More than words
The Speech and Hearing Clinic goes beyond expectations when treating patients
By Paula Wheeler
James Kasper, age 3 1⁄2, arches backward over a yoga ball. “Guh, guh, guh,” says the young woman at his side, stabilizing the ball as the toddler reclines.
It’s a scene straight out of any community gym’s “Mommy and Me” playtime class, but this setting has a more serious focus. James is a patient at the Marquette University Speech and Hearing Clinic, working with speech pathology graduate student Samantha Godfrey. His mom is on-site, but she’s watching them from a side room, through a two-way mirror.
While little James seems to enjoy lolling on the ball, Godfrey is hard at work trying to coax him to repeat the sound she’s making — a hard “G.” Later, she may have James bounce upright on the ball or lie prone on a gently swaying platform swing, all the while encouraging him to vocalize and communicate.
“I teach my students, from day one, that you can’t just look at the head, neck and mouth,” says Bridget (Schuh) Valla, M.S., CCC-SLP, CJPA ’91, Grad ’92, clinical assistant professor of speech pathology and audiology. “In speech therapy, you’ve got to look at the whole body. Any physical motor impairment is going to be something we look at because it can interfere with speech and language development.”
This yields a treatment approach that integrates movement — much of which might seem like play to the clinic’s youngest patients, keeping them engaged enough throughout the 45-minute therapy sessions to make measurable progress.
James first came to the Marquette clinic in spring 2015. His mom, Katie Kasper, Bus ’09, says she and her husband had been searching for a place where the therapists would exercise creativity in working with their uniquely challenged son.
“There is not another kid in the world like James,” Kasper explains. “In addition to having Dandy-Walker Syndrome (a congenital brain malformation that affects motor coordination), he’s visually impaired and also hearing impaired. If you think about the challenges of each of those impairments and how they are magnified when combined, it’s not a simple addition equation.”
The clinic at her alma mater, and the approach of Valla and her students, impressed Kasper from the outset. While therapy sessions elsewhere saw James confined to a seat, during his very first session at Marquette, “He had the run of the room,” Kasper says. “They were letting him take the lead. They would let him move around to objects and activities and toys that interested him, and use his interests to drive the angle they took on therapy in a given moment. Seeing them meet him where he was, and use the things that were interesting to him to drive progress and the activities, is how we knew it was great fit.”
Valla, who has been teaching at Marquette since 2007, explains that supporting a patient’s overall development throughout a therapy session is critical and helps improve factors related to speech production, such as cognition, muscle development and postural control. In addition to positioning James in ways that make sounds physically easier to produce — such as on the back for “K” and “G” sounds, on the tummy for the “L” sound, and bouncing on the yoga ball for labial sounds like “B,” “P,” “M” and “W” — Valla and her students work with him on feeding and chewing.
The motion of speech
Even something as simple as the transition from yoga ball to feeding chair has therapeutic relevance for James. At a recent session, Valla chose to support James as he walked on a mat from the ball to his chair, rather than carrying him.
“That way, I’m getting more movement from him, as well as postural control and balance,” she says. “This provides a base of stability prior to feeding, to get that trunk a little bit more active before we work on the mouth.”
Once in the chair, James is presented with small pieces of a cookie. Godfrey and another student gently encourage him: “Mmmmm!,” they say, exaggeratedly bringing their own molars together in demonstration. “Chew, chew, chew!”
But, as Valla explains, James sucks food because his chew pattern is not developed. While James is eating, one of the students wipes his mouth from side to side. Valla, watching through the mirror, is on her feet. “I have to go tell them not to wipe his mouth,” she explains, “because it’s disorganizing to the motor patterns.”
The work with chewing and biting helps improve mouth motor control in a way that also impacts vocalization and pronunciation. Kasper says a different therapy provider had told her they didn’t think James’ feeding issues could be addressed. “We didn’t buy that, and we took that report to Bridget and the students, and they’ve been working slowly but surely with him on accepting solid foods,” Kasper says. “Sure enough, now he will eat a cookie or a cracker. He’s making progress. The concept of ‘There’s nothing that can be done,’ is absolutely wrong, and the clinic has showed us that.”
Good communication with specialists from other disciplines who may be working with her patients is a key priority for Valla. She knew, for example, that James was working on walking with his physical therapist and that informed her choice to help him walk from ball to chair. “I wanted to make sure I was supporting his development in an interdisciplinary way,” she explains.
The collaboration promotes professional understanding of other fields that impact the patient, and Valla has introduced it clinically to her students since she began at Marquette.
Continuity is key
Continuity with the families of pediatric patients is another component that can have a major impact on speech therapy. For James and many of Valla’s other patients, that can take the form of practicing much more than speech sounds at home.
“Everything James does in the speech clinic is a homework assignment,” Kasper says. “He’s in there twice a week, which is a pretty high frequency of therapy for a child, but for him to really master skills, he needs to practice all the time. When we see things working in the therapy environment, we try to replicate them at home.”
"When we first brought James to the clinic, we weren’t sure if he could understand anything we were saying to him. Now, it’s pretty clear that he can understand just about anything.” — Katie Kasper, Bus ‘09.
For example, the family installed a platform swing in their basement when they saw James enjoying using that tool in the clinic. When he’s happy during therapy, Kasper says, he’s more motivated to work on his communication skills.
Overall, Kasper is thrilled with James’ progress. She appreciates that the clinic focuses on developing James’ overall communication skills and development, not simply producing speech.
“When we first brought James to the clinic, we weren’t sure if he could understand anything we were saying to him,” she says. “Now, it’s pretty clear that he can understand just about everything, and his receptive language continues to grow every single day. His reciprocal communication, listening and responding have come such a long way, and we couldn’t be happier.”