Speech Pathologist, Speech Therapist, SLP…
For many of my friends and family, it can be hard enough to figure out what to call my job, let alone understand what I do. I thought I’d shed some light on the issue. Who knows- maybe this will even provide a peak into a future career for somebody or be helpful for patients and families participating in rehabilitation to learn what the heck speech language pathologists do.
First, I should clarify my intent. The title of this post may seem to imply a degree of generalization (“A Day in the Life of a Speech-Language Pathologist”… any speech-language pathologist). Much to the contrary, this “a” is meant to emphasize singularity. Speech-language pathologists address a wide array of impairments in many different settings with diverse patient populations. So we’re just talking about me here. At its broadest, this description could probably apply to most SLPs working in an acute inpatient rehabilitation hospital, but I wouldn’t even promise that.
So here we go, let me break it down for you.
The patients I see are between the ages of 18 and 1,000,000, but tend to be on the lower end of the range. They usually come to us after something really terrible has landed them in “the hospital” (meaning acute care). I hope “really terrible” isn’t coming off as sarcastic because I truly can’t think of anything worse in life than what some of these people and their families have been through: strokes, brain tumors, traumatic brain injuries, anoxic events, advancing neurological diseases… The good news is that by the time they come to us, they are medically stable enough to participate in at least 3 hours of therapy, 5 days each week. Some of my patients have very mild impairments and will likely return to home and work. Others come to us in a very compromised state. Most of the time I have about 3 weeks to make as much progress as possible.
8:05 am: Arrive to work 5 minutes late. Usually there’s an hour to prepare for the day, do chart reviews, sign orders, go to team meetings, etc. etc.
9:00-12:00: Evaluate or treat patients in half-hour sessions.
12:00-1:00: Eat, catch up on documentation, go to meetings, tie up loose ends from the morning.
1:00-4:00: See 9:00-12:00
4:00-hopefully not later than 5:30pm: finish documentation, do all the stuff there wasn’t time for between 8:05 and 4.
There are 3 types of evaluations I give.
This is usually some blend of informal and formal evaluations to assess a patient’s thinking skills (arousal, attention, initiation, processing, memory, reasoning, organization, planning, social skills, etc.), language skills (word finding, fluency, comprehension, etc.), and speech (volume, rate, articulation precision, phonation, etc.).
Non-Instrumental Clinical Evaluation of Swallowing
I use my special powers to determine whether my patient’s food is going down the right way. If regular food doesn’t look safe, I may recommend thickened liquids or chopped foods, or give my patient some strategies to decrease the risk of aspiration.
Videofluoroscopic Swallow Study
Every now and then, the special powers described above don’t cut it, and I need to watch my patient swallow some barium on a video x-ray. This one is usually a team effort: a couple SLPs, an MD, a radiology tech. Here’s a Youtube video of what we see during a VFSS. Some of my colleagues also perform Flexible Endoscopic Evaluations of Swallowing, but I do not yet have that certification.
In many ways “speech therapist” is a misnomer. Many, if not most, of my patients speak just fine. To give you an idea of what treatment may entail, I’m simply going to list some of the activities I did with my patients today in no particular order:
Recall from a paragraph/Trials of mechanical soft solids/Neuromuscular electrical stimulation/Research Celine Dion/Strategies for improved speech intelligibility/Match written sentences to pictures/Swallowing exercises/Complex sorting tasks/Copy written words/Read prescription labels/Calculate orders from a menu/Follow a daily schedule/Practice saying family member names/Family education
Treatment possibilities are infinite. The key is to write long-term goals that reflect the patient’s deficits and personal goals, to write short-term goals that support the long-term goals, and to construct treatment sessions that address the short-term goals. What do you think, fellow SLPs?
My hope is that this sparse overview has provided some insight into what I do all day. In writing it, I’ve realized how much more I would like to say about speech, language, cognition, and swallowing disorders. I realize I didn’t even name them here! I hope you’re interested, because there will most definitely be some follow-up posts.
Work is a funny thing. We spend the majority of our time at our jobs, and yet they are often completely separate from the people and places we love. Not only that, but the daily responsibilities of even the most familiar occupations are often complete mysteries to the casual bystander. What is it like to be a postal worker? A special education teacher? A computer engineer? There are a lot of jobs out there- each with its own expertise, jargon, and culture- and I’d like to know what at least some of them entail.
What do you do?