As a part-time speech-language pathologist at Akron Children’s Hospital, Shelly Vaughn’s services are in high demand.
Today, she’s at the Akron campus where her diverse skill set allows her to see a preemie in the NICU for feeding therapy and a teenager struggling with stuttering, all in the same day.
On Wednesdays, she does outpatient evaluations and therapy. On Thursdays, she takes her talents to our NICU at Summa Akron City Hospital.
“Many people hear the term speech pathology and mistakenly think all we do is speech and articulation therapy and that’s not the case,” said Vaughn. “Medical speech pathologists see complex and difficult cases.”
It’s a subtle art form marrying thinking, memory, motor control and communication – one that Vaughn does well.
“With younger patients, we start with teaching pre-linguistic skills, including attention to external stimuli and cause and effect,” said Vaughn. “While they are young, children need to have good listening and attention skills. When those are established, we can address language comprehension and expression needs. Language has to be understood before it can be meaningfully used.”
“Once children start expressing themselves, we sometimes see that they have difficulty making sounds that allow them to be understood,” Vaughn continued. “I have to teach some patients how to coordinate all the muscles necessary to make a sound – connecting the brain to the mouth and then making the sound happen. It’s a complex process to learn communication skills, and we are here to help kids anywhere there is a breakdown in the development of that process.”
Oral feeding therapy for our tiniest patients
Vaughn has already seen 3 outpatients in the infant therapy block this morning. This unique program provides speech, occupational and physical therapy to patients with complex issues.
Vaughn’s first patient of the afternoon is baby Brice who was born 13 weeks premature. Brice, who has been in the NICU since his birth on April 28, hasn’t been taking oral feedings well and has an NG tube to make sure he consumes enough food for growth.
“We waited for Brice to reach 34 weeks and be medically stable until we came in and evaluated him,” she said. “Once that happened we developed a treatment plan that included some goals we could work toward.”
A few of Brice’s goals are to stay awake for a 20-minute feeding session, to demonstrate visual regard for voices and faces, and to consume a certain amount of formula without any signs of distress.
“The ultimate goal is to protect the baby’s airway and make feeding a safe and positive experience,” she said. “Babies show a whole lot of behavioral cues that I need to teach parents to look for.”
Vaughn reviews how to position Brice’s bottle and how to pace the feedings, then sticks her pinky in his mouth to see how his tongue moves. She advises Brice’s mom and grandma to continue to use a slow flow low-flow nipple and watch for nostril flares, finger splaying, color changes and head bobbing, which could indicate Brice is struggling to breathe while eating.
“Babies need to learn how to coordinate the suck-swallow-breathe pattern for feedings,” Vaughn explained. “When feeding preemies with a history of lung issues, we need to be extra careful to make sure they are eating safely, as poor feedings can compromise their lung development even further,” she said.
Taking a team approach
Vaughn sees her next patient, 4-year-old Dylan, in the sensory gym located on the rehab unit.
“Dylan has very limited verbal communication,” Vaughn said. “He has a condition called dyspraxia, where his brain can’t plan for the motor movements to make speech happen.”
Vaughn has been seeing Dylan for 2 years now. When he first came to her he wasn’t speaking at all.
Vaughn attempts to verbally engage Dylan during their walk to the gym area, where his only spontaneous communication occurs when he sees a fish tank in the hall. “Fish” is all he says.
Dylan and Vaughn are greeted in the sensory gym by occupational therapist Heather Reiss, who is co-treating Dylan for sensory issues.
“OT helps Dylan to perceive things visually and can help get him back on track when he starts to lose focus during our sessions,” said Vaughn.
Dylan sits in a big swing suspended from the ceiling while Reiss offers him the option to spin or swing. He doesn’t answer, so she asks again.
Vaughn pulls out flash cards of everyday objects to try and get Dylan to identify. She is testing his ability to recall, retain and retrieve information. He guesses wrong when presented with a picture of a clock so Vaughn tries another approach – “tick, tock, tick tock.”
When Dylan starts to zone out Reiss lets him climb out of the swing and rolls him up in a blanket – a Dylan burrito she calls it. This provides sensory input that his body was craving, allowing him to focus and attend to Vaughn when he returns to her activity.
Once he focuses, Vaughn places 3 cards in front of him – a sink, a broom and a chair.
“Which one do we sit on? Which one do we sweep with?”
When Dylan can’t readily answer, Vaughn cues him to say “help please.”
Dylan is quick to mimic her when Vaughn says the words in quick succession. She taps out the syllables with her hands for words he struggles to grasp.
“Dylan, what do we sit on?” she asks.
The answer she’s looking for is chair, but when he answers carpet square (a familiar sitting place at his preschool), she is thrilled he understood the question.
“I think that was my favorite answer of the day,” she said.
Today’s therapy session focused on labeling common objects and adding “ing” to work on verbs.
Reiss gives Dylan thera-putty (a therapeutic form of silly putty) to help him refocus while Vaughn throws in some action words such as pinching, rolling and patting to reinforce today’s vocabulary.
The session ends with Vaughn asking Dylan to imitate her facial expressions. Oral and verbal imitation and oral motor coordination are skills necessary for speech production.
“Can you make an ‘O’ with your mouth? See if you can lick your nose? Can you make this buzzing sound with your lips?”
Vaughn’s last patient of the day is a 13-year-old fluency patient who has struggled with stuttering.
Eighth grader Austin has been seeing Vaughn every other week for about 2 months now.
“Austin has made great progress, but I purposely try and make it hard for him in therapy so that we can practice techniques for controlling his stuttering,” she said. “I want him to stutter when he’s here so I can work with him on techniques to use when it happens at school or at home.”
Some of those techniques include slowing down the rate of speech, learning how to coordinate breathing and speaking, thinking about what to say ahead of time and using light contact between the articulators – the lips, tongue, teeth and roof of the mouth – so everything in the mouth relaxes.
Vaughn asks Austin about school.
“Tell me 2 good things and 2 bad things about your first week of school?”
Austin said he likes that he has classes with friends and that he enjoys his funny social studies teacher.
Vaughn is quick to pick up when Austin gets stuck on a word, and she isn’t shy about calling him out on it.
“Did you just get stuck? What did you do to get out of it?”
Since Austin often gets stuck on ‘B’ and ‘N’ words, Vaughn has him read from a dictionary-like book.
The session ends with Austin’s mom being tasked with making him stop and start over when she catches him stuttering at home.
“Rather than allowing him to push through his blocks and repetitions, I want him to become more aware of when they are happening,” she said.
She teases Austin, “You’re not allowed to get mad at her – it’s part of the therapeutic process.”
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