“It’s a Challenge and an Honor”: 20 Years of Speech Therapy at Gillette

Erin Ingvalson, speech therapist and speech clinical educator at Gillette Children's tells us about her work on the brain injury Rehabilitation team, collaborating with other rehab experts, and one of her fondest memories from her long career. 

What is your role in rehabilitation for brain injuries?
Brain injuries disrupt cognitive processes like attention, memory, and understanding language, making it difficult for the person with a brain injury to communicate with people and makes it difficult for family and caregivers to know how to interact with their loved ones.

It’s my job as a speech therapist to teach strategies to not only the person with the brain injury but also their family and caregivers to facilitate meaningful interactions that help the person with a brain injury get daily needs met as well as help them be able to go to school and play with friends. Because a child's primary job is learning through play, speech therapy is often done with toys and games which makes it a lot of fun!

Speech therapists also work on helping restore swallowing function which is often affected by brain injury. Speech therapists guide patients through a gradual reintroduction to various food and liquid textures and adjust a child’s diet based on how safe they are with swallowing during their recovery.

Speech therapy isn’t only restoring speech because sometimes speech is just not possible. When speech is not possible, it is our job to teach other forms of communication such as using technology like computers which allow patients to point to pictures or words with their hands or even their eyes to say what they are thinking. That’s where the rest of the team comes in.

How does the rest of the rehab team help your speech therapy work?
Brain injury rehabilitation cannot be done without a team. Our team involves physicians, nurses, OTs, PTs, speech therapists, psychologists, music therapists, therapeutic recreation specialists, child life specialists, social workers and care coordinators all working together to support the patient's recovery.

Sometimes when I am working with a patient with swallowing difficulties, I may discover that they are having difficulty progressing because they have poor head and neck positioning. I need the physical therapist on the team to help me problem solve ways to optimize the patient's position in their wheelchair so I can continue to make progress with their swallow. Or maybe a patient needs to use an augmentative communication device to communicate but they cannot reach out to touch the buttons due to difficulties with arm and hand function. I need the occupational therapist on the team to help me problem solve other ways to allow the patient to access the device. Or finally, I may be working with a patient who is having a really hard time adjusting to their injury and is displaying behaviors that inhibit their progress in speech therapy. I need the psychologist on the team to help me problem-solve strategies that help the patient to be better able to participate in therapy. 

I simply cannot do my job to its best ability without all the other specialists on my team.

What is the most challenging aspect of your work?
The toughest part about working with the brain injury population is that you cannot fix an injured brain like you can a cut or a broken bone. There are certainly varying levels of recovery, with some patients recovering more function than others, but the fact remains that the brain has been altered permanently.

The patient, their family and caregivers are left trying to navigate a new path and it is traumatic. I am not only assisting the patient in trying to improve speech, communication or swallowing but also assisting them in trying to understand and navigate this new path where the answers are not always clear. There is confusion, frustration, anger and lots of sadness. But there is also joy, excitement, pride and lots of hope. I get to be part of an adventure with each patient and their family as they begin the hardest work of their lives to regain skills and discover parts of themselves they may not have known existed.

In turn, I am constantly discovering more about myself as both a professional and a human being. I wake up in the morning not only to do a job but also to engage with, form connections with, and influence the growth of others in countless ways. It’s been very rewarding.

Tell us about one of your favorite memories at Gillette.
I always feel very honored to be present when a child says their first words again when they come in non-verbal. Working in the brain injury program, that happens a lot. I remember working with a little boy who was around 7-8 years old. Due to his injury, he needed to have a tracheostomy placed which made it difficult for him to be able to speak.

When I first met him, he was trying to mouth some words but could not produce any voice. He would also try to write words on a whiteboard however that was difficult for him as well. A few days into his hospitalization during one of his speech therapy sessions, we tried a speaking valve. It is a small, plastic, one-way valve that is placed on the end of the tracheostomy tube. The one-way valve allows air to come in through the tracheostomy tube but directs it up and out through the mouth so that the vocal folds can vibrate to produce sound. 

When the valve is first placed on the tube, we direct the person to simply focus on breathing in and out – we don't want them to try to speak right away. With a tracheostomy, sometimes people have gotten out of the habit of breathing through their mouth and nose so when the valve is first placed it can take a little time to figure it out again, which sometimes is a little scary. This little boy, however, did not have any problems and was breathing very comfortably so I told him to go ahead and try to make a sound.

He took a deep breath, opened his mouth, and let out a gentle "ah" sound. The look on his face was priceless – his eyes widened and a huge smile took over! I asked him to count to three which he did effortlessly and then he just started talking non-stop – telling his mom he loved her and saying that this was the best day of his life. I remember him and that happy moment. I couldn't help but fight back a few happy tears.