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Wednesday, Aug. 31, 2016

Speech pathologists have hands full caring for adults

Saturday, May 3, 2003

Jennifer Steelman, speech pathologist at ReStart, uses a computer program to help Sam Dean of East Prairie rehabilitate his speech problem
(Photo by Scott Welton, Staff)
May designated Speech and Hearing Month

SIKESTON - While most people seem to associate speech therapists with children and schools, injuries and even aging make speech therapy necessary for many adults as well.

The American Speech and Language Association observes May as Speech and Hearing Month each year "to promote information about speech and hearing everywhere throughout the United States," said Jennifer Steelman.

Steelman said she and Beverly Keefer, speech pathologists at Missouri Delta Medical Center's ReStart, hope this year the word gets out that many speech pathologists have their hands full just caring for adults.

It is estimated that nationally 40-60 percent of long-term care patients have swallowing or speech disorders, according to Patty Holloway, clinical coordinator and speech pathologist for Health Facilities Rehab Services. Holloway said her company has five speech pathologists who service four home health agencies and seven long-term care centers in Southeast Missouri.

With children, speech problems are very often just the mastery of new sounds like "r's." But there are a variety of problems for adults that can make a speech therapist necessary.

"Lots of people who have strokes may or may not lose control of their speech," Steelman offered as a ready example.

There are also vocal nodules that can cause a hoarse voice, and Steelman recalled one incident in which a spinal surgery resulted in paralyzed vocal cords on one side for a patient.

Holloway said voice disorders are also common. "People lose their ability to phonate within normal limits," she said, "or don't have adequate volume."

Then there are some head injuries which can cause problems ranging from difficulty paying attention and solving problems to memory and reasoning difficulties.

"Aphasia is where you have a problem coming up with the word or saying what you want to say, or even understanding what is being said to you," Steelman said.

Treatment of language disorders can include computer programs that work like flash cards to retrain word associations.

"Dysarthria is a motor speech disorder. They can talk, but they have trouble being understood," Steelman continued. "Maybe their speech is slurred or it's not coming out correctly, too slow or even too fast."

Steelman said patients with Parkinson's disease sometimes need speech therapy as well because tremors may affect the voice.

Adults may also experience hearing loss due to an injury or aging and require some aural rehabilitation, which is also closely related to speech. "If you can't hear adequately you are going to have a problem making the sounds," said Steelman.

One of the things speech pathologists do is teach those with hearing problems to "speech read" by watching the speaker's mouth, and offer advice such as limiting background noise while listening to speech.

In addition to helping patients with speech and hearing problems, speech pathologists also help those with dysphagia - swallowing disorders. "For instance, people that are on tube feedings, we often can get them off of tube feedings," Holloway said.

Swallowing and speech use many of the same muscles, Steelman explained, "So that's where we come in." With swallowing problems, the epiglottis doesn't operate properly, she explained. "Food is going to go down the other way settling in your lungs and even causing pneumonia."

Sometimes a change of diet can help with dysphagia and other times it may take exercises for the tongue, lips and throat. "Each person is a little different," Steelman said.

With any rehabilitation, however, the patient's motivation is very important. "That's a big factor in improvement," Steelman said. "If they don't want to get better, they are less likely to."

For those who have "reached a plateau" in their rehabilitation, Steelman said augmentative communication devices can be very useful.

"They can be high-tech or low tech," she said, ranging from a notebook with pictures to a computerized speech generator to speak for the patient.

Steelman said the computer speech generators, while expensive at around $6,000 each, are becoming more popular as Medicare pays a large portion.

"They want to go to their favorite restaurant and be able to order a meal," said Steelman, "or to the emergency room and be able to type in what's wrong with them."

Holloway said anyone looking for career opportunities should know there is a shortage of speech pathologists that it is expected to only get worse as the "baby boomers" age. "There's zero unemployment," Holloway said of her field.