Tuesday, February 24, 2009

What I Do All Day

I've received many questions over the years, like, "so what does a speech therapist do?" I also get a lot of, "oh I had a speech therapist. she helped me with my s's." And sometimes I get, "how do make a stutterer stop? do you tell them to stop?" I've even heard, "do you teach people English?" So I decided to blog about the day in the life of a speech therapist today. Here is what I did yesterday...
At one of my schools, I am responsible for the speech services for the multi-handicapped room (lingo speak for severely disabled kids ranging from mental to physical impairments), and two CDC rooms (lingo speak for kids who spend all day in the special ed room). Yesterday I got on the floor with Abby** (not her real name of course). I asked the PT (physical therapist) to show me how to sit holding her so she wouldn't be in a constant flexed position. Abby is in a wheel chair because she cannot walk, sit up on her own, or crawl. When she lies on the floor she constantly throws herself into rigid positions because she cannot control the spasticity in her limbs. So I sat around Abby positioning her into an upright 90 position and we rocked and vocalized together. When she would make noise, I would make noise back and shape it into a speech sound. We did that until she fell asleep either from being totally relaxed or from being tired from the effort--I'm not sure which. Then I sang Bingo with Charlie**(also not his name). He loves the Bingo song. Charlie is also in a wheel chair all day. He has some upper limb movement (he can move his arms enough to feed himself and give high fives and make some signs) so we worked on signing more, giving high 5's for yes, and generally having fun communicating. He is also working on requesting objects and choosing the correct response from a picture set (i.e. I put 2 pictures in front of him and say, "show me __.") Then I helped another child Gavin** feed himself. He is learning to feed himself. He has some upper body movements, but they are not under his control very well. It's hard to say if it's lack of motivation or lack of ability with Gavin. It just depends on the day. So I made him feed himself 3 or 4 bites (while ducking as he flipped purreed peas at me and sneezed ground chicken patty in my face b/c he sometimes aspirates if he doesn't pay close attention to eating) then I would take the spoon and feed him a few bites so he could rest his arms. I worked with two other folks in that room, but they weren't having a good day so we made each other smile and I brushed their arms with a plastic brush (it's an Occupational Therapy thing) for sensory input hoping to get some attempts at requesting, or any response at all.
Then I went to the special ed room and did language and artic work. I told a Matt and Molly story. Matt and Molly are characters that do a whole host of things in 4 picture cards. So we retold the story together, then we acted it out, then we worked on sequencing the story correctly (the back of the picture cards are numbered). Then we worked on pronouns, "Molly is a girl. SHE told Matt to get the ball." etc. etc. etc. While I'm doing all this, I'm embedding words that have the sound some of the kids are working on (basketball--sk, sk, sk, sk--basketball, Now you say it) and having some make a choice. This story is about basketball, which of these balls (there are three a football, soccer, and basketball) is the basketball? Tell me on your talker (i.e. the augmentative communication device, or "talker" is a machine that uses digital sound and pictures to help children who cannot use their voices, participate in spoken language). After circle time, we split up into small groups of 2-3 or even 1 at a time and work on specific skills. It's a full day.
Today I went to my other school where I work with three boys who have some severe articulation (speech sounds) problems. One can read and write. So we make word lists with the sounds that are difficult and we write stories and sentences (working on grammar like subject verb agreement--"do you say is or are in this sentence?" and on using function words like "I play the slide"--okay great sentence, but you forgot a word. Do you play slide or do you play ON the slide?). We also work on proper speech sounds and positioning the tongue correctly in the mouth, and awareness of sounds. I could get technical but I won't. The other two boys are Pre-K/K. Today we spent 20 minutes playing Thomas the Train. Now of course we weren't just playing trains. We were working on locatives and increasing the levels of conceptual information. They are trying to graduate from front/back to first/last, beginning/ending. So we took turns (also something that needs work). Who's train is in the front? back? first? last? middle? Put your trains on the track. Take your trains off the track. Where is the beginning of the track? Where is the end? Look there are blocks on the track? Can the train go OVER the blocks? Nope. Can we go AROUND the blocks? And so forth and so on. And since we can't sit still for too long we walk up and down the halls looking for different shapes and colors. Hey, look at the floor. I see a square. Do you see a square? What shape is that? Look at the bulletin board. What shape is that? Is it a rectangle or a square? Hey look at the door nob? What shape is that? CIRCLE. (I get bonus points, because /s/ is a sound they are working on and though circle begins with c, the sound is an /s/. Plus, square starts with the /s/ sound too!)
Anyway, maybe it all sounds Greek to you. Maybe it makes complete sense and you're wondering why they pay me the big bucks (hahaha). Maybe if you're an SLP and you're reading this you're thinking, kill me now thank God I work with adults. Either way, I thought you'd like to know what I do all day. At least, that's what I'm doing these days. Last semester I had a few folks who had stuttering problems and when I did home health I managed a whole host of dining plans and dysphagia problems. I also did a lot of functional communication development, staff training, and communication plans involving pictures, and the occasional swallow study (I accompanied for support and also to watch it in radiology myself. I didn't actually perform the study although I am trained to do it, b/c I don't have hospital privileges and that would not be legal. But I was able to watch it which was more helpful than just reading the report).
I can say there is never a dull moment in my job. There are many days that are not fun. Nothing goes the way it should. I have to talk to parents about reality and expectation and limitations. Noone is motivated to participate. Everyone is agitated and upset. I can't do what I wanted to do because I have to go to a meeting or any number of things. But there are many days that just rock my world. I love what I do. I can't really see myself doing anything else. I like to do a lot of things and I'm good at a lot of things, but this is what I like to do best.


Lori Ellen said...

That's your day as a speech-therapist. Mine is full of sticking "hoses" (flexible endoscopes) down peoples noses, telling them what they can and can't eat, how to manage their reflux, to drink more water, and stop clearing their throat. Today I educated a 90 yo man and his wife on the anatomical and physiological changes that would take place as a result of his laryngecomty next week and how a prosthesis would allow him to talk again eventually. I also spend a lot of time with fully grown adults humming, blowing bubbles in water, and teaching them how NOT to hold their breath when they talk. So that's MY day in the life of a speech therapist. Love, LEMS

Susan said...

Sounds like you are enjoying your job. I love my job too! I am at one school with a caseload of 55-60. I only have three children who are severely impaired. My room consists of a therapy room and a private office (it was built at the end of a hallway for an assistant principal who decided to keep her personal office in the main office at the front of the building). It doesn't get any better!