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Learn about a treatment option for adult upper limb spasticity. Learn More


Hello everyone. Welcome to another episode of the Note Plateau podcast. I'm your hostHenry Hoffman. I'm excited to be with you today. I would like to introduce our special guest. We haveAbbe Simon, who is a speech language pathologist and the owner of iCommunicare. She is also an integrated health coach. And we have a couple of things in common, which I learned pre-show.Abbewent to school in Buffalo. I am from Buffalo. Go Bills.

Podcast Transcript

Henry Hoffman (00:31.044):
Place of employment, which is Brooke Rehab Hospital. And I forget when she'll, we can never dive into that. So I thought that was pretty crazy. And I am excited to have her on today. We're gonna talk about a lot of things about communication disorders and whatAbbedoes and her specialty. So welcomeAbbe, how you doing?

Abbe Simon (00:48.366):
I'm very impressed that you remember those things,Henry. Thanks for reminding me.

Henry Hoffman (00:52.432):
Yes, yes. Now, refresh my memory. Did you go to University of Buffalo? Okay. And when did you work at Burke Rehab Hospital?

Abbe Simon (00:57.13):
I did, went to Snoopy Buffalo.

Abbe Simon (01:02.963):
I was working at Burke until I moved out of New York to come to North Carolina. So I guess that was about nine years ago I left Burke. I don't think he overlapped though, right?

Henry Hoffman (01:11.188):
Okay. No, no, I left Burke and when I started Sabo, it was 2002-ish. And so that's when I took off and followed my dream. Yeah. Yes, yes, we're all living a dream, right? Yes, love Burke, always love Burke, love bragging about Burke, they do great things. Well, listen, let's start off because we have a lot of stuff to talk about. Let's start off with a little quick background about you. How about you go there first?

Abbe Simon (01:23.015):
Oh, good. I think I did too. I love my days there, I did.

Abbe Simon (01:39.474):
Okay, sure. So as you said, I am a speech language pathologist. I've been doing it for just over 25 years after graduating from Buffalo. And have always, even though I've worked with people of all ages and reasons that they need speech therapy, I had a natural calling and passion for working with adults who have acquired a communication disorder. And we can talk a little bit about types of communication disorders in a minute.

But my career has included working in rehab places like Burke, acute care hospitals, outpatient clinics, long-term care facilities, and doing some intensive aphasia programming has led me to create my own business called iCommunicare, which I didn't know when I made up the name 25 years ago would lead me to helping people achieve maximal communication post brain injury or stroke.

In a caring way, but then also a couple of years ago, I decided to go back to school to become an integrative health coach so that I could serve care partners.So the name of my business, iCommunicare, which started so that it represented the caring way I deliver communication therapy, wound up having double meaning because I focus on communication and the care partner because as we'll talk about, when someone, a communication disorder. It could be very abruptly and suddenly. It could be slowly and insidiously. They're not the only one that's impacted by the diagnosis. So over the years when I'm working with people and see a communication or care partner in my office, I realize that they too need some specific attention. And so I'm really fortunate to now be able to serve them as well.

Henry Hoffman (03:24.236):
Wonderful, wonderful. So let's start there because you bring up a good point. Our listeners are divided between health professionals, mostly occupational therapists, although we do get a mixed bag. And then we have a lot of clients, patients, as well as caregivers or slash care partners. So why don't we cater to both audiences? I think we will, but let's start off with what exactly are some of these communication disorders that you typically treat as a speech-language pathologist.

Abbe Simon (03:52.322):
So I think oftentimes people perceive a speech therapist when they first hear the word as someone that's sitting on the floor playing with kids who have maybe a language delay or children that have difficulty articulating words and they need to catch up to speak better and more like their peers. I focus, like I said, working with adults and when an adult acquires or gets a communication disorder, it's the result of something happening in their brain.

And our brain, as you know, and most of your audience knows, is split into two hemispheres. And in most of the population, especially right-handed people, language is housed on the left side of the brain. And some people, especially those that are left-handed, might have some language in the right side of the brain. But when a disturbance, via a stroke, a brain injury, degenerative diseases like Parkinson's or dementia syndromes, or even some mild cognitive impairments that alter

the part of the brain that is responsible for language, of which there are many. We could be specific if you would like to, we think your audience would. But when there is a change in the brain's function, as a result of blood flow or change in neurotransmitters, language and the retrieval of words and communication becomes impaired. And I focus mostly on people who develop as a result of stroke or brain injury or brain tumor, something called aphasia, which most of the time happens from a stroke.

Henry Hoffman (05:24.356):
Gotcha. Okay. So then let's take aphasia. We'll dive deep because the audience will be made up Since we are the no plateau podcasts serving typically brain injury individuals specifically stroke survivors I know aphasia is a hot topic How do speech therapists actually evaluate and treat the classic? What's a traditional? Model for evaluating treating patients with aphasia then we'll dive into what some of the latest evidences and where people are, you know Where are we going in the future?

Abbe Simon (05:50.85):
The word traditional is interesting. I would say that I, traditionally, I could sit outside on a bench or taking a walk with someone and decide whether or not they have aphasia and what type of aphasia they have. But when we use that word traditionally, or the way that I was taught 27 years ago, there are these things called formal measures that we have to probably administer in order and especially when insurance is in the picture. But...

Because aphasia is a language disorder, and one of the most important things I must stress and hope that the listeners take away from this is that aphasia does not affect intellect, one's intelligence or the knowledge that's stored in their brain before the stroke or other reason that happened caused it occurred, right? So it may take away the ability to access the information, but all the information is stored in the files in our brains.

And traditionally, when a speech pathologist meets someone for the first time, they just want to get a sense of how a person is exhibiting language function. And language is reading, the ability to read, the ability to write, the ability to comprehend information that they hear and read, as well as obviously speaking. So a speech pathologist would look at those four domains of language using a mix of their own subjective ear and eyes as well as objective measures so they can get some quantitative and qualitative baseline information and then decide the type of aphasia they have. But what I must add, and hopefully all speech pathologists know this, is yes, we have to use these batteries that have a standard set of questions. And if I'm seeing someone with aphasia maybe for the second time they're getting speech therapy, it might be possible that client has seen that battery before.

So there are these standard language measures, like I said, but what's really important that anybody have the chance to participate in are something called patient-reported outcome measures, which are the less language-based tests and more opinionated questions and personally answered questions that reveal a person's confidence, their...

Abbe Simon (08:07.19):
Perception of what they're capable of and the goals that they want to achieve. So really digging down deep into what the person feels is compromised by their aphasia and what they want to improve. Because it's not the same for everybody regardless of their diagnosis.

Henry Hoffman (08:21.24):
That's very interesting that you say that. And again, I always take it from the standpoint of an occupational therapist, because I can only go back on my experiences treating arm, hand, and recovery. And when I think about treatment for aphasia, I think about what treatment do I currently do motorically to help someone's arm or hand? And we know that there's something called the phenomenon learned on use.

So let me digress for one second. So we've learned on use, the audience knows if they listen to other podcasts that we've had, when you stop using your impaired side, neuronal cells continue to shrivel up and die because you're no longer giving that feedback to the brain that's needed right around that core area that died. So right after that stroke, the immediate core, the lesion, that's dead, that's never coming back, but the surrounding area, the paralegional area, that's alive, but it needs to be reactivated.

It's hurt and it'll take some time to get re-engaged. And during that acute, subacute, that could take several weeks, it could take a couple months. That's where they get that spontaneous recovery. And after that part's over, then you start that chronic phase where you have to do the rewiring process. But during those critical phases, many therapists in my profession, a lot in the hospital setting, are forced to do one-handed techniques and forced to compensate because they gotta get them independent as soon as possible through adaptive strategies.

And we know that's a big no-no cortically if we're trying to rewire the brain. The last thing the brain wants is a compensatory strategy where you're not talking to the brain, the affected area. So how does speech language pathologists handle that situation? That's a tough subject for OTs because, you know, some will give dirty looks to other clinicians if they're doing one-handed strategies just to get them out the door as soon as possible, where technically you really should be starting the process of, you know,

purposeful task training, you know, engaging that limb with a lot of repetitions at the appropriate time. What is the battle for speech therapists with learning on use? And how does that even look like? What does that even look like as far as adaptive strategies versus remedial strategies? Is that a big deal?

Abbe Simon (10:33.71):
Right. Yeah, well, I'm gonna just say something you mentioned was what the brain wants. So you said the last thing the brain wants is a compensatory strategy, but we need to acknowledge some people's brains or some brains actually want that, dare I say, easy way out, right? And when we approach speech therapy to improve language, like you mentioned occupational therapists can do or rehab professionals, we can introduce compensatory strategies.

Or we can introduce restorative strategies. How can we restore something, regain its function? Or we could compensate. There's nothing wrong with compensating, but it's not maximizing. And all those terms you mentioned lead to that big word, neuroplasticity. And we know, and I tell every patient of mine, regardless of their age, that the brain can change. And I'm sure you're familiar with the Climon Jones article about neuroplasticity and the 10 salient features that allow a brain to be capable of rewiring itself. And you mentioned a lot of things that speech pathologists do as well when trying to treat aphasia. So learned non-use, right, is that philosophy of use it or lose it. And so yeah, if I don't use it, I'm going to lose it. And it's the same thing, whether it's your limb or with those parts of the brain that spark the use of language.

So we have to use it or lose it. We have to do salient behaviors in a repetitive way. So if someone is asked to use a form of language that they've never used before or don't wanna ever do any long-term writing, then we probably wouldn't focus so much on repeating a writing drill. We want to use things that matter to a person and do those things in a language focus while using some impairment-based treatments, right? So there's an impairment, what can't, quote unquote, the person do, and how are we going to restore that function by, like you said, all those perilesional areas of the brain that were not affected, how are we gonna recruit the neurons from those regions and ask more neural networks to be formed? And I am a firm believer in doing intense and repetitive work.

Abbe Simon(12:53.958):
So that a one and done feeling is not allowing the client to think they've mastered something and they can move on to the next. But we have to do things so that new pathways are established from repetition.

Henry Hoffman(13:09.528):
That's really good, that's a great way to say it. And I know we'll get into treatment interventions and technologies, but just to keep this conversation going just a little bit longer, I wonder when you think about adaptive strategies for speech, clearly if one cannot communicate and they're trying to live an independent life, and there's tools and there's apps, we'll talk about apps and tools. I remember talking to the gentleman who suffered a stroke, he has a salt app out of Canada, speech and language therapy app, where it has text to speech folders. So if you happen to be at CVS, and you're trying to say, please fill my prescription, and you can't say that, you go to one of your folders that's under pharmacy, and you hit play, and it says your sentence. So we'd want to deprive people from their independence, because stroke is also a mental health problem, right? But at some point, we still want them to improve. And so where's the cutoff? Where is, and I don't have the answer. I don't think a lot of people do. I'm just curious to get your feedback.

Where's the cutoff from saying, okay, Bill, we're gonna work our butts off to get your speech back through rewiring and versus, okay, Bill, we've tried, now we're moving on to adaptive apps because I know in the physical impairment world, you have to do hours and hours of repetitions to receive enough rewiring to see something functionally happen. So to ask Bill to keep trying and trying and trying and failing and failing and trying. How many hours a day? And then, and then it doesn't work. He has to stay motivated. And then the alternative is, okay, well what I would do is I'd say, look, we're going to try as much as you can during a feeding session to incorporate your hand. But at some point after, after you've tried enough, you're hungry. You know, you're going to have to come in with the other hand to help. What, what say you on that?

Abbe Simon(15:02.183):
Yeah, well you just had a lot of thoughts enter my mind and I want to go back after I respond to that about a couple things about aphasia. Let's just acknowledge you said, you know, aphasia and stroke also into causes some emotional change of the brain. And I love incorporating the counseling aspect into my aphasia therapy because overlooking.

Henry Hoffman(15:04.801):

Abbe Simon(15:30.146):
the incidences of depression, whether it's just, you know, just stroke. So we know that like a third of people or more of people who have stroke wind up having episodes of depression, which are rightfully so. And then if a person has had a stroke and has aphasia, they may have a greater incidence of feeling depressed, withdrawn, and especially isolated. So before I answer a little bit about that example, I wanna say something I should have said earlier about aphasia, because aphasia...is often an unknown word until somebody learns about it because it happened to someone they know or themselves. There are more than two million people in the United States that have aphasia, yet more people know what Parkinson's disease and cerebral palsy are than aphasia. So this is leading me up to saying that this word acceptance and being able to look forward as opposed to get stuck in the present or look back in the past has a lot to do with a person's engagement and motivation in any kind of therapy. And the example of someone using a phone with an app on it or saying, no, I don't want anything to do with technology is really very person-centered. And when more people know what aphasia is and how individually necessary it is to meet that person's needs where they are.

It's very important in planning the trajectory of the therapy because there are some people who come to speech therapy with very little interest to be there. They come because they have to. They come because somebody told them that they should. If the person doesn't find purpose in what they're doing, they're not gonna want to improve. And you saying that someone is gonna get discouraged by failing and doing over and over and over again, my approach is to include errorless learning and I want to set up a client to succeed in every way they can. And if that means starting maybe at a lower quote unquote level and gearing up to what they want to achieve, then we want to show success as possible, because little steps will incrementally cause bigger ones. And when people engage in success, what we really see is this concept of transference. And I had a client this morning who has what we call severe apraxia.

Abbe Simon(17:51.822):
And apraxia is another form of an acquired communication disorder that involves the motor planning of the oral muscles so that you can say what you want to say, which is different than dysarthria, which is muscle weakness. So this gentleman engaged in lots of different impairment-based, if you will, therapies that has treated his apraxia and the control he has over his mouth to say what he wants to say. Anyway, one of the things he says, because he's involved in a lot of meetings in his is, you know, I know what I want to say, please be patient. He just puts his hand up and he says, please be patient. And today he was trying to say the word please with another word, and instead of saying please play, he went please be, and we both were like, ah, perfect example of neuroplasticity, perfect example of how all that script training, which is a therapy approach he and I have used, to get him to be able to say please be patient.

It overgeneralized, it carried over, so as soon as his mouth said please, he said please be, and he caught himself. So it was like just perfect proof of neuroplasticity in this 66-year-old guy who can now say please, alright, he may not want to say please be patient everywhere he goes, but he was like, oh, I can do it now, and he corrected himself. So it had purpose for him, and it just proved that, you know, the hard work pays off.

Henry Hoffman(18:57.496):
That's great.

Henry Hoffman(19:05.994):

Henry Hoffman(19:13.792):
Yeah, that's amazing. That's awesome. Thanks for sharing that. I love that. So that's a perfect transition point for us because I wanted to get into another area that OTs are very familiar with is something called constraint-induced movement therapy. And for the folks listening that are not familiar with CIMT or constraint-induced movement therapy, it's when you restrain your healthy limb and force it to use your impaired side for a period of time. There's different forms of CIMT, so I'll save that for a different show. But the results are fantastic. They show that there's significant progress that can be made through forced use, forcing that affected limb to do purposeful tasks repeatedly. And we all know reps, you know, reps are one thing, but not all reps are the same. So to your point about having salience and having meaning and purpose, those are important reps, versus just going to a gym and doing 30 repetitions of elbow flexion.

So that there is a difference there. But I've also heard over the years something called, since that was so successful, there was offshoots in other disciplines, one being speech, where it's called constraint-induced speech therapy, right? What exactly is that? And is that even successful? Because the science behind it makes sense. It's kind of leading up to what you're saying. What can you share about that?

Abbe Simon(20:35.106):
So have you ever played the game Taboo?

So, oh you should, yes you should. So Taboo is a game where two people or two teams each get a card and at the top of the card is a word. It could be the Empire State Building, it could be let's just say for argument's sake, Burke Rehab, okay, which it wouldn't in the game Taboo, but let's say it did. Oh, I shouldn't use that because not everyone knows what that is, but let's just say it said hospital. And.

Henry Hoffman(20:40.425):
Gonna have to I'm writing it down now.

Abbe Simon(21:01.258):
Get that card and underneath the word hospital are five words I cannot use to describe hospital to you and you have to guess what I'm saying. So I'm constraining the obvious words like medical, doctor, ambulance and forcing myself to be creative so that you can still understand what I'm saying. So when we constrain a form of language and like I said there's four forms of language right reading writing speaking and understanding and then within each ofin jive, you might speak in poetry, we all have different ways of delivering spoken words. And in, if you will, constraint-induced language therapy or constraint-induced aphasia therapy, a person might be asked to restrain or not to try really hard not to use single words, right? Or, you know, there may be someone who answers with a one word, you know, oh, what would you like to have?

Abbe Simon(22:01.078):
That's fine. I know that you want bacon, but if I say, I will not respond unless you give me at least three or four words in an utterance or a sentence. Um, the person's going to work harder at forming a complete sentence with increase, what we call syntax and grammar features. Other ways of constraining language are by, you know, you can use like a barrier. Let's say there was a picture in front of me and I wanted to describe that picture to you so that either you could draw it or you would know exactly what I was looking at. And I would say, okay, I'm gonna put this barrier up. I want you to describe in as many different ways what this picture scene is. So they can't gesture, they're not gonna write, they're not gonna use other forms of language other than spoken because language could be multimodal.

And if someone is having a really hard time explaining a picture or what they want, like I said before the bacon, oh, they could still convey that message in a different form. They might write it. They might have a picture book with things in it. They might act it out in gesture. They might point. But if we're going to constrain one of those forms of expression, we're going to focus on a specific part. Like you said, you know, the eccentric concentric movement.

We're going to force them to use the modality of language that we're really trying to hone in on and improve. But language can be successful even without spoken words. And so while it might feel compensatory, it still could be successful. And so because aphasia severity varies so much from person to person, everybody should still feel competent because there's so many ways to communicate.

Henry Hoffman(23:51.028):
Right. Not yet. Yeah.

Abbe Simon(23:51.09):
I could go on about this for hours, but I just want to say that, so that OTs know and you, if someone needed a splint or a brace or a foot support or a ramp to get into the house because they're in a wheelchair, people with aphasia can be given the same kinds of communication supports, like a communication ramp or a support, whether it's other choices that we can write for them, pictures that we can offer and other external ways to represent what you're thinking and feeling if the spoken word isn't possible.

Henry Hoffman(24:23.148):
Got it. So that is awesome the way you explained it, because I wasn't too familiar exactly with constraint-induced speech therapy, and you're constraining the language, which makes sense. SoHenry Hoffmanfor OTs is very popular. And they had the landmark study with Dr. Wolf's group years ago. How come we're not seeing the same popularity with CIST, I guess?

Abbe Simon(24:33.441):
Form of it.

Abbe Simon(24:50.362):
C-I-L-T, it's called like Silt, yeah. Because I don't know in terms of research why, but I will agree with you that it is not a popular form of aphasia treatment. And I would say my instinct without having done research about it is because there are lots of evidence-based principles that speech pathologists use in treatment sessions that are probably much more functional. And what we...

Speech pathologists who work with clients who have aphasia address is life participation. How can someone participate in life who has aphasia regardless of what their communication ability is? We know what people have in terms of potential. We want to reach potential and maybe even go beyond. But to constrain something is really limiting the brain from exploring other ways of recruiting different parts of the language region.

To do things they maybe weren't doing before. And if somebody loses the ability to articulate their words clearly, but might be able to write or point or type on a screen, they should learn that that's another way to convey what they once said by speaking. And I don't know if it has to be specifically defined as constraint-induced.

But if someone's targeting a goal of increasing response length, or using verbs in past and future tense, or using adjectives, or asking questions, all those language goals can be done with a skilled therapist by constraining or limiting a person's maybe instinctive way to respond.

And making that person aware, you know what, you're answering like this, does this sound right to you or would you like to maybe elaborate it and do it in a different way? So I think that's probably, we might be constraining things without even knowing that we are by using the goals that address specific principles.

Henry Hoffman (26:53.752):
Got it. You know, outcomes for hand and arm post-stroke, not a lot of people get their arm and hand back to where it was prior. Now, unless you fall into that cortical sweet spot where you get spontaneous recovery, other than that group, the group that transitions to the chronic phase and now it really comes down to rewiring and neuroplasticity, not a lot of them get their hand back to where it was before the stroke. And what I always ask these...

Patients is I'll say, you know, because I'm excited. It's a game of inches as therapists, right? When we see the upper trap move by 10 inches, or if we see the fingers extend 20 degrees, we're celebrating. But for a lot of them, yeah, they're kind of excited, but they're not because what they want is what they want. They want to be Billy wants to be back to Billy prior to the stroke. So are you experiencing the same with aphasia? I mean, what's the outcomes like for folks with aphasia? Because it sounds like there's many ways to communicate.

You're just not going to do what you did prior to your stroke exactly the way you did it.

Abbe Simon(27:53.126):
Maybe not. I mean, people do make huge strides and

Henry Hoffman (27:56.504):
Is that during that, you guys have that spontaneous recovery and that's when you see a home run and it's 100% speeches back and then everyone else? Or what's, how does that?

Abbe Simon(28:05.154):
First of all, the name of your podcast is perfect for one of my mottos, which is, there ain't no such thing as a plateau. I probably don't say ain't, I probably don't say it with that poor grammar, but there's no plateau. I could work with someone who is six days, six weeks, six months, or six years post-stroke and has aphasia, and they will make improvements if they want to. And it is amazing. I mean,

Henry Hoffman (28:15.045):
I kind of like it.

Abbe Simon(28:30.25):
I wish I could share recordings of patients that I met who were years post-stroke and maybe said one word, maybe said the same word over again and was perseverative. People can improve their language.

Abbe Simon(28:46.682):
You said, you know, Billy wants to speak like Billy did before the stroke, before his aphasia. I'm thinking of different people that, and especially with the right arm, I mean, you know, typically if someone has a non-fluent or telegraphic type of aphasia, they may have some right limb involvement or right leg. And so that's where all this OT support and help hopefully will coincide with the clients I have who have aphasia. They may feel like...

I can't move forward until my right hand works. I'm waiting for my right hand. I'm doing all these exercises, these neuro balls. They do everything they can. They're waiting because they believe that it will improve. And so what I focus on in terms of language is you will. You will continue to make improvement. And it's really hard. It comes back to that word acceptance and say, this is like a new way of communicating.

You can still be successful in your communication efforts and wants, as long as you're willing to learn something new, and as long as the people with whom you communicate realize that you need to communicate in a new way. So all that pressure of communication success isn't on just the person who has the aphasia, because aphasia affects all the people in that person's life, whether it's the barber, whether it's the doctor, whether it's the daughter, spouse, or dog.

People have to learn to speak aphasia friendly in a way that individual lets people know works for him or her. And so what's the success rate with aphasia? I would say anyone with aphasia can improve. Now, improvement is different for everybody. You refer to that man from Canada who uses maybe an app. There are clients who are really and truly nonverbal. Rare, but someone with a real serious global profound aphasia.

May not have the ability to utter words. And there are very high tech forms of augmentative systems that provide speech, digitized speech that we program so that it's personally relevant. There's a very low form of technology where a person can use a letter board or eye gaze board, but there's always tweaks that someone can make to change their current state of language function.

Henry Hoffman (31:02.237):
That's very interesting.

Abbe Simon(31:04.082):
And people say, you know, and you know this, the brain can change until the day it's not alive, until we're not alive anymore, right? The brain always has room for change.

Henry Hoffman (31:13.896):
Right. Well, the brain changes positively and negatively. I mean, think of PTSD. Think of OCD, depression, right? So if I put my arm in a cast for three months because it's fractured, and you MRI that area of the brain, you might see it diminish as well because of disuse. So you're absolutely right. Before we get into, I want to learn all about your eye communicator and what you're doing as a health coach.

Abbe Simon(31:19.967):
Mm-hmm. And dementia, right? Yeah.

Henry Hoffman (31:41.572):
we get into there, you know, two other thoughts to bring up to kind of bridge the gap between the OTs and what we're doing is two other interventions that are pretty darn beneficial for stroke survivors is mental practice and action observation therapy. And for the audience, mental practices, if you ever watched Michael Phelps, if you ever watched Michael Jordan, Tiger Woods, a musician, a Olympian, they imagine specifically doing the movement or the performance or the skill over and over as if they were doing it and they imagine explicitly and vividly every part of that skill and By doing that your brain rewires that rewires As if you physically did the task which is unbelievable So that enhances performance and it's a wonderful tool for stroke survivors You can listen to audio recordings Imagining or you can you can make up your own but the whole concept is if I'm going to imagine picking up a cup and bring it to your mouth, there's gonna be 25 steps and you're going to, okay, step one, you know, elevate your shoulders, step two, extend your elbow, and you're vividly going through that experience without actually physically doing it, and the brain rewires as if you did it. The second one is action observation therapy, which is if I'm on YouTube watching someone swing a club or throw a baseball or do any type of skill, play the piano,

By me watching that person, or if I'm at the gym and I suffered a stroke and I'm watching the patient next to me do hand training exercises, but me watching that patient, my brain rewires as if I did the physical movement. So those two are very powerful, you know, imagination, visual imagery interventions. Is there any opportunity to use those types of interventions for speech and aphasia? Has anyone been talking about that?

Abbe Simon(33:31.086):
Well, I don't know if there's research. I'm a very clinical-based speech pathologist. I don't think there's anything out there about visual imagery other than using visualization in two ways. So we've been focusing so much on aphasia, but plenty of adults have cognitive impairment. And cognitive impairment might imply that they have difficulty remembering or retrieving information.

The power of visualization is huge. I, and this is actually a good segue into the health coaching piece, but let's just go back for a second. When someone has aphasia and they have that tip of my tongue feeling like, oh my God, what's that meat, that big, they think, oh, it's that crickly stuff, and it's the crunchy with the eggs and the, and they're trying to say bacon, a speech pathologist will say, okay, stop.

Let's think about it, picture it in your mind, and we will prompt them. There's a form of therapy called semantic feature analysis. We will think about all the features of that item and maybe even visualize it. What does it look like? Where would you find it? What does it make you think of? What does it do? How does it feel? And so that imagery, if you will, might cause someone to produce via spoken or written words, words related to the target that they're trying to say.

So that's what makes me think of visualization, because I often will say, when someone's getting frustrated with their inability to say something, pause, stop, try to picture it in your mind. Can you see it? And even if they can't say the actual word, but they can describe it, it's still conveying the meaning. I don't care if they can't say bacon, but if they give me enough information and I know what they mean, they've achieved success.

Then maybe, oh, did you mean bake it? All right, let's go back. We can say it, we can write it. Do you wanna say, okay, is it chewy? Is it crispy? Let's talk about bacon, blah, blah. So that use of creativity, and remember, creativity and imagery and all those things, they may come from the right hemisphere, which is usually intact after someone has aphasia. And then that action observation.

Abbe Simon(35:36.562):

When I mentioned earlier repetition and redundancy and salience, there's another kind of therapy that we do called script training, which involves a lot of, "you do what I do" or imitation, repetition, right? I say something, you say something. It's not that functional, but if you do what I do or watch what I do, you can often mirror here and repeat what you see. So it probably has to be a little bit more action-based and intentional-based than passively doing it.

And the other thing I wanted is in terms of speech acquisition. The other thing you were mentioning about guiding someone through that visual task and you were saying, okay, think of the 25 steps, do all those things with their limb to create it in their mind. We have to consider that aphasia does alter some people's comprehension. So when we deliver auditory information and or written, we may have to simplify.

The length of information and even maybe slow down the pace in which we speak. So you'll see me sometimes, you know, and I use a lot of gestures when I'm talking. You may have to walk a little bit and use your hand and, you know, make a fist. All that multimodal input helps somebody's understanding. So if you're speaking to someone with aphasia and you want them to imagine it, you may not be able to speak to them the way you would speak to someone without aphasia. They could still accomplish it, but you'd have to just be a little sensitive to it.

Henry Hoffman (36:57.356):
Right. I was internally chuckling because I would love to see the dinner table at your house with kids. Do you have kids? And your husband? Our speech therapists, they tend to do the, they're doing the verbal, they're doing the visual, they're slowing it down, treating everyone.

Abbe Simon (37:03.582):
Yeah, no, you're imagining it just fine.

Abbe Simon (37:12.158):

I'm meant to be on a stage. My new life is gonna be, I'm gonna be on a television show.

Henry Hoffman (37:17.76):
You know what's also funny is a little side note. The OTs will totally get this one. Out of the three disciplines, PTOT speech, there's no doubt about it. If there was a vote, speech therapists dressed the best. Have you guys had that conversation?

Henry Hoffman (39:12.277):
Okay, so we got through that. All right, so let me start over with, well, let me start with what I was gonna say with the therapist, my little side conversation. All right, so you know what's another funny thing that happens between PT's, OT's, and speech therapists is when you do a poll, no, when you do a poll and you ask them who are the best dressed health professionals, you guys win hands down. I'm sure you've heard that before, right?

Abbe Simon (39:30.254):
Is this gonna be a joke?

Henry Hoffman (39:39.569):
It's like you guys come in with like briefcases, you got heels on or guys wearing a sport coat. No, I love it. Because then here's us in our scrubs all wrinkled up. Obviously you're making us feel worthless at that point. So that was my other... And you get your own private little office that you can bring your patient. And then we got to be... I know, I know, I love that.

Abbe Simon (39:43.294):
Not made for. That's an awful stereotype.

Abbe Simon (39:55.966):

And Medicare reimburses us so much higher than they reimburse you. So that's because of the way we dress.

No wind- with no windows.

Henry Hoffman (40:07.233):
All right, so now thank you for explaining mental practice, action, observation, how there's a link. I totally thought there was a link there because if there wasn't, there should be like an app or something that a variety of words hit play and you repeat it 25 times, of course, nice and slow. You have different speeds.

Abbe Simon (40:22.466):
There are speech entrainment. There's everything, there are so many different forms of technology that can augment what someone does in speech therapy and at home because.

Henry Hoffman (40:31.117):
All right, well that's what I was gonna ask you. That's what I was gonna ask you. I know there's hundreds, but can you just list for the audience what are your top three or four recommended tools that is, go more if you wanna go more. I'm just curious, what do you recommend? I mean, I could be here all day recommending arm and hand stuff, but what would be your, you know, top three or four that you think are for aphasia that you think could help, and why do you think so?

Abbe Simon (40:56.686):

Top three or four forms of technology. I mean, I'm not, you know, I'm not endorsing or picking anything because somebody asked me to. The first thing I'll say is, not everybody wants a form of technology. Not everybody wants to look at a screen, touch a keyboard, or touch a tablet. They don't wanna do any of that. But if someone is accepting of, I prescribe something called HELP, which is a home exercise language program.

Henry Hoffman (41:00.689):

Yes, yes, you've seen more helpful.

Abbe Simon (41:22.978):
That someone has to document in a way showing me that what we do together is also done on their own time. Because if the 50 minutes we spend accomplishing things is great and they don't do it again until they come back, well, it was purposeless in my opinion. They have to use it in the real world. So I will say your home exercise language program can consist of blank, or blank. And if one of those blanks is technology and they have a smartphone or a tablet, there are apps. I guess I could just...

Talk about the obvious companies that make them. And so there's some language software apps that one is called Tactis Therapy, which is T-A-C-T-U-S, which offers wonderful personalized language applications that people can practice at home. There's something called Constant Therapy, which is another cognitive linguistic program that people could use and download. There's monthly subscriptions to that one. There are free apps through the company called Lingrafika.

Which has really great apps that can be put on phones and tablets. There are way too many specific speech and language other applications that provide what we call speech to text or text to speech output, and that you could, like you said, make folders and pre-program things. You can use your photo app. You can use your note app. You can use your dictation feature on your phone. You don't have to purchase anything. There's tons of free ways to enhance your verbal communication if you want to use technology.

Henry Hoffman (42:54.885):
Great, well definitely that was awesome. And I think what we'll do in the show notes is we'll obviously have all your contact details.

Abbe Simon (43:00.318):
Yeah, and I have a link in that somewhere. I have a link of all those things and more on my website so I can just share those resources with you.

Henry Hoffman (43:06.969):
All right, well, wonderful. Let's switch gears. You've answered all my questions so far, all about aphasia, the treatment, the interventions, the outcomes. Let's switch gears and talk specifically about your practice at CommuniCare. I'm very interested to learn more about this. Yep.

Abbe Simon (43:23.593):
Okay, so as I said in the beginning to augment my speech therapy practice so that I could address the needs of care partners, I formed this program for care partner coaching. So it's twofold. It's one to emphasize that after a stroke, health can still be achieved and improved.

So people think of a health coach as somebody that focuses on nutrition, weight loss, macros, and eating more green food. And I agree that those things are healthy. But what I stress is that health is much more than the food on your plate. And when people get a diagnosis of a stroke, they may worry. They may just learn that they have diabetes. They may have to watch their salt, their sugar, their fat, and that could be very overwhelming.

And I live in a state where diet is very different than it is in other parts of the country. And so people can imagine not frying, you know, certain foods that they have. They can't imagine eating a multigrain bread or people wherever they are, can't imagine eating anything more green than the celery that's in the tuna fish. And yes, I feel very competent in talking to people about health and nutrition, but there are other ways to be healthy and happy and well.

And when I focus with the care partner on those things, I really address that self-care, that the feeling of guilt and burden and overwhelm doesn't have to reach its high. And that by learning how to say yes to help and expressing what you yourself need when you are not giving up the role as a care partner, will, if not addressed, compromise your own health. And if your health isn't great, the health of the person you're caring for, the receiver of your care is going to suffer as well. And so health and wellness could have something to do with spirituality. It could have something to do with nature. It could have something to do with being social with friends. It could have to do with learning. It doesn't have to be, oh, I have to address my self-care and go get my hair done or go play golf with the guys. No, and so what I do as a care partner coach is educate them on how their life has changed as becoming a care partner and what they can do to still find their own time, be independent while assuring the receiver of their care, I don't love saying loved one, so I say the receiver, that their life isn't just about taking care of them. And so I also love to talk about being neuro-proactive.

And how after a stroke we can make changes in our lives and in the food we eat that are actually enhancing for good neural development and cognitive health. Because that's, you know, from physical exercise, sleep and diet are really important for people with stroke or without. So that's it in a nutshell, really what I love talking about.

Henry Hoffman (46:27.401):
And with the community cares, is that typically with the integrated health coaching? Is it usually one-on-one? Is it group?

Abbe Simon (46:34.398):

It's usually one-on-one. I think I'd love to get some care partners together and talk about the approaches I use with them and see how they're using it and they could share it with each other. But we talk a lot about mindset, about how to get rid of your guilt. And it's not an ongoing program because when I work with people who have aphasia, which is a chronic condition, I might see them for quite a long time.

But care partners I work with between six and 10 weeks and we say, this is what you're struggling with. I'm really gonna hold, you know, when I'm a speech therapist, I don't really hold a person's hand. I make them struggle a little bit more and work harder. As a coach, I'm a little bit more of an accountability partner and I do hold hands a little bit tighter, so.

Henry Hoffman (47:18.605):
Yeah, well, what's crazy is, you know, I guess I haven't thought about it from this perspective as a caregiver slash care partner. It's got to be a little bit more frustrating when you can't communicate, a lot more frustrating. You can't communicate to your loved one, to your spouse versus the arms not working right. Because you can still sit down, have dinner, break bread, you know, talk about the day. I mean, there's got to be a significant amount of management there on your side from an emotional standpoint.

Henry Hoffman
Dealing with a care partner.

Abbe Simon(47:49.318):
Especially when it comes to like dicey and sensitive subjects, and I'm someone that doesn't want to avoid those things. So you're a care partner, your person that you're caring for has aphasia and you want to talk about intimacy. You should still be able to talk about intimacy, even if you need a picture, a diagram, or a written word. Because someone with aphasia has every right, has the right to speak just as much as someone without aphasia. And as a care partner and you're like getting frustrated with your spouse or someone that's not giving you what you want, well, hopefully, the speech pathologist is giving that care partner the tools so that they know how to get the information in and out of the person with aphasia. And there are different ways to validate and verify that a person has done that well.

Henry Hoffman (48:35.577):
Well, Abbe, we need you in every zip code. I can tell you that right now. And you are just full of knowledge. And how do folks find you? We'll definitely put everything in the show notes, but what's the best way for folks to find you if they want to carry this conversation forward?

Abbe Simon(48:49.674):
Yeah, I'm not a huge lover of social media, but I have agreed and do go on there. So on Instagram, my social media is iCommunicare, which is I-C-O-M-M-U-N-I-C-A-R-E. But my website is a really great source for people to find some blog information and sign up for newsletters. And that's iCommunicareN as in NancyC.com. iCommunicareNC. And they could reach me with any kind of questions and I'm always available to answer.

Henry Hoffman (49:17.325):
Well, it's a huge problem, and they need resources and you're the perfect person for those resources.

Abbe Simon(49:22.236):
Well, thank you so much. I love talking with you.

Henry Hoffman (49:24.813):
Yeah, thank you. This was great. We'll have to do it again. And we will definitely add Carly, our producer will put the information in the show notes. And I want to thank all the listeners today. If you have questions, obviously reach out to us. And it was wonderful talking with you today, Abbe. Okay. You do the same. Thank you. Take care, guys.

Abbe Simon(49:37.25):
Thanks, Henry. Have a good day.

Henry Hoffman (49:43.961):
All right, perfect. That was awesome, Abbe. You are awesome. You had great information.

Abbe Simon(49:46.986):
Well, I could, I was getting very nervous because I have a 12 o'clock client, so I was getting distracted.

Henry Hoffman (49:52.811):
Did you? Yeah, so you're almost Carly. You will let us know when you can.

Abbe Simon(49:57.694):
No, no, I'm fine. I'm just gonna open my own Zoom account here.

Henry Hoffman (50:00.657):
Yeah, sorry, go ahead, Carly. Yeah, yeah, so I'll stop that. Sorry, I'll stop that.

Abbe Simon(50:07.362):

Were you reading any?

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