took me two weeks to be able to even talk to my husband again, to even understand and process what he was saying to me. That was the loneliest time in my life. Because the man who I married, the man who I have vowed to live with for the rest of my life, I couldn't communicate with him. I felt like I'm alone, and a lot of our patients, I feel like feel that way. I never struggled with depression until I had my strokes. Mental health is so important, and so we, as SLPs can help people to not only express their wants and their needs, but we also help them express their feelings, and we help teach them to advocate for themselves. There's a lot of people who never learned that. Maybe their parents didn't teach them to advocate for themselves, or maybe, they've just been through so much in life, that they're just like, "Whatever."

But I believe that every person with or without aphasia has a story to tell. I think that a big part of my treatment sessions is reminding them of that, that this is your story, and you're here for a reason. Right now, it really sucks and that's okay. If you need to spend the whole session crying with me, we can do that. Then, you encourage them that I know that this is really hard, and this really sucks. But I'm on your team, and I'm here to help you do what X, Y, Z, whatever goal they told you, or that You kind of helped them work towards whatever their goal is. It's more than just to talk. 

[0:30:08] MBH: Mental health is so important for all of us, but especially for people who have had a stroke. That's multiple traumas to deal with.

[0:30:18] MBH: Did you find in your rehab journey, were there mental health resources specifically for people with aphasia? 

[0:30:26] KW: Yes. I mean, I feel like it took me probably until I was in the neuro rehab facility to be able to tell someone like, "I think I'm depressed," or something along those lines. I think the biggest help for me was when someone, my SLP gave me the language of, "I think that you might be depressed and I want you to talk to someone about it." Thankfully, there was a neuropsychologist, a different one from the one in Texas after my strokes, but there was a neuropsychologist who was really, really good at his job. He had me sit down, and had me do an evaluation, and then got me the follow-up care that I needed.

There's not as much as I would like there to be because I feel like a lot of times people assume that if you can't talk that you can't think, which is not true. We have to presume competence with our patients with aphasia, which going back to a recommendation is presumed competence. That's a big part of supported conversation for adults with aphasia is presuming competence. Because Ð just because you can't talk doesn't mean you're stupid. A lot of times, what I've found with my patients and with myself is that I feared looking like I was an idiot for a long time. Yes, I do feel like there's more when it comes to mental health for people with aphasia. I feel like it's becoming Ð even people without aphasia, I feel like mental health is becoming a conversation that more people are having, especially since COVID, it's becoming more of something that we talk on the forefront. But it's still I think has a long way to go.

[0:32:45] MBH: I think you're right, and getting over that fear. Do you feel like getting over that fear was something that happened gradually? Or did that happen after you saw the neuropsychologist and got the follow-up? What changed for you to be able to either overcome or meet that fear?

[0:33:04] KW: I feel like it's still an ongoing thing that I'm working on every day, just like my aphasia. But I will say that I feel like graduate school really forced me to come to terms with it. One of my professors had us do this thing, and I can't remember what she called it. But basically, it was like, every day she would have us journal, just journal, just sit down and write, or type in my case. That's where it just gave us the chance to kind of decompress ourselves to debrief what we did during the day. That became especially helpful during the second year of grad school when you're out kind of in the community and you're really doing it. Being able to write down, honestly, like, ÒToday I felt like an idiot, this is what happened and it was okay. It wasn't as big of a deal as I thought it was going to be.Ó

So just allowing myself the opportunity to look like an idiot, even though I wasn't looking like an idiot but it felt like to me like I was going to look stupid, helped to show me that, "Oh, I'm not like that. I didn't come across like that." I think that it was just allowing myself the room to mess up and to realize that even people who don't struggle with the same things that I struggle with also mess up and I don't think they're stupid and I don't think they're idiots.

[0:35:00] MBH: As you were talking, I was thinking this is something that anyone who's been in graduate school for speech-language pathology or communicative disorders has felt at one time or another. I think Ð I mean, please, if there's someone out there who never felt stupid at some point during their training, please let us know. But I think everyone goes through a version of that. Then, because of the aphasia, and because of everything that you've been through, that was probably multifold for you. What an inspiration that you have gotten to where you are, so thank you so much for sharing. We have a comment that says your perspective is amazing, and you're so inspiring. Thank you for sharing your story with us. Thank you, participants. I want to remind you that you can also ask Katherine any questions that you might have, as we were going through this. She was very kind to say that she would take them throughout the session. Okay. Let's talk about supported conversation to optimize functional communication with people who have aphasia, and their communication partners, because communication, of course, goes both ways.

[0:36:11] KW: Absolutely. Supported conversation was developed by Aura Kagan. She lives in Toronto, and she developed or started the Aphasia Institute, which is there in Toronto. Her thesis for her doctorate was on this idea of supported conversation for adults with aphasia. There's a lot of different types of supported conversation, or like conversation partner training. But when I heard about this one, there's just something about it that really kind of stuck with me. When it comes to supportive conversation, people with aphasia are taught about interaction and transaction. Interaction is like, "Can they take conversational turns?Ó Do they understand, the one person talks, then it's my turn? Then transaction, can they get the information out? Can they comprehend information? Can they express information?

The way that we do that is to have a trained conversation partner. Again, perceiving or the presuming competence. So you acknowledge that they're a competent human being. You treat them with respect, you look at them in the face, you listen actively to what they're trying to tell you. You don't interrupt them. Just kind of those basic respect things that we give to people when we're having a regular conversation. Then, you reveal the competence by getting your message in. Supported conversation has this toolbox, so to speak, of the different strategies. I'll talk about that in a minute. But you use the strategies to get their message in to help them get their message out and you verify their message. 

Not only are you letting them talk to you, in some way, shape, or form, but you're also verifying that, "Okay, this is what I heard you say, is that what you meant?" Give them an opportunity to correct themselves. A big part of it is not allowing communication breakdowns to kind of mess you up, laugh with them, keep trying. I have a patient right now who has, I would say, moderate to severe aphasia, but he is very insightful that he has this issue. Today, he said the word squirrel instead of the words straw, and we just both kind of giggled about it. Because he knew and I knew that that's not what he meant, and you just allow them to correct themselves if they can, and you help them to correct themselves if they can't. Some of the strategies for that is giving them a written or pictorial representation of yes and no. You can also use gestures of like, "Yes" or "No" and you kind of use your face and you can use, "Yes" or "No." And you can use a gesture for before, like putting your hand kind of behind you, or now, like pointing down now or later, kind of pushing forward with your hand. One that I really liked to do is having a piece of blank white paper, and I use a Sharpie marker, just to kind of make sure that it's dark enough for them to see. I write down keywords. 

For example, my patient right now, he was trying to tell me about himself when I was doing his evaluation. He was trying to tell me that he worked in the fields. He was a farmer. I assumed that he was trying to say, farmer, and so I wrote down the word farmer. I pointed out, I said, "Are you trying to tell me that you're a farmer?" I pointed out the word? He said, "Yes, yes." He was able to Ð that was me helping him get his message out. Then, I was verifying it by writing it down. If someone has a really difficult time with something, you can give them a clue, just kind of the same way that we give semantic and phonemic cues. We can give them a clue of it, or even like how I did, I wrote it down and said, "Is this what you're trying to say?" He said, "Yes," and he could read it, but he couldn't say it, and so I had to practice it with him like, "Okay, this is a farmer." He tried to say it, wasn't able to, so we worked for about probably two or three minutes just to say the word farmer because that's something that was important to him.

Make sure that you relax, don't let it stress you out. If you can't get the information out, that just means you try again. Some people do better with pictures than with written words, especially if their reading comprehension is low. So you could give them pictures, and then also, you can have them point to things. Maybe they're not able to repeat after you or to say things. But if you say, "I want to know, do you want coffee?" Then you can let him write down, yes, no, other. Then, "Do you want coffee?" "Yes." "Okay. Do you want cream in it?" "Yes." "Do you want sugar in it?" "No." A lot of times, people Ð we're told to not ask yes or no questions, but I think that when it comes to SCA, asking yes or no questions is an okay thing to do. Because that's allowing the patient to verify with you what they want to say. 

Another big part of supported conversation with SCA, this is what I will call it, that's the trademarked acronym. Another big part of it is involving their communication partner. That can include you, that can include the other therapists, that can include a family member, a friend, encouraging them to use it with you once you have a general understanding of it. Training other people to use it is really helpful. That's one thing that I wish Ð and part of the reason that I went into this research is because I wish my husband had been trained on it. Because we could have communicated so much sooner than two weeks after my first stroke than what we did. To include people who are going to be conversation partners with them, whether that's the doctor or the nurse, or whatever. When you find the strategy that works for your patient, tell other people about it, because it's not just you they need to communicate with. That's kind of a gist.

[0:43:15] MBH: Well, that is such a good point, and so Ð such good advice about, I'm sorry that no one trained your husband. But from your perspective, for us to hear that, that is really important, especially for those working in acute care. Thank you for sharing that.

[0:43:33] KW: Absolutely.

[0:43:33] MBH: Okay. Anything else involving the communication partners, family, friends, staff?

[0:43:41] KW: Yes. I mean, that's kind of Ð and then, not just introducing it, but using it every single session, because what that does is Ð just how the same way that practice makes permanent. Using it constantly with them is going to help them not only to feel more confident, and competent themselves, but it's going to increase their quality of life overall. It's going to give them a sense of, "Okay, I'm less scared about going home and dealing with this on my own, because I have these strategies." The communication partners are going to be able to say, "Okay, I have these strategies. I know how to talk to my loved one with aphasia." Because there's so many people who have never even heard of aphasia. I feel like by using it frequently, then the person with aphasia sometimes becomes even more adept at it than their loved ones, and so they can help. Yes, I mean, that's kind of the gist of it. You just kind of Ð you learn it, and you use it." I have seen it time and time again really improving how my patients interact with me. There's so much more willing to work with me. When I walk into their room, they light up, because they're like, "Finally, somebody who can talk to me." 

[0:45:13] MBH: Exactly. Here's one of our participants lighting up with what you shared. They say thank you for sharing your story openly, you have used a very difficult personal situation to add so much light and kindness to the world. Thank you for sharing such great advice on how to help people with aphasia. You are so enlightening and inspiring.

[0:45:32] KW: Absolutely, anytime.

[0:45:35] MBH: Well, thank you. I feel the same way, and I do appreciate the participants letting us know how they feel. You had said that you would bring some case studies to demonstrate how helpful this can be. Being HIPAA compliant, will you share some of those case studies, where supported communication helped a person with aphasia optimize their functional communication? 

[0:45:59] KW: Yes. When you told me that you wanted me to bring some case studies, the very first thing that came to my mind was my very first independent patient when I was a CF. When you become a CF, you do a lot of sort of watching, and then you just kind of get thrown in. My first patient as a CF had global aphasia, so he was not understanding, he was not talking, there was nothing, but he was only in his 40s. He had a wife, and he had four children who are between the ages of 12, and 18, I think, or something like that. I taught him, and his wife to use SCA. It actually improved his comprehension so much, and I was so surprised by it. I was like, "Holy moly, I know that this works. I've read the research. I did my whole thesis on it." But then, seeing it functionally in the real world, it was like mind-boggling. 

We started with pictures with him, and then we slowly moved to very simple words, and he and his wife were able Ð I was able to be a part of their first conversation, and where they were really taking the turns that you would expect in a conversation. Just seeing that, I mean, after that session, I like took a minute in my office and just cried because I was so excited by it and just relieved that something that I had been working on and researching was actually working, even though I knew that it would because I've read the research. It was just Ð there's just something about seeing something work with a patient. That's my very favorite story to tell because it just was so inspiring to me, as a speech therapist. Okay, you are doing a good job, you are making the right choices for your patients and doing that on my own for the first time ever, nobody was watching me, it was just kind of me. That was really cool.

[0:48:21] MBH: That is a very cool case study. I liked that we named this episode Ð we included conversation partners in it because not only did you help the patient that day, you helped his wife and therefore help the whole family. For the first time, they could see a way out of this situation because they were able to have that conversation. Thank you for sharing that one.

[0:48:49] KW: Yes, absolutely.

[0:48:50] MBH: All right. We have some time, so okay. Give us another one.

[0:48:57] KW: Another patient that I had recently was completely independent prior to her stroke as a 90-year-old, which is I mean Ð

[0:49:06] MBH: So awesome. 

[0:49:07] KW: Amazing. But she had a pretty severe stroke, and she lost the ability to say anything more than no. She would talk to me and she would be like, "No, no, no, no, no, no, noÓ and have no idea that she was only saying no. She just thought that we were having a conversation. I started using it utilizing SCA with her. That one was actually really, really hard because she was legally blind, and so I had to get really creative with how do I use this with a patient who is legally blind, which kind of goes into what I want to do in the future, but that's a lighter thing to talk about. I had to get really creative. I had to use dark backgrounds with bright red, or yellow, or bright blue so that she could see the contrast. I had to have Ð I would make things on the computer because she had an iPad that she used a lot, and she could zoom in to see things and would pull it really close to her face, and so she would kind of read that way.

It was so cool, because her last day with me, the day before she discharged from the facility, I said, "Okay, so and so, I've loved working with you. It's been so nice meeting you. I just really hope, all the goodbyes." She looked at me, and she said, "Bye-bye. Love you." I was like, "I love you too." The fact that she said that to me, I mean, there was just Ð I feel like we all have stories about that, right? There's just those wholesome moments. But the fact that it was because Ð well, I feel like it was because I used SCA, that she was able to functionally say bye-bye to me, and not just say, "No, no." It was really amazing. That's another favorite of mine. I still think about it all the time. 

[0:51:10] MBH: Ah. Well, it sounds like she was a gem. 

[0:51:12] KW: Yes, she very much was.

[0:51:15] MBH: Again, it's great to see that in action.

[0:51:18] KW: Yes, absolutely. Okay. My last one is a little nerdy, but it's about my research study. For my graduate thesis, I wrote my thesis on this, and I did a full-blown study. I didn't just do like Ð at my school, because we're such an involved medical program, it's only required for you to do Ð it's like a review of the research. You had to choose five articles on a single topic and give a review of the research for your graduate project. I was like, "No, no, no. Peer review? Yes, thank you." But I was like, "No, I think I want to do a full thesis, I want to do a study because I love research." I was the kid in high school and college who was like, "Guess what I read?" Then my friends are like, "What? An article?" I'm like, "Yes." I did my thesis on this and by training Ð 

What I did for my research study was training graduate students to use it with patients with aphasia, and their scores were the person Ð so I only had two, it was a small pilot study. I used two graduate students, and one person with aphasia. The person who got the training increased her scores by over 160%. The person who did not get the training increased her scores by about 20%. Then, the big part though, was that my person with aphasia, when she was communicating with the trained communication partner, her scores; her ability to get information out that was correct increased by 32%, versus only 2% with the non-trained conversation partner. So just seeing that happen in my research was absolutely astounding.

[0:53:14] MBH: That is significant. Those numbers are huge. Have you been able to continue with the research?

[0:53:20] KW: Yes. My thesis advisor and I have created basically the same study but on a larger scale. We currently have Ð I think it's 15 or 16 graduate students and eight people with aphasia. My thesis advisor is kind of leading that research study, because he's still in Utah, and is able to do that. But I'm double-blinded to the study, and so I get to, essentially analyze all of the data. Because I'm double-blinded, it's an even better study, because I don't know any of the students, I don't know who's gotten the training, who hasn't gotten the training. Initially, I was supposed to train the students, but just because of my work schedule, and the time change between Utah and California, I wasn't able to. Now that I am actually double-blinded to this study, it makes me an even better analyzer of the data, because I don't know. It will show it, I feel even better. That's kind of what we're working on right now. Then, can I talk about what I want to do for the future?

[0:54:33] MBH: Yes. Yes. Yes, you can. But before we go into that a little bit, I would like to know, when will this phase of the study be completed and when will you have the analysis done.

[0:54:48] KW: My advisor, my professor told me that he's finishing up the last couple of interviews as the semester kind of was ending. Then, he's working on uploading all if the information to a HIPAA-compliant drive that I can have access to. Then, he'll send them over to me sometime early June is kind of the goal. Then, I'll kind of work on it over the summer, and then have all of the analysis. Then, my professor and I are going to try to write it up and try to get it published.

[0:55:24] MBH: Good luck, I hope you do. Whether or not you get it published, we would love for you to come back, either to Keys for SLPs, or through SpeechTherapyPD.com and share that research study with us. We have some other comments about your perspective, and then you've touched so many on both a personal and clinical level. They love learning from you. Here's another one, your description and explanation of how your experience with aphasia helped you develop your therapy skills with understanding was very well presented. Thank you. Let's talk about your future projects and plans.

[0:56:00] KW: Yes. My future project is, I would love to do a longitudinal study. So train graduate students in graduate school, and then see how they continue to kind of grow and use SCA through their CF in their first year or two as a licensed SLP, and see if their abilities get even better. Well, it would be hard with their patients because then you'd have to add in an extra component of following up with the patients. Then, we have neuroplasticity and all of that. But I would really like to do the longitudinal study with the graduate students kind of following them post graduate school. Then the other research study that Ð it's still in the very beginning phases of very Ð like still thinking and kind of mulling things over of how I would do it. I want to develop kind of an addendum to SCA to utilize it with patients who are legally blind because I've had multiple older geriatric patients who are legally blind. 

Using SCA with them is a lot harder because they can't see. So trying to figure that one out would be a really interesting Ð not only improvement in my own therapy but also to study it. To see like, okay, is this actually helping, is this just dependent on patient by patient, that sort of thing. Then, when it comes to other future goals and plans, I'm in the final processes of getting my certified brain injury specialist certification. All I have left is to take the test because I live with aphasia and a couple of other things. I am really anxious about that, but you know what, I'm just going to bite the bullet and do it in the next coming weeks. Then, finally, I would love to become board certified by the ANCDS, which is the Academy of Neuro Communicative Disorders and something, I think. That could be wrong, but it's ANCDS, I know that for a fact.

[0:58:20] MBH: You had written it in your notes, so is that the board certification in neurogenic communication disorders? 

[0:58:26] KW: Yes. So it's not recognized by ASHA as a board certification, but it is a board certification. It's just through a different company and I don't know what to call them.

[0:58:37] MBH: Excellent. Well, I think all of us listening tonight and in the future have no doubt that you will get those certifications and any others that you wish to get because you are amazing. It's so wonderful to have met you and talked with you tonight. We're just about out of time, but I realized that we had a question in the Q&A. It's a good question I want to clarify for people. The question is, do you personally train the communication partner or do they go through a special program?

[0:59:07] KW: Yes, that's a really good question. I actually trained the communication partners. I went through the Aphasia Institute's training, and then I also got the certification from them to train other healthcare individuals, but I train the communication partners, whether that's the family or the other therapists. But what I will say is, if you're interested in learning about more of this, there is a free training. It's only like 45 minutes. I don't think that they offer CEUs, but it is free, and it's on the website of the Aphasia Institute, which is called Ð the website I think is www.aphasia.ca. You should be able to find it on there. But like I said, it's free, it's 45 minutes, and it just kind of gives you an intro to it. Then, I got a grant to go to their training. But I mean, I would encourage anybody to go to it because it's just full of information, and there's so much more than what I could give you in a quick spiel about it. But if you're interested in getting more information, I definitely highly suggest going to their website and just kind of engrossing yourself in it because it's beautiful and wonderful. I wish everybody had it in graduate school. 

[1:00:37] MBH: Well, thank you for sharing that. That is also a great resource to give families.

[1:00:42] KW: Absolutely, yes.

[1:00:43] MBH: Excellent. Okay. Well, Katherine, I'm going to say goodbye for now, but I would love for you to come back and share some of your research, and I know that Yumi has been talking to you about some other things on SpeechTherapyPD.com. So please look out for that. Thank you so much. I like to remind everyone if they are listening tonight to get their CEUs live, please go to your SpeechTherapyPD.com account today before the end of the day and complete all course modules including the one that says quiz. Thank you so much, everyone. Went a little bit over. Thank you for hanging with us. Thank you, Katherine, for sharing and your honesty. We really, really appreciate it. Here's someone else. Another participant said, "Yes, please. There's a great need for SCA with visually impaired and yes, I look forward to hearing your research findings and results."

[1:01:42] KW: Absolutely. I'm excited to have them.

[1:01:45] MBH: Yes. Okay. Thank you. Take care, everyone. Thanks for participating. Have a great night.

[1:01:51] KW: Thanks, you too.

[OUTRO]

[1:01:53] MBH: Thanks for joining us here at Keys for SLPs, providing keys to open new doors to better serve our clients throughout the lifespan. Remember to go to SpeechTherapyPD.com to learn more about earning ASHA's CEUs for this episode and more. Thanks for your positive reviews and support. I would love for you to write a quick review and subscribe. Keep up the good work.

[END]
KFSP 65		Transcript

	©Ê2023 Keys for SLPs Podcast	1