A Long and Winding Road: My 41-year Career as a Speech Language Pathologist

The Role of the Speech Language Pathologist

May is National Speech-Language-Hearing Month (formerly called Better Hearing and Speech Month).

Each year at this time, I get a little reflective about my career as a Speech Language Pathologist and all the changes I’ve seen take place in the field. I’m proud of the 41 years I’ve spent in the field, I think I’ve accomplished a lot, and I feel like I have some experience to share with others. So that’s what I’m going to do in this month’s blog post.

But before I get into my background and experiences, I’d like to share some thoughts about the SLP field itself. The truth is, most people don’t really know what a Speech Language Pathologist is or does.

I guess I can’t blame them; after all, the word “pathologist” is right there in the job title, but we’re really not pathologists (if you look up the word “pathologist,” you’ll find that they “study fluids, tissues, or organs taken from the body”). We definitely don’t do that. So that’s confusing to start with.

But while we don’t take tissues out of the body to study them, we do a lot of other things that many people don’t know about.

Of course, a Speech Language Pathologist works with people who have difficulty hearing or discriminating sounds and we work with people who can’t speak or have various challenges with speaking. But we also work with people who have trouble swallowing—people who have aspirated or had pneumonia or were intubated and now their throats are raw, and people with conditions like Parkinson’s or ALS sometimes have trouble swallowing, too.

We also work with people who have problems with cognition. During COVID, many people were socially isolated and had brain fog. This affected them cognitively, and in many cases, an SLP was called on to treat them and get them back to baseline cognitively.

Many of us also work with young children, and when that’s the case, we’re often involved not only with helping the child to learn how to speak, but also to actually teach the child vocabulary. We also work as part of a medical team in some cases, like when a child is born with a cleft palate or some other birth defect. We even work alongside physicians and nurses to help preemies that have trouble feeding.

So, as you can see, a Speech Language Pathologist is kind of a do-it-all medical professional—kind of like a Swiss Army knife. And I’m proud to say that I’m part of the field.

Early Days: How and Why I Got into the Field

My journey as a Speech Language Pathologist has been a long and eventful one. As far as how and why I got into the field in the first place, I’d like to say that I had a plan from the outset, but that wouldn’t be true.

After high school I went to junior college and played softball. I just took general ed classes because, like so many young people, I “didn’t know what I wanted to be when I grew up” at that age.

I kind of thought that I wanted to be a teacher, but there was this aptitude test that you could take on the computer (yes, they had computers back then) and I decided to see what it would tell me. It gave me a list of about 30 jobs that I might be good at, and when I looked up “speech pathologist,” it kind of sounded like being a teacher, so after junior college, I began looking for schools that had majors in speech pathology.

I actually ended up getting a softball scholarship to Western Illinois University, so I got my undergraduate degree in speech pathology and a minor in psychology and then went to SIU Edwardsville for the Master’s degree program.

So, I kind of just fell into it, but since I like to teach people and help people, it was kind of a natural fit.

My First Speech Language Pathologist Job: Working with Children

During my Master’s program, I did my student teaching with kids and then worked in a practicum in a hospital. I had always favored the classes about helping adults more than the children’s classes, but when I graduated, the first job I was hired for was a position at a school for physically and mentally challenged students, ages 3 to 21, so I ended up working mostly with kids. It’s funny because one of my professors, when he found out I was working with kids, said, “Then why did you take all of my adult classes?”

Anyway, I worked in schools for 10 years and I really enjoyed working with the kids. That was the fun part. The parents, not so much. In fact, it got to be difficult, trying to hold parents accountable for following through with what I’d done with their child during the day.

For example, I was working with a young lady with cerebral palsy (I’ll call her Lisa) who had near normal, if not above normal intelligence. She was very good at math. And we procured a really good system for her with an infrared pointer that she could use to do math problems and all kinds of other things. And numerous times, I brought the parents in, and I would teach them how to use the system.

And then I saw them out in public and Lisa didn’t have her communication device and I said, “Oh Lisa, where’s your light talker?” And she voiced a couple of words and looked up pointedly at her mom. And her mom said, “Oh, we don’t take it when we go out. She doesn’t need it.” So, it just got kind of frustrating and depressing.

And that’s when I thought to myself, “OK, it’s time to move on.”

My Second Speech Language Pathologist Job: Working with Adults

When I left the school position, I began working in skilled nursing facilities. This move allowed me to finally work with adults and put the frustrations of working regularly with parents behind me. Plus, it paid more than the school position.

On the flip side, there were a lot of different challenges in working with the adult population. There were adults with speech issues, with hearing issues, with swallowing issues, and with cognition issues. In addition, with adults, sometimes it’s a little harder to establish a relationship than it is with kids.

It was kind of scary at first, actually. I knew what I needed to do as far as the job itself goes, but you’re meeting an adult for the first time and maybe they don’t want therapy or they’re crabby or they want to sleep.

But I remember vividly my first mentor in this new position. What she made me do was go into a room where I needed to do an evaluation or treatment and not take anything in with me except the evaluation tool, pen and paper. She taught me to utilize the natural environment when it comes to communication. I had to learn to break the ice, assess their personality, in addition to learning how I could help them with their challenges. You almost have to be as much of a psychologist as a therapist because many adult patients are depressed and frustrated because they used to be able to do something and now they can’t.

Augmentative and Alternative Communication (AAC) Tech: An Enduring Passion

One of my greatest joys throughout my career has been working with Augmentative and Alternative Communication (AAC) technology. When I first started working with young patients, AAC wasn’t nearly as developed as it is now. By the time I began working with adults, there was a little more technology available, but it still wasn’t much.

So, what I ended up doing for a long time was making my own communication devices. I created a lot of switches where, if the patient tapped it, they could communicate their wishes. It might be “yes” or “no,” or it might be to select one item or another. Some of the switches lit up when tapped; others made a noise.

I also made my own early version of an ETRAN board to use with some of my patients. An ETRAN (Eye Transfer) board is a communication device intended for use by patients who have limited body movement and speech but who retain good control over their eye movements.

I used a clear rectangular sheet of plexiglass and cut a hole in the middle so I could look through and see the patient. I would then place different photos or symbols in the corners of the board on the patient’s side. I could then ask a question and the patient could look up, down, right, or left and I could tell what their answer to the question was based on where they were looking. Of course, today there exists eye tracking technology that can convert the patient’s eye movements into data, but my model worked pretty well, even though it was low-tech.

And of course, I spent a lot of time buying pictures and mimeographing pictures to paste onto communication boards. These were static and didn’t talk, but they were one way to teach a young patient how to communicate and teach them some vocabulary.

There were also a few tech devices available at the time. There was a company called Prentke-Romich, which is now PRC-Saltillo. They had a couple of big box items that I worked with—the Touch Talker, the Light Talker, and the Liberator.

APP2Speak: The Beginnings

During the time I was working in the skilled nursing facility, I had two patients who had had strokes. While the strokes affected each of them differently, I had made picture communication boards to help each of them communicate. But they didn’t always work well. The patient would point at a picture, but the staff person might not be looking to see what they were pointing at.

So, I tried a few other approaches. I bought a couple of devices—a talking photo album and a Go Talk 20+. The Go Talk 20+ had a limitation in that you could only have 25 items on the board, then someone would have to physically pull out the sheet of pictures and put in another one. With the talking photo album, you could record something to go with each picture, and then you could push the button with the picture to have it speak. But again, the problem was that you had to flip pages constantly. They just weren’t very practical for my patients.

Then there were several bigger, more costly systems that used symbols or icons or drawings—kind of like stick figures—and my two stroke patients just didn’t really understand them because the drawings were too abstract. And other patients who had their cognition intact but who just had lost their ability to speak, they found the icons and drawings too childish, so they didn’t like them, either.

What really pushed me over the edge, though, was when I was sitting with my patient, Dorothy, and she was trying to have a conversation over Skype with her daughter in Bulgaria. She was using the picture-word board I had created for her to try to communicate. And even though the pictures were real pictures that I had taken and that Dorothy was used to using to communicate, it was really hard over Skype for her daughter to see what picture her mom was pointing at.

Dorothy was frustrated, her daughter was frustrated, and I was frustrated, watching it all happen. So that’s when I decided that something needed to be done, and I started researching. I checked to see if there were any photo apps out there that had voice or speech output. And there really wasn’t anything out there for adults to use.

My inherited inventor genes kicked in. My dad, an inventor, created a diode scanner and various sports games. About 8-10 years ago, I decided to turn his invention into an iPhone app as a tribute. I interviewed local developers and hired one for the project.

At the same time, I was helping two patients who had a stroke communicate better. After completing my dad’s app, I shared my idea for a speech-impaired communication app with the developer. I designed the app’s layout, grid, and color scheme, emphasizing a voice feature. I took all the photos for the app myself and provided them to the developer.

The next step was to do some Beta testing to see how the app worked for different people with various challenges and get their feedback so we could improve the product.

The first version of the app was pretty basic with preset photos and the ability to customize a few pages. But I soon found out that people using the app really preferred customizing the app with their own photos. They didn’t want my “eat” picture; they wanted their “eat” picture. So, we gave them the ability to create an unlimited number of custom pages.

Another big thing many people wanted was text-to-speech capability. This was because the people who had the physical ability to type wanted to be able to say things the way they wanted to say them right in the moment, not to go searching for a previously recorded phrase tied to a photo. So, we added that capability.

We added low-vision features that enlarge selected items and integrated with the iPad’s accessibility options. This includes touch accommodations and Bluetooth switch compatibility for people with physical disabilities, making the app more user-friendly for those with navigation or accessibility needs.

So, over a period of a few years, we just kept testing it and adding functionality to make it better.

Once we gained traction with people using the app, I began marketing it more heavily. I expanded the website and exhibited at conferences. I could likely make more sales, but as a passionate speech pathologist, I’m not a natural salesperson. I need to be more assertive but don’t want to bother anyone.

Some APP2Speak Success Stories

In the years since I created APP2Speak, users have shared a number of success stories with us.

One of my favorite stories is that of Bob and Wayne. I was introduced to Bob through a customer service inquiry from his best friend, Wayne.

Wayne had discovered APP2speak after his friend Bob was diagnosed with throat cancer and was told he had to have a laryngectomy and would lose his voice.

Bob asked Wayne to try and find something that would allow him to communicate with his mobile phone once he became speech impaired. He wanted to be able to text his words and have his phone speak them out loud for face-to-face communication.

Wayne did a diligent search on the web, and APP2speak kept popping up as a great option. He checked out the website and then eventually reached out to me directly for a demonstration.

Bob purchased the app and the two began practicing with each other until he was comfortable using it before his surgery.

The best part about this story is when Bob had his surgery at Tuffs Medical Center in Boston, he woke up from recovery and was able to communicate with the medical staff immediately. The nurses were amazed and had never seen the app before. They took the information down for future patients.

Not only could he text his words to speech, but he found the preloaded photo pages to be extremely helpful. Once Bob arrived back home from the hospital, he had his custom pages set up for everything from the supermarket to an emergency call photo with critical emergency information.

Wayne wrote me later and told me that APP2Speak was truly a life changing tool. That brought tears to my eyes!

Then there’s my patient Helen. She had Bulbar Onset ALS, which caused her to lose her voice, and she had been using an expensive big box computer system to communicate before she found APP2Speak.

What Helen found so helpful about APP2Speak was how easy to use and portable it is. Instead of having to pack a big computer bag to take with her anytime she wanted to go out, she just had to take her device with APP2Speak on it. She was fond of saying, “APP2Speak on my iPad gives me the freedom to carry speech in my purse!”

And then there was the patient who had a stroke and whose therapist at the outpatient clinic had demonstrated APP2Speak app to him and he and his wife purchased it.

I didn’t even know about him, as he wasn’t one of my regular patients. But I was called to work at the clinic one day as a floater and this gentleman was on my schedule.

When it was time for his therapy appointment, he comes walking up with his backpack and he had a big smile on his face. He pulls out his iPad, opens it up, goes to the custom pages on APP2Speak, and hits a photo he had added of a beer mug. The app then said, “Beer me!”

Turns out, the therapists and his wife had worked with him to customize the app and he would use it to say, “Beer me!” whenever he went out for a drink with his buddies. To see him getting so much joy out of being able to communicate with others in his own unique way using the app just made me so happy.

These are just three of the many success stories that have been shared with me about how people have benefitted from using APP2Speak. And it just makes me extremely proud that I could provide this amazing tool for them to use.

APP2Speak: Future Plans

I have big plans for APP2Speak, aiming to reach more people in need. Before COVID, I made strides with presentations at two major St. Louis hospitals. I hoped the pandemic would prompt hospitals to license the app due to increased intubations, but they were too overwhelmed. Post-pandemic, many contacts had moved on, so I am to starting over.

I’m reaching out to new partners. One company is integrating APP2Speak with eye gaze and Neuronode technology for the iPad, currently in Beta testing. I’m also working with medical professionals to expand the app’s adoption.

Conclusion

As you can see, as a long-time Speech Language Pathologist and amateur inventor/tech geek, I’ve had quite a career.

I’m proud of all Speech Language Pathologists for the work they do and proud of the field in general. It has been my life’s calling, and I feel like I’ve made a solid contribution, especially through my efforts of designing, creating and self-funding APP2Speak.

I know that I won’t be able to do this work forever, but after 41 years, I have to say that I still have a little bit of gas left in the tank!