Group Therapy: The Intangible Benefits for Acquired Brain Injury

Friendships after Acquired Brain Injury

Nancy, Felix, Ted and Alex* shared more than their acquired brain injuries. They were all isolated from friends after their acquired brain injuries. Socializing was too much work. Friends didn’t understand. Friends stopped calling. It was hard to initiate a conversation with someone new. We heard the stories again and again. They were different faces, but the same stories. They all attended group therapy to help with their communication disorders.

After Group Therapy

We heard new stories: “Group is one of my most important appointments”, “When is the next one?”, “It was really great”, “Do you have Ted’s number?”, “She inspired me because if she could do all that with all her physical problems on top of her brain injury, and with a kid, then I can do it too.”

Our clients establish a new sense-of-self linked with renewed abilities to interact successfully with peers. We have seen so many positive changes in our clients. They have developed relationships with each other outside of sessions. Clients meet before or after sessions to continue the relationships that began in the sessions. Recently Felix (an extremely shy person since his acquired brain injury) participated in a presentation that was made possible through a relationship formed through group. The other group member inspired and encouraged Felix to get involved. Ted obtained a bus pass for the first time ever, as a direct result of wanting to attend group independently. This goal was not one that Ted had ever expressed before. Alex plays in a band and now Nancy has become inspired to try to play guitar again, “Alex is really good and he learned after his brain injury”.

Group Therapy offers more than just Practice

Friendships aren’t made overnight and having an acquired brain injury can make that dynamic even harder. Group therapy helps build confidence by allowing clients to practice important skills in a safer environment, and provides emotional support by way of a client realizing that he or she is not alone. The skills to make and maintain relationships are practiced, but there is So. Much. More.

Do you need some help getting back into socializing? If so, check out our groups online, or call us to discuss your individual needs. We would love to hear your story and see which of our groups is the best fit for you.

*names and some details have been changed to protect our clients’ identities

BobiTychynskiShimoda-220Bobi Tychynski Shimoda is a Speech-Language Pathologist with more than a decade of experience working with neurological communication and swallowing disorders. She has worked in a variety of settings including inpatient rehab, acute care, community, and private practise. She is highly skilled in assessment, and innovative treatment approaches.

 

What’s going on with my voice? Videostroboscopy can help!

Is your voice not what it used to be?

Are you losing your voice frequently, experiencing hoarseness, or persistent strain?

Has an Ear, Nose, and Throat doctor (ENT) indicated that nothing is wrong with your vocal cords themselves?

A videostroboscopy assessment will provide a more detailed analysis of your vocal cords while you are producing sound and will help give you information on what is causing your voice issues so that changes can be made.

What Exactly is Videostroboscopy?

Videostroboscopy is a much more sensitive tool and more helpful in identifying subtle issues happening with the voice compared to other techniques, such as rigid or flexible transnasal laryngoscopy with continuous light sources (these tools are used through the nasal cavity). Videostroboscopy (through the mouth) provides a more detailed view than these other techniques and can reveal problems with the vocal cords such as growths, or irregularities in the vibration pattern or movement of the cords themselves.  Muscles surrounding the cords are viewed to see if they are working when voicing occurs.  The color of the cords and surrounding muscles is viewed to see if there is redness or swelling, and you can see if one cord is engaging more than another to make the voice work.  Videostroboscopy provides key elements in voice assessment to assist in a plan for voice recovery.

How Does Videostroboscopy Work?

Videostroboscopy uses a flashing light source to create a slow motion view of vocal cord vibration. Vocal cord vibration is very fast – the “slow motion” view is actually taken from many successive rounds of vibration. This unique viewing allows the voice care team to look at how each vocal cord vibrates during the different phases of the vocal cord’s vibration cycle, allowing for clear identification of smaller abnormalities in vocal cord movement that are unable to be observed using any other technique. From this information, therapy sessions to improve voice use can be prepared so that your intervention can be individualized and suited to your own specific needs.

Here is an example of a videostroboscopy analysis and how it looks when the vocal cords are viewed this way.

Who is a Candidate for Videostroboscopy?

Videostroboscopy is highly recommended when a voice disorder is due to abnormalities that affect vocal cord vibration. These abnormalities can include:

  • vocal cord scarring
  • a mass (cyst, polyp, nodule)
  • incomplete closure of the vocal cords
  • abnormal vocal cord vibration
  • asymmetrical/uneven movement of the vocal cords

At S.L. Hunter SpeechWorks we have a comprehensive Voice Lab where our voice team will assess your needs using both instrumental and non-instrumental equipment.  Our Voice Lab offers state-of-the-art videostroboscopy equipment to fully analyze your vocal issues.  Call us today or check out our voice lab for more information.

LindaSaarenvirta-220Linda Saarenvirta is a speech-language pathologist who has been practicing for over 20 years in the healthcare field.  She has worked with a variety of communication disorders and clients of all ages.  She is extremely passionate about voice therapy and enjoys helping clients achieve their vocal needs.  Her client centered approach to therapy ensures all clients maximize their potential and achieve their goals.

Difficulties with Social Skills and Autism

Throughout my career as a Speech-Language Pathologist, I have always had an interest in the role that social skills play in the social, emotional and academic successes of children and teens.  Over time, I started seeing more and more people who struggled with social confidence and social skills. Most of these children and teens had been diagnosed with autism spectrum disorder (ASD) and some simply felt or been told that they didn’t do well in social situations. This is definitely a common challenge faced by all people with autism no matter what their language or cognitive skills. No two people will share the exact same pattern of difficulties with social skills. This is why autism is now commonly referred to as a spectrum disorder which represents a large range of abilities and difficulties found with those who have autism.

Difficulties with Social Skills Across the Ages

Preschool   

Most social difficulties for many children with autism can be identified in early childhood or even infancy. Some of the earliest signs are:

  • Limited eye contact
  • Responding to their name
  • Sharing attention
  • Difficulties with imitating

These above signs can become worse and children might shy away from social situations or avoid them all together. On the other hand, some signs may go undetected because they are similar to the behaviours seen in typically developing children going through the regular tantrums or being defiant.

School-Age

For children who are unable to access early social intervention, the problems tend to develop as their social demands increase. They often have limited play skills and show little interest in playing with friends. Or, if there is an interest in engaging with other children, they may not have the appropriate skills to:

  • Initiate play
  • Respond to the play invitations to other children
  • Or to learn play through observations of other children
  • Attempts at social interaction is immature

When they do have friends, their friends tend to be very accommodating children who adjust to their need to control play. Difficulties with social skills and maintaining friendships as they get older can be very challenging given that typical children become less accepting of the one-sided nature of these friendships.

Teens

As children with autism age and move into high school, they continue to have difficulties with social skills and are likely to feel isolated from their peers. Schools often try to create an environment for acceptance and inclusion to help increase the potential for friendships. Often those who have high language abilities may have great self-awareness of their differences and a greater motivation to want to fit in. But, that being said, teens by this point may have faced social rejection and are more comfortable communicating with adults who encourage them in their specific interests or spend more time on their own.

What can you do to help someone with difficulties with social skills?

There are many different social skills interventions out there such as, video modeling, social stories and activity-based intervention to name a few. Cognitive Behavioural Training (CBT) can be used in teaching social skills, which involves increasing knowledge about the social world and at the same time increasing awareness of thoughts and feelings. One specific type of CBT is Social Thinking!

What is Social Thinking?

Social Thinking is what we do when we interact with people.  The Social Thinking approach (based on the work of Michelle Garcia Winner) focusses on helping individuals think strategically in social situations. It helps them to observe and consider their own and others’ thoughts and feelings.  It bridges the connections between thoughts, feelings and behaviours, paving the way for social skills that can apply to many situations.

Social Thinking also sheds light on academics; children who struggle in conversation, struggle to understand literature – not due to a lack of core skills in reading fluency and decoding – but rather, in perspective taking. Its main focus is on teaching individuals to think about how others perceive them.

When individuals are unable to interpret others’ perspectives, they may struggle with developing meaningful relationships. Social Thinking breaks down social concepts so that we can convey them in ways that are practical and logical.

Social Thinking is a language-based approach for individuals with social learning disabilities, not just specific to individuals with autism but anyone that may have ADD, ADHD, Nonverbal Learning Disabilities and/or Language Disabilities, ages 4 years through to adulthood.

For more information on Social Thinking or if you are interested in programming using Social Thinking contact us today about our March Break/Summer Camps or individual sessions!

AmyWebAmy Grossi is a pediatric Speech-Language Pathologist, practicing for over 10 years. Amy enjoys the area of early language, literacy development, apraxia and fluency. She has a passion for working with children with multiple developmental needs and implementing creative and interactive treatment sessions.

I’ve had voice loss for 2 weeks! What Can I do?

Losing your voice can be a scary thing.  Voice loss or laryngitis happens when your vocal cords become inflamed from overuse, infection, or irritation.  If you’re wondering about the severity of your voice loss, the Mayo Clinic has excellent information on symptoms and causes.

If you experience voice loss (laryngitis) for 2 weeks or longer, you should seek medical advice from an Ear, Nose, and Throat doctor (ENT) to examine the cause of the persistent voice loss.

Short-Term Tips for Managing Your Voice Loss

Below are some tips to help reduce the strain associated with voice loss while awaiting your appointment with the ENT:

  • Vocal rest- try not to use your voice as much as you typically do, however, do not whisper as that can be more harmful than shouting.
  • Avoid calling out and yelling- walk to the person who you are talking to
  • Drink lots of water- keep hydrated
  • Manuka honey and ginger are great for the voice and soothing to have when the voice is not at its best.
  • Avoid singing and throat clearing as they can be harmful to the voice when it is already in a weakened state.

What if the ENT recommends speech therapy for the voice loss?

If speech therapy is recommended for the voice loss, you will be referred directly to a qualified speech pathologist with experience in voice disorders.  The speech pathologist will complete an assessment and set goals to get your voice back on track.

Exercises may focus on the following areas depending on your specific type of voice loss:

  • Reduction of tension in the larynx (area where the vocal cords are housed)
  • Improving the tone of the voice (may sound rough, raspy, hoarse when you are experiencing voice loss)
  • Improving the pitch of the voice (how high or low the voice is)
  • Altering diet to reduce symptoms of acid reflux
  • Reducing hard contacts of the vocal cords when voicing, so that the voice starts easily and gently
  • Relaxation exercises to help alleviate stress and strain

How long will it take to improve my voice loss?

Everyone is different with respect to their vocal use and musculature, so it is tricky to put an exact time frame to the therapy.  Typically you will see vocal improvements in 6-10 sessions; you may need some maintenance sessions to keep up with the new strategies and improved way of using your voice.

At SpeechWorks, we have a fully equipped voice lab with videostrobscopy analysis to view your vocal cords when you are speaking and computer equipment that allows us to track your progress in therapy.  Call us or check out our voice lab for more information! We would be happy to help you with your vocal needs.

LindaSaarenvirta-220Linda Saarenvirta is a speech-language pathologist who has been practicing for over 20 years in the healthcare field.  She has worked with a variety of communication disorders and clients of all ages.  She is extremely passionate about voice therapy and enjoys helping clients achieve their vocal needs.  Her client centered approach to therapy ensures all clients maximize their potential and achieve their goals.

How Can I Help Pay for Speech Therapy?

It can be a scary and confusing time when you or a loved one is dealing with a chronic illness such as stroke, brain injury, Multiple Sclerosis, Parkinson’s disease, or Alzheimer’s disease.

The lack of publicly funded rehabilitation for the difficulties that come along with these illnesses can leave families feeling desperate and wondering who will help foot the bill for the therapies they or their loved ones need to recover.

In a cruel twist of fate, these illnesses often occur at a time in life when people are now needing to live on reduced income (e.g. retired and on pensions).

Take a closer look at your extended health benefits

Although most people know that services like physiotherapy and massage therapy are covered by the extended health benefits provided by their insurer, they often don’t realize that these benefits often include coverage that can help pay for speech therapy as well.

Typically this coverage is listed under the Medical Rehabilitation section of your policy. It may include a lump sum per calendar year (e.g. coverage up to $500 per calendar year) or a maximum amount covered per therapy session (e.g. coverage up to $100 per session).

If it’s unclear what is covered in your policy, a quick call to your insurer can answer many of your questions.

Think outside the box

Many insurance policies offer a maximum amount covered per year per claimant. This means that you and your spouse could BOTH be entitled to that amount of coverage.

Speech therapy sessions for you or your spouse can often include a component of caregiver/spouse training. This is where the speech therapist teaches you how to target the skill area so that you can practice with your partner at home in order to help carryover the skills learned in the therapy session.

What this means is that, if your case fits the criteria, part of the session can be billed/claimed for your spouse/caregiver and part of the session can be billed/claimed for you – extending the amount of coverage you can access to help pay for speech therapy

Stick it to “the man”

Just because the government doesn’t always fund these health services through OHIP doesn’t mean that you can’t get some assistance from the government to help pay for speech therapy

If you are receiving speech therapy for a chronic medical condition (e.g. brain injury, stroke, multiple sclerosis, etc.), you may be eligible for a Disability Tax Credit.

Visit the CRA website at http://www.cra-arc.gc.ca/tx/ndvdls/tpcs/ncm-tx/rtrn/cmpltng/ddctns/lns300-350/316/pply-eng.html for more information on eligibility and how to apply.

Take Advantage of Assistants

Communicative Disorders Assistants (CDAs) can work under the direction of a speech therapist to provide treatment to you or your loved one and are a lower cost alternative to treatment with a speech therapist.

However, CDA services are not appropriate for all clients and candidacy for these services is determined by a Speech-Language Pathologist. A speech therapist would still need to complete sessions with you or your loved one at regular intervals to monitor progress and make recommendations.

Consider Creative Alternatives to Help Pay for Speech Therapy

Although nothing can replace the benefits you or your loved one would receive from one-to-one treatment with a speech therapist, there are other alternatives to receive some level of help.

Group therapy, such as our brain injury groups, where people working on similar difficulties can receive therapy together, is one option to consider as the cost of a session could be shared with the other individual(s). Support-Focused groups can also be a more affordable alternative, such as the supported communication group offered by our clinic for adults with brain based communication impairments (e.g. stroke, dysarthria, brain injury, etc.).

Again, the caveat here is that there is less “treatment” going on in these larger group scenarios, so the gains made by you or your loved one will not be as great as if receiving individual therapy. That being noted, there is much to be said about the benefit of practicing communication skills with others in more natural contexts!

Although it may be frustrating to consider the lack of OHIP funded therapy, no matter what your situation, there is often a creative solution to help you provide for you or your loved one’s needs!

MelissaKiley-220Melissa Kiley is a registered Speech-Language Pathologist with a special interest in concussion/acquired brain injury as well as literacy skills development. She has been working with clients for over 10 years and is highly skilled in developing functional and innovative treatments.