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How technology helps speech therapy patients in pandemic

Q&A: Joni Hodges, HopeHealth Visiting Nurse Speech Language Pathologist

Talk about a challenge. Patients who have difficulty moving their lips, jaw and tongue when they are speaking will benefit from watching the mouth of another person forming words.

But this is a pandemic. What’s a mask-wearing speech language pathologist to do?

Turns out there’s an app for that, says Joni Hodges, MS, CCC-SLP, who joined HopeHealth Visiting Nurse in January. Over her long career, she has treated patients ranging from infants to age 103 for issues related to swallowing, speech and cognition, and using voice and language. Joni has a master’s degree in speech-language pathology and is certified by American Speech and Hearing Association, which has proclaimed May as Better Hearing & Speech Month. Joni shares some of her creative techniques and perspective on making a difference in the lives of home care patients with communication impairments.

What kinds of patients do you see?

I see people who have aphasia and apraxia. Aphasia is the loss of language after a stroke. Apraxia is a motor speech disorder — the brain doesn’t know how to tell the muscles of your mouth and tongue how to make sounds. I see people with Parkinson’s disease and other progressive diseases such as dementia and brain cancers, ALS (amyotrophic lateral sclerosis.) A lot of what I do deals with caregiver education and compensation strategies. That could mean modified diets or liquids or different positioning for eating and swallowing. There is a simple chin tuck technique you can use to help protect your airway when swallowing.

How common are swallowing issues?

Very common. I would say half the patients I see have swallowing issues. The same muscles you use to form words are the same muscles you use to chew your food. Sometimes we have to make diet modifications. Patients might need to go on a pureed diet or have thickened liquids.

Female speech language pathologist checks male patient's swallowing while he drinks from a cup
A speech language pathologist observes her patient’s swallowing as he takes a sip of water from a cup.

How might your diet affect your voice?

A lot of people suffer from reflux, heartburn. It has to do with our lifestyle and our food choices. How we eat, when we eat, where we eat. We’re eating late at night. We’re eating in bed. We’re laying down after we eat. We’re eating spicy food. We’re drinking a lot of coffee. It all affects our voice.

What kind of voice problems can heartburn cause?

Heartburn can lead to what’s called LPR, or laryngopharyngeal reflux disease. It’s basically your stomach acid is burning and inflaming the tissues of your throat. That makes it desensitized to aspiration, when food or fluid is accidentally breathed into the lungs and the normal protective response is to cough. It can make you sound hoarse. Eventually it can lead to a very breathy, whispery voice.

Pretty much all of them tell me, “I want to be heard better when I’m talking on the phone.”

What do patients commonly ask you for help with?

Pretty much all of them tell me, “I want to be heard better when I’m talking on the phone.” Right now, there isn’t a lot of face-to-face social interaction because of the pandemic and everything is either over Zoom or over the phone. If you can’t make yourself understood, it can be extremely frustrating.

What’s it like treating patients in their own homes?

It’s great because you’re seeing people in their own environment. You are treating aspects of their daily functional life they need help with. If they like to get up every morning and read the newspaper and they’re having trouble comprehending what they’re reading, you can use that in the therapy session.

How is using your voice involved with reading comprehension?

Speech therapy is more than just about the words and the sound that come out of your mouth. It has a lot to do with you how your brain is processing information. When you’re reading, you’re not just looking at words or when you’re reading out loud, you’re not just saying words. The brain is processing what each word means and putting the words together to comprehend what they mean.

How do you help someone who is getting confused about what they are reading?

You find their area of interest. Some people like to do the crossword puzzles in the paper. They like to read the sports section or home and garden section. I have them read out loud. If they get stuck on a word, then we stop and look up the word online or use a dictionary. Just breaking sentences down. We attack the vocabulary. They read the first sentence and put it in their own words so they can comprehend what they’re saying better.

Senior man with a female doctor at his home. About 70 years old Caucasian male and a 35 years old African female.
A patient reads while his speech language pathologist observes.

What kind of technology do you use in treating patients?

I use a lot of apps for my therapy practice on the iPad. The adults love it. I use a lot of apps for kids that I modify to use for adults. You’re playing a game and you don’t even realize that you’re in therapy! I also work with augmentative alternative communication systems. I have one in front of me now. (Holds up a Lingraphica TouchTalk tablet.) This is a system called Lingraphica. I use this with patients who are primarily nonverbal and unable to use their voice. I could play with it all day. It has a lot of different apps you can use.

What’s your favorite?

An app called VAST. It was created for kids with autism, but it’s great for people with apraxia or aphasia. You can use this in so many different ways. It’s a lot of different songs and it shows the mouth singing the songs. For example … (She plays the traditional “Happy Birthday” song.)

Oh, wow!

I need to wear my mask at all times due to COVID-19. But when you’re working with people with apraxia, they have to see your lips moving. This app has a mirror function on it so you can actually see yourself as you’re singing. It records you.

Speech therapy is very fun, you know. I use pinwheels sometimes. Kazoos, harmonicas.

What did you do before there were apps?

I had a big plastic box and in it were things like a hammer and a cup and a spoon and a flag. Every object in the box had a corresponding picture. Every picture had a corresponding word. Every word had a phrase. I would put objects in front of someone and say, “Can you point to the hammer?” Or if you want to make it a little more complex, you say, “What would you use to work with nails?” Some people, we might say, “I want you to pick up the hammer and show me what you do with it.” So then they’re demonstrating function. They might say that’s a hammer, but some people might pick up the hammer and pretend to brush their teeth with it.

What is something you still do in therapy without using technology?

We do bubble therapy! I take my patients outside on the deck or patio and we’ll blow bubbles using a bubble wand. You’re working on breath support and you’re working on your lip strength, lip rounding. A lot of sounds, you have the “oooo.” You have the lip pursing or rounding.

That sounds fun.

Speech therapy is very fun, you know. I use pinwheels sometimes. Kazoos, harmonicas.

Any particular tune people like to play on the kazoo?

“You Are My Sunshine.” “God Bless America.” “Take Me Out to the Ballgame.” We do karaoke. There are apps on my iPad I can open up. I use singing a lot in my therapy.

Are patients open to that? Some people might be too self-conscious.

Some people are. But once the music starts and I sing along with them and if family is present and they want to jump in, we include everybody in the room. I say to the patients, “I don’t care how you sound. I’m not looking for a professional singer. We’re just exercising our voice.”

We take our voices for granted, don’t we?

Yes, we do. We take our voices for granted. We take our communication for granted and we take our swallowing for granted until something happens. You don’t realize what an incredible mechanism our body is in terms of being able to speak and eat.

What made you become a speech and language therapist?

Communication is a basic life function that makes us human. That’s at the core of what I believe.

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