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Answer transcribed from Brightway's interview with Dr. Cristen Gordon (pt.2):
That is such a deep question for me. I read a lot of research and out of all the research that I've read from the beginning of becoming a therapist until now, there are two things that really stick with me. One is a documentary I mentioned last week about neuroplasticity. There were children who were five years old who were having severe seizures, so severe that they couldn't function. They couldn't go to school and their seizures were life-altering. In order to treat them, they did surgery that took out half of the brain that was being affected by the seizures. They put a filler into the skull and left the other half intact. They finished the surgery, did rehab with the kids, and then sent the kids on their way. They came back and followed up with the kids five years later, so now they're all 10 years old and you could not tell the difference between those children's function and the other children who hadn't had that surgery.
To me, that is just so poignant. Both as a therapist and as a mom, I can't imagine making the choice to send my kids to have that sort of surgery. Then, knowing that their brains were able to heal and recreate all of these pathways to be able to do everything a “normal kid” can do with half a brain to me is just amazing. As a therapist, it gives me so much hope for the recovery that we can make these injuries. This was possible all because of neuroplasticity. The way our brains work is that one-half of the brain controls a certain number of functions as well as the opposite side of the body. You would think that if you took out half of it, it would be like recreating a stroke. However, what they found was that especially because they were kids and they were such young little brains, their brains were able to reprogram and rewire. They could create pathways so that they could use their whole body.
Another one that sticks with me and that scientists continue to do research on with the answer continuing to remain the same relates to patients that have had strokes. There are so many of these articles out there and I could mention many of them, but they do a lot of research around stroke. The biggest reason is that there are a lot more similarities amongst patients who have had strokes as far as their function goes. In the way they clinically appear, brain injury can become very diverse. Brain injury can look so many different ways, which makes it harder to do standardized research. In the article I read, these patients that have had strokes were given a certain number of tests. We call them objective measures, and they put the patients through a certain number of tests and look at their performance six months after stroke, one year after stroke, five years, and ten years. Now, they're doing research up to 20 years post-stroke, and they are showing that if you send patients to physical therapy and you have them do exercises that are specific to them and their needs, these objective measures will improve. This means that even 20 years later, they can do exercises and still improve upon their performance from five, 10, and 15 years ago.
Again, that just really validates my job and really makes me feel good about when I'm “torturing” patients and they're complaining that they're tired. I’d say “okay, well we have a goal and so we have to do what we have to do to reach these goals, and that means me pushing you”. A lot of research will show you that you cannot just do exercises that are comfortable, easy, and gentle. We have to really put patients into uncomfortable positions to see these gains, but the gains are there to make, so that really drives me every day when I work with a patient. It also I think validates that no matter what your age is, you can still be making improvements many years later. The children are maybe one thing because they have young brains and correct me if I'm wrong on this, but stroke survivors I think tend to be a little bit older. As neuro therapists, we are still bound by the same insurance regulations and the same productivity regulations in the clinic. Sometimes progress in neuro patients is slower, so I have to stand up for my patients and say this is why we need to work on this. When I say stand up I mean to the insurance companies and corporate leadership and I have to be able to explain myself and show this progress. It can be a downer when you're trying to just do what you think is best for your patients, but reading research like that and actually seeing progress, for example, patients saying I haven't been able to get in the bathtub for years and yesterday I took a bath, is just such a driving force for me and keeps me excited about my job.
Answer transcribed from the Brightway Answers interview with speech-language pathologist Amber Kloess:
I look at research a lot, especially during the initial stages of treatment. One of the biggest things - and this is for community reintegration - is functional outcome measures. What does a patient need to do to be a productive member of society? Do they want to return to work? Do they want to return back to school or run their household as they did prior to their brain injury? These are all functional and are able to be worked on within speech pathology sessions. One of my idols in the therapy world is Sarah Barr of Honeycomb Speech Therapy, and she is great for coming up with tests and ideas for functional needs for patient-centered care.
Evidence-based practice for the goal-plan-do-review-model is used by many different disciplines, not just speech pathologists. But this works on being able to select a goal, coming up with the plan to achieve it, and then identifying the barriers that could arise and then actually executing the goal. This is great for giving a patient time to reflect on what could have gone better, what would they have done differently, are there any strategies that I should introduce. This is one of the most valuable tools that I use with patients who are about to or have returned to work or school or their normal daily activities. I use this at least once a day with my patients.