When Rosa Zavaleta, who is pursuing a bachelor of science in speech-language pathology, began learning about aphasia, she became especially interested in “communication partners” – those people, such as family members and caregivers, who interact with a person who has aphasia. “I began to wonder whether we can tailor interventions to match communication partner traits, thus improving their effectiveness as communication partners,” said Zavaleta. “If that is, indeed. the case, how can speech-language pathologists create better interventions to serve all partners?”
Over the summer, Zavaleta worked with her mentor, Professor Laura Wilson, to design a Tulsa Undergraduate Research Challenge (TURC) study that will uncover the traits that lead to more confident and, therefore, successful communication partners. She explained: “My surveys, which I will administer to a group of TU students in the fall, will walk them through a simulated case study to see if a tailored intervention can make people more confident communication partners.”
Zavaleta will use Qualtrics to administer these surveys. “One of the benefits of using this program is that it has allowed Professor Wilson and me to collaborate remotely during the COVID-19 pandemic. At the information-gathering stage, it will enable me to view responses almost instantly, which will give me time to organize my findings and present them in time at the Student Research Colloquium in 2021.”
Eventually, noted Zavaleta, it would be interesting to have actual communication partners of people with aphasia in the community participate. “For now, I am very glad to have the opportunity to participate in research as an undergraduate, especially for something so relevant in my field and to many people in the community.”
Between 2019 and 2029, the U.S. Bureau of Labor Statistics predicts a 25% growth in employment for speech-language pathologists. Take a look at TU’s undergraduate and graduate programs in communication sciences and disorders.
Since launching in the spring, telepractice has enabled the program’s students to gain valuable experience, meet their clinical practice requirements and, most importantly, serve their clients’ health needs. Ashton Clark and Mimi Khoury are two of the students involved in this novel methodology, and both of them are enthusiastic about the ability of telepractice for delivering quality care.
Originally from Fort Smith, Arkansas, Clark completed an undergraduate major in communication disorders plus a minor in human development and family sciences at the University Arkansas. Now about to enter the second year of graduate studies at TU, Clark says “speech-language pathology is an extremely rewarding field, allowing one to work with people of all ages in such a wide variety of settings and with different types of communication impairments.”
Khoury also grew up outside Oklahoma – in Junction City, Kansas – and her undergraduate degree in communication sciences and disorders, with a minor in human development and family science, is from Kansas State University. “I have always had a passion for working with children with disabilities,” Khoury noted. “Through speech pathology, I am able to make a positive impact on young people and their development.”
Clark and Khoury began conducting telepractice therapy sessions in early June and are set to wrap up in mid-July. Supervisors are present for each meeting and, while, delivering therapy via Zoom is not without its challenges (for instance, finding appropriate digital resources), Clark and Khoury agree it has benefited their clients and propelled their development as speech-language pathologists.
Some of Clark’s clients meet with her on a weekly basis, while others log in twice a week. Khoury’s five clients, meanwhile, include one child with whom she takes a “speedy speech” approach, which involves meeting for 15 minutes each day for four days a week. With two others, she gets together twice a week for 30 minutes at a time. “It all depends on my clients’ character and needs,” Khoury said.
Personalized, well-planned, flexible
For Clark, one of the keys to success is differentiating the scenarios for each client. “I start off our sessions by targeting the goals I hope to accomplish,” Clark commented. “I then incorporate fun, computer-friendly materials throughout in order to ensure my clients remain engaged.”
Ensuring responsiveness and variety are also central to Khoury’s approach. “Every kiddo is different, so every session needs to be too,” she said. “Some days I am using action figures and toy cars to capture a child’s attention. Other days will find me reading books or playing connect-four in order to target specific speech goals. With telepractice, you have to be extra creative and come prepared with a handful of potential activities, because you never know what might work or even what challenges you might face, such as background distractions or a poor internet connection!”
“Telepractice has given our students the opportunity to prepare for a changing work environment by using new technologies and platforms to provide services,” observed Suzanne Stanton, the coordinator of TU’s Mary K. Chapman Speech and Hearing Clinic and the Chapman Clinical Assistant Professor of Speech-Language Pathology. “For many of our patients, it has meant that they can access services they would have difficulty getting any other way. While our telepractice initiative was spurred on by COVID-19, the experience has opened up a new avenue for service delivery that we will use even after the pandemic.”
One of the advantages of telepractice that Khoury has witnessed this summer is the ability to grab and hold certain children’s attention during shorter therapy sessions. This has been especially apparent when treating articulation disorders. “The speedy speech approach has allowed us to really focus our time on placement and correcting errors in the allotted 15 minutes. This has resulted in a tremendous amount of progress,” Khoury explained.
For her part, Clark echoed Stanton’s comment that telepractice has eliminated the travel burden for clients from outside Tulsa, adding that it has given them greater access to therapy in the comfort of their own homes. Beyond that, telepractice has enabled Clark to boost the involvement of her young clients’ parents. “Coaching parents during the sessions on ways they can help their children meet their goals allows my clients to then receive more exposure to their personal goals outside of our official therapy sessions.”
Life after graduate school
In the fall, both Clark and Khoury will begin their second and final year of the master’s program. Following graduation, Khoury’s goal is to deliver speech-language pathology care in an educational setting. She is especially interested in helping either early childhood or elementary school-aged children, and she is keen to specialize in speech sound disorders.
Clark, meanwhile, has her sights set on working with adults in a hospital or long-term care facility, assisting people who have cognitive-communication disorders. “I want to help others find their voice,” she remarked. “It’s a great feeling when I can help my clients share their thoughts with their loved ones.”
Do you have a desire to help others communicate their thoughts, emotions, needs and desires? If so, The University of Tulsa’s Department of Communication Science & Disorders offers the knowledge development and skills training to prepare you for this vibrant, growing health care field.
Teletherapy – or telemedicine – has been around for some time. But the recent arrival of COVID-19 has led to a surge of activity for health care professionals from many disciplines. Faculty and students in The University of Tulsa’s Department of Communication Sciences & Disorders are among those who have embraced teletherapy in order to serve patients during this crisis.
Communication Sciences and Disorders has the largest number of patients in Oklahoma who attend an on-campus clinic. Indeed, the department has more patients than most graduate program clinics anywhere in the state.
“Over the past few years, our faculty have seen a few patients via teletherapy,” said Suzanne Stanton, the coordinator of TU’s Mary K. Chapman Speech and Hearing Clinic and the Chapman Clinical Assistant Professor of Speech-Language Pathology. “One such individual was a young adult who lived in rural Oklahoma and needed therapy to use her eye-gaze communication system. There was no one in her area with that specific expertise, so teletherapy sessions with one of our faculty members was the solution.”
In 2019, Professor Kris Foyil initiated a contract with Connects Academy to allow the department’s graduate students to work with practicing teletherapists in the community. Since then, each semester two students have been able to work with an experienced licensed teletherapist in her practice.
Rising to the challenge
With the COVD-19 crisis, Communication Sciences & Disorders students were forced to abruptly discontinue their externships and onsite clinical experiences. The Council on Academic Accreditation, however, sent out a notice to accredited programs stating that the standards for certification and completion of clinical hours would not change. As a result, the department had to find new ways for their students to satisfy those requirements in order to graduate on time in May.
“We are meeting the needs of our students in several ways,” Stanton noted. “And teletherapy has been a major asset to accomplish that goal.”
During the week of March 23-25, faculty began teletherapy evaluations to assist graduate students who had been pulled from hospital experiences. This included having members of TU’s Tulsa Aphasia Group participate in online aphasia evaluations with students using Zoom technology and following both state and federal guidelines for teletherapy. Stanton coordinated these evaluations, which allowed patients to get the services they needed and the department’s students to continue interacting with individuals.
“It was a quick turnaround to organize,” remarked Stanton, “but rewarding in so many ways. For instance, the patients we helped were isolated, and this taught them how to use new technology to foster social interactions in other situations and settings. One gentleman, for example, was able to use Zoom to talk with his grandson and son in Colorado.”
Simulations are the second way Communication Sciences & Disorders is meeting its students’ needs through digital technology. The benefit of such simulation is it allows no-risk practice in aspects of care that previously could only be experienced with patients in person.
Sarah Launchbaugh, a clinical assistant professor of speech-language pathology, has worked with other clinical faculty to organize simulated clinical experiences through Simucase. “By using Simucase’s digital learning platform,” Stanton observed, “our students are able to continue their clinical practica, even during the pandemic in a time of uncertainty in the world around us. It also gives them exposure to patient populations that are at times unavailable in our speech clinic due to low incidence of the disorders.”
Spurred on by the COVID-19 emergency, Communication Sciences & Disorders faculty are working with students to offer all clinic services via teletherapy soon. According to Stanton, “we are currently providing online resources for patients and their families, and we are reaching out to determine which patients have the ability to participate in teletherapy.”
When you were in elementary school, did you ever stealthily pass a handwritten note to a friend while your teacher’s back was turned? Have you ever nodded approvingly as a colleague presented her ideas at a meeting or sent a smiley-face emoji to a friend while texting? These and myriad other forms of familiar non-verbal communication are examples of augmentative and alternative communication (AAC).
For most people, AAC – which roughly boils down to communication that happens without talking – is a common addition to speaking. Speech-language pathologists, however, deploy AAC technologies to help people for whom speaking is either a major challenge or even an impossibility; for example, children with autism or cerebral palsy, and adults with aphasia or who have suffered a stroke or a traumatic brain injury. “Speech-language pathologists help people engage with the world around them,” remarked master’s student Cassie McGough; “AAC technologies support that work.”
AAC for all ages
At The University of Tulsa, students in the Department of Communication Sciences and Disorders have the opportunity to acquire essential AAC-related skills and knowledge through their coursework at both the undergraduate and graduate levels. Master’s students are also able to deepen their engagement with AAC by participating in a clinical practicum. In addition, TU is the only university in Oklahoma that delivers AAC assessments for community members who have complex communication needs, both children and adults. Graduate students conduct these through the on-campus Mary K. Chapman Speech & Hearing Clinic, and the hope is one day to be able to expand this service beyond the university.
One of the linchpins of the AAC training made available at TU is Clinical Assistant Professor of Speech-Language Pathology Ronda Marfechuk. Certified for the past 14 years as an assistive technology professional (ATP) by the Rehabilitation Engineering Society of North America, Marfechuk explained AAC as “an area of speech-language pathology that helps individuals who don’t have natural speech to communicate.”
In speech-language pathology treatments, she observed, AAC can be something as low-tech as a pen and paper, as medium-tech as a push-button device that speaks individual words or as high-tech as digital tablets not dissimilar from an iPad. “As technology advances,” Marfechuk said, “AAC tools are becoming smaller and contain more vocabulary and abilities in the area of eye gaze. Experiments are also now underway to develop switches that can read the brain in order to activate them and generate speech.”
Of course, the humans using and benefiting from AAC are the prime concern for speech-language pathologists. “Working with little ones who haven’t yet spoken, these devices are a way to enhance and support their language development,” McGough commented. Now in her final semester of graduate school, McGough is also passionate about hospice work at the other end of the life spectrum, and she noted that AAC technology can be a great help in that context. “For some hospice residents, the muscles that work to enable speech are very weak, which means they are unable to communicate their wants and needs. So, if they have a device they are able to activate to say ‘I love you’ to a family member or ‘I need my pain medicine’ to a nurse, that’s what AAC is able to accomplish.”
Clinical experiences and community service
One of the benefits of studying speech-language pathology at TU is the opportunity to engage in clinical experiences. For Marfechuk’s students, these include working with people who require AAC technology. Clinical observations and interventions take place at the university’s Speech & Hearing Clinic, which welcomes a wide variety of patients from age 2 to beyond 90. It also occurs within community organizations, such as The Little Light House and The Center for Individuals with Physical Challenges.
During the fall 2019 semester, for example, students in Marfechuk’s course on communication modalities and special populations spent five sessions working directly with children at The Little Light House. The sessions focused on teaching how to use AAC. Working in pairs, students also had the opportunity to do an evaluation for an AAC device, write a report and make recommendations based on their findings.
“A lot of time parents will feel defeated,” noted master’s student Claire Collard, “because they hadn’t expected to have a child who they will never hear say ‘I love you’ or even just a simple ‘I’m hungry.’ Being able to provide that bridge for parents – whether in the classroom, clinic or a place like The Little Light House – is amazing. It’s about helping parents form a bond with their children.”
Clarey Sharum, a speech-language pathologist at The Little Light House, emphasized the impact of the therapy and training sessions TU students delivered:
The Little Light House is fortunate to have an ongoing partnership with the TU speech-language pathology program. We are so grateful for the graduate students’ hard work and interest, as well as for their loving spirits, which they continually show toward our kiddos who require AAC assistance.
These emerging speech-language pathology professionals expertly helped the children develop their confidence and communication skills. In addition, their efforts and dedication provided the Little Light House with 10 completed AAC reports. Once these are submitted through the children’s insurance providers, it could allow several of them to receive their very own speech-generating device.
These AAC devices will certainly be life-changing to these children and their families. It will allow young people who do not have a voice to be able to walk down their school hallways greeting their teachers, expressing their needs in the classroom, engaging with their peers at lunchtime and much more.
Marfechuk underscored not only the importance of such clinical experience to the professional development of future speech-language pathologists but also the enthusiasm for and personal satisfaction her students derive from those encounters. “Indeed, most of our master’s students graduate with over the maximum number of required hours in clinical work,” she noted. “I’ve had a whole bunch of great experiences using AAC with my clients,” remarked one of those students, Elizabeth Dorre. “So many of my clients improve their communication using a device and I see so much satisfaction – even joy – on their faces when they are able to make a request or express an emotion. This makes me so motivated to keep going.”
AAC travels the Mother Road
Another sign of the vibrancy of AAC at TU is the decision to make these systems the focus of 2020’s annual Route 66 Conference on Communication Disorders (Feb. 28): Building Blocks for Successful AAC Intervention. Anna Petersen, the co-chair of this year’s conference and a fourth-year student in the undergraduate speech-language pathology program, commented, “I have seen firsthand how important AAC can be for clients who are not making the progress they need without additional tools and support. AAC opens the door for people who can’t use the typical speech pathways. As research and technology advance, AAC therapy techniques are only going to improve.”
The presenter for the 2020 conference is Trina Becker, an associate professor at Eastern Illinois University in the Department of Communication Disorders and Sciences, as well as the director of that university’s Speech-Language-Hearing Clinic. Commenting on the value of having such an expert lead the conference, Petersen noted, “I’m really excited that TU is hosting Trina Becker because she will be able to provide practical and meaningful training for implementing AAC with maximal results. I specifically hope to learn more about how to train communication partners because effective communication is, after all, a two-way street.”
Housed at The University of Tulsa, the Tulsa Schweitzer Fellowship is a 12-month health leadership and service program for graduate and professional degree students who want to address unmet health needs in the community while sharpening their leadership skills. In the 2019-20 cohort are two dynamic speech-language pathology master’s students from TU: Gabrielle Cozart and Emily Gore (BS ’18).
After hearing a presentation by Tulsa Schweitzer Fellowship Director Rachel Gold, Cozart and Gore decided to team up and design a project. “Both of us have tutored kids in various subjects since high school,” Gore noted, “and we share a strong passion for literacy. Our objective was to find a way to use our knowledge of literacy development to help others – in particular, young people.” Cozart added, “Coming from a speech-pathology background, we are deeply aware of the importance of literacy and vocabulary, and how this knowledge impacts a person not only academically but also in everyday life.”
Literacy, community, confidence
At first, Cozart and Gore’s Schweitzer project plan was relatively simple. They contacted Catholic Charities of Eastern Oklahoma and proposed setting up a literacy table and book drive during their food pantry hours. However, that discussion led the duo to St. Elizabeth Lodge, a North Tulsa transitional housing facility and support service program operated by Catholic Charities for working single mothers with children. The families at St. Elizabeth Lodge come from various challenging situations, including experiences of eviction and domestic violence. The facility gives these families “a soft place to fall,” supporting them with housing and educational programs, while residents build a community with each other. The opportunity there would enable Cozart and Gore to have a long-term, measurable impact on the participants, a key requirement of Schweitzer Fellowship projects.
As they dug deeper into the St. Elizabeth community and mission and met with Sharisa McDaniel, Catholic Charities’ transitional living coordinator, Cozart and Gore expanded their Schweitzer Fellowship project plan and aspirations. “It took interacting with the participants before we fully understood what could work and what could be most beneficial,” Cozart remarked. “And that was followed by a couple of months over the summer spent planning the curriculum and our strategy for project implementation.”
The result is a 10-month project (June 2019-April 2020) geared toward supporting and enriching the lives of youth, ages 11 through 15, residing at St. Elizabeth. “Our overall purpose,” Gore noted, “is to promote the children’s confidence and academic success through literacy and one-on-one tutoring. But Gabrielle and I also make sure to have just fun times, moments when we’re just talking, eating snacks or playing games together. Being casual, consistent, reliable and offering listening ears is important for the children, too.”
Each Tuesday evening, Cozart and Gore arrive at St. Elizabeth Lodge to help seven children focus on writing skills and expanding their vocabulary. “We practice communicating ideas clearly and concisely through writing,” commented Gore. “Some of the main topics we cover are organizational strategies, transition words and different narrative types.” One of the key features of their Schweitzer project is a personal writing journal for each child. An advantage of this tool is that Cozart and Gore can then provide individualized feedback and guidance.
Cozart continued, “We also teach vocabulary the kids are likely to encounter in various academic contexts. Some of these we feature as ‘words of the month,’ which we talk about during group sessions and post on a bulletin board. Emily and I encourage the participants to learn the meanings of those words, and we offer prizes to keep them motivated.”
Wednesday evenings at St. Elizabeth Lodge are spent on reading and academic development. Cozart and Gore call this session “Homework Hangout” because it involves time and space for the children to do their school homework. According to Cozart, research shows that such opportunities are often scarce for young people living in transitional housing. If a child doesn’t have any homework that day, Cozart and Gore encourage them to find and read books that spark their interest. “The kids have come to enjoy tracking how many hours they spend reading each month,” noted Gore.
A central feature of these two-hour Wednesday evenings is one-on-one meetings. The approach Cozart and Gore developed for these pivots on close collaboration with each child. “Our aim here,” Cozart explained, “was to develop specific academic goals they want to achieve during this school year. Every child thought up personal goals, such as improving their grades, being more confident, making new friends, staying organized and turning in homework on time. Emily and I then help them plan the concrete steps they’ll need to take in order to succeed.”
But goal-setting isn’t only for the kids. Cozart and Gore wove in measurable outcomes for themselves, too. As Gore explained, “Our objectives for the Wednesday classes are to foster the children’s school success, guide them in personal goal-setting and increase their academic self-confidence. When they flourish, we know the aims of our Schweitzer Fellowship project are being met.”
The Albert Schweitzer Fellowship is a 12-month health leadership program for Tulsa-area graduate and professional degree students from any discipline. The fellowship exists to address Tulsa’s vast health disparities in two ways: by piloting immediate solutions through fellows’ projects and by developing leaders who have the confidence, skills and networks to address these disparities for the long haul. Fellows receive a $2,000 stipend. Fellowship applications for the fifth cohort are due on Feb. 10, 2020. If you are interested in becoming a Tulsa Schweitzer Fellow, visit us online or send an email to email@example.com.
A lot of the research that occurs within universities remains confined to the domain of academic specialists. Sometimes, however, through design, serendipity and a combination of the two, investigations carried out at universities break through to the wider public sphere and have a measurable social impact.
From university project to state legislation
In winter 2019, speech-language pathology master’s student Natalie Mayberry (MS ’19) developed and delivered a training program aimed at expanding police officers’ understanding of acquired communication disorders and strategies for interacting with people experiencing these issues. At the time, several media outlets reported on Mayberry’s pilot project, helping to expand public awareness of her work and the problem she was endeavoring to address.
As a result of that media attention, Shelley Kelley – a volunteer coordinator for Apraxia Kids and the mother of a son with apraxia – heard about Mayberry’s work. (Apraxia is a motor speech disorder that makes it difficult for children to speak.)
“When I saw the Channel 6 story about Natalie’s research and training program,” Kelley said, “I immediately recognized the potential benefit for people with communication disorders as well as law enforcement personnel.”
Kelley took inspiration from Mayberry’s work, which spurred her on to research legislative changes passed in Ohio and to advocate with her local state representatives in Oklahoma to add similar language pertaining to communication disorders to proposed legislation. “The timing of Natalie’s research and training program was perfect,” noted Kelley. “I was able to leverage her work in my discussions with Oklahoma representatives and senators, and the result was the inclusion of the words ‘apraxia or other communication disorders’ to House Bill 2516.” Gov. Kevin Stitt signed the bill into law on May 9, 2019, and it went into effect on Nov. 1, 2019.
For a more detailed look at the need for law enforcement training in communication disorders and the place of Mayberry’s work within the journey to the final draft of House Bill 2516, read Kelley’s post on the Apraxia Kids site.
Since first going public with her project and findings, Mayberry has continued to make revisions to the training program, including the production of professionally filmed videos. Mayberry is enhancing the program with an eye on delivering it to more law enforcement groups as well as on gaining certification for it from the Council on Law Enforcement Education and Training (CLEET). In another fortunate twist to this tale of connections and influences, Kelley’s husband, who is a police officer and a CLEET instructor, is now helping Mayberry gain that certification.
If you want to prepare to evaluate, treat and conduct research with persons with communication and swallowing disorders, consider The University of Tulsa’s master of science in speech-language pathology. We have one of the best speech-language pathology graduate programs in the United States, with our graduates achieving excellent Praxis exam pass rates and 100% employment.