Melanie (Host): Welcome to Healing Heroes PDX, the podcast series from the specialists at Shriners Hospitals for Children in Portland. I'm Melanie Cole, and I invite you to listen as we discuss speech therapy at the Portland Shriners Hospital. Joining me is Diana Deaibes. She's a speech and language pathologist at Shriners Hospitals for Children in Portland.

Diana, it's a pleasure to have you join us today. Give us a little overview of what areas speech and language pathologists treat. What areas do you treat and what is the difference between speech and language?

Diana Deaibes (Guest): Sure. Licensed and certified speech-language pathologists work to prevent, assess, diagnose, and treat those individuals with various disorders as it relates to communication and swallowing. There are nine different major treatment areas and these include articulation, fluency, language, hearing, voice and resonance, feeding and swallowing, and all the cognitive and social aspects of communication.

A speech-language pathologist work in a variety of settings. And many of us work in schools, skilled nursing facilities, private practices, or hospitals such as Shriners Children’s Hospital. And here at Portland Shriners Hospital, our speech-language pathologists work with children from birth to 21 years old, who present with speech and language disorders ranging from mild to severe and retreat children who present with various developmental disorders including cerebral palsy, Down syndrome, Rett syndrome and many others.

They're evaluated and treated in our outpatient rehab clinic. And we also work closely with children who present with speech sound disorders and resonance disorders due to cleft lip and palate, and here at Shriners Hospitals for Children, every patient who's in our cleft lip and palate program and has an identified speech, language or resonance concern are followed throughout their entirety of their care here when they're a patient.

Melanie: Well, thank you for that, Diana. So how would a parent know if their child needs a speech and language evaluation? What should they be looking for? Give us some red flags and signs of things that would signal the need for an evaluation.

Diana Deaibes: So most children develop speech and language within a specific age range, and a child who takes a little bit longer to learn a skill may benefit from being evaluated by a speech-language pathologist. The best tip I can provide to a family is if they have a concern, to just bring it up to their child's primary care physician and let them know about their concerns.

Sometimes we hear families say, "It's okay that my child isn't talking yet because their sibling was a late talker" or the family might have a friend whose child is a late talker. And I would really encourage those families to still be seen by a speech-language pathologist, because we know that early identification of those speech and language delays can result in better outcomes.

Some great resources families can refer to include the American Speech Language and Hearing Association website and the Centers for Disease Control and Prevention website. Both of these websites have great information related to speech, language, and development.

Melanie: Well then, tell us a little bit about the evaluation itself. How do you determine recommendations for treatment? What does the eval look like?

Diana Deaibes: We complete a very thorough evaluation with each patient and family we work with. The evaluations are usually driven by the concerns of the patients and their family as well as the referral source. And our goal is to address all the questions of the patients and families we serve and to determine a treatment plan that is best suited for that individual. And every treatment recommendation is individualized based on the needs of the patient. There's no one-size-fits-all as every family and patient we work with has their own unique strengths and abilities.

For example, I once evaluated a patient with cerebral palsy, whose family had concerns about delayed speech and language milestones. We completed a play-based speech and language assessments, during which I assessed the patient's speech sounds, and what sounds the patient could and couldn't make. During play, I evaluated their ability to express English grammar and use different types of messages, such as requesting for more of an activity or asking questions or commenting.

And within the same activities, I evaluated their ability to understand language and follow verbal directions. And during that evaluation, we found that their ability to understand others was stronger than their ability to express themselves. And this patient really wanted a way to communicate successfully with their classmates in school and their family members at home.

And after ongoing treatment, a collaborative decision was made by me and her family and her school team to acquire a communication device for that patient, which was incredibly helpful.

Melanie: That's really wonderful what you do, Diana. So the Portland Shriners Hospital is so unique because you offer this wraparound care to patients, all available under one roof. Tell us more about your team and how the care you provide is integrated with other services at the hospital. Talk about this multidisciplinary approach.

Diana Deaibes: We collaborate with the patient's medical team and other rehab clinicians. We also collaborate with the patient's school teams to ensure that continuity of care. I recently worked with a patient who was utilizing a communication device. And during our sessions, I noticed the patient had difficulty using their hands and fingers to access their communication device.

So I immediately contacted their occupational therapist on our team here at Shriners Hospital. And they worked with the patient to create a splint for their hand to allow this patient to keep their pointer finger extended so that they could access their communication device with accuracy. And then I also collaborated with their physical therapist, who was helping them obtain a manual wheelchair because this patient was coming in in a stroller and their body was not fully supported to access their communication tool. So after discussing this with their physical therapist, it was decided that they would benefit from a manual wheelchair.

And then I reached out to this patient's school team, specifically their school's speech-language pathologist, and we worked together to just ensure that our language interventions were similar and all the modifications that needed to be made to this patient's communication device were in place so that she could be well supported in the classroom. So this is just an example of some ways we provide that interdisciplinary care and wraparound care for our patients.

Melanie: You've mentioned communication. Obviously, you're a speech and language pathologist. A specialized area of treatment that you provide is augmentative and alternative communication or AAC. Tell us a little bit about what this is and what types of AAC devices you have in-house, how they help with patient care.

Diana Deaibes: Sure. Augmentative and alternative communication or AAC for short are tools and strategies that are used to replace someone's existing speech or support a person's natural speech. AAC is a specialized area of practice intended to assist those individuals who present with complex communication needs.

There are different forms of AAC. And there are unaided forms, which could include the use of our bodies, such as gesturing and changing our facial expressions and using sign language. And then there are aided forms of AAC, and these can include the use of communication books or picture symbols, alphabet charts, a voice output communication aid or some sort of high-tech speech-generating device.

And the goal of using AAC is to increase the patient's ability to be able to express themselves using strategies and tools, whether that would be to assist a patient who is having difficulty communicating using verbal speech or a patient who has verbal speech, but maybe they're unintelligible and their AAC tool might be used to help them repair that communication breakdown when they're being misunderstood.

Melanie: Well, so then how have these communication devices been accessible for patients to own or to have long-term? Tell patients listening and their families how this process works.

Diana Deaibes: Once the patient is evaluated at Shriners Children's Hospital, we determine if there's a need for a communication device and we trial several different devices through a feature matching process. And once a particular device is recommended and the family agrees with the recommendation and the school team is on board, we then go through their insurance company to request funding for it, because these devices are very expensive. And this process can take from several weeks to several months. But once we go through that process, and their device is funded through their insurance, that device can get shipped straight to their home.

Melanie: What are your goals for your patients and what skills do you teach them to do? And while you're answering that, Diana, tell us how you work with the families as well, because obviously they've got to be doing some of this stuff at home, practicing the skills you're teaching them. Tell us a little bit about that.

Diana Deaibes: My goals for my patients are very specific to their needs and their families' goals for their child. Our goals for our patients is to increase their ability to participate in communication and in their daily activities and school activities. For many of our patients who utilize AAC, this is done through speech therapy, ongoing speech therapy services. And one thing I like to encourage families to do is just to try to implement some of these things that we're working on in our sessions during their child's just daily routines at home. So we also like to train families and caregivers on some of these language interventions that we're implementing in our sessions and empowering families so they feel confident practicing this at home with their child.

One example of a patient, a teenage patient I worked with who was utilizing a communication device, her goal was to maintain that social connection with her peers. And since she's quarantined right now, the way she wants to do that is through social media. All of her friends are on Facebook and she wants to be able to read her friend's posts and respond to them on Facebook.

So in therapy, one of her goals was to work on increasing her literacy skills and be able to ask questions by commenting on her friend's posts and be able to have that back and forth and continue a conversation online. So this is just one example of how we tailor some of these goals to the patient's needs and what they want to work on.

Melanie: As we wrap up, Diana, please tell the listeners what you'd like them to know about speech and language pathology at the Shriners Hospitals for Children in Portland, what you do for a living and your philosophy of care.

Diana Deaibes: We want families to know that we care about their child and we want them to be able to communicate as best they can. And here at Shriners Hospitals for Children, we are the hub for assistive technology and augmentative and alternative communication. We work very well as a team with our physical therapists, occupational therapists and your child's speech-language pathologists in their school team to ensure that all of their needs are being met.

Melanie: Thank you so much, Diana, for joining us today. For more information, please call the Rehabilitation Department at the Portland Shriners Hospital at (503) 221-3429 or you can visit our website at portlandshrinershospital.org for more information.

That concludes this episode of Healing Heroes PDX with Shriners Hospitals for Children in Portland. Please remember to subscribe, rate and review this podcast and all the other Portland Shriners Hospital podcasts. I'm Melanie Cole.