“Okay, try this one. Pat your knees. Cross your fingers. Stomp your feet.”
A simple enough sequence, but the woman across from you purses her lips before repeating the instructions, “Pat my knees. Cross my fingers. Stomp my feet. Cross my knees and… tap my fingers? How am I supposed to do that?!”
She stares at you like you’re crazy. In a matter of seconds your client has gone from hearing and understanding your instructions to completely mixing up all the actions.
This is a regular occurrence at Sarah Soriano’s speech and language pathology internship where she works with different clients dealing with communicative disorders.
We talk with her about her chosen field, what it’s like being in a Master’s program in Communication Sciences and Disorders, and the hands-on experience she’s getting during her internship.
Kellen McKillop: What does it mean to major in Communication Sciences and Disorders?
Sarah Soriano: Majoring in Communication Sciences and Disorders prepares students for professional positions in the specialties of speech-language pathology or audiology. I am going into speech-language pathology (SLP). You need a Master’s degree in order to work as an SLP.
SLP is concerned with the evaluation, diagnosis, and rehabilitation of persons with speech and language disorders. Audiology, on the other hand, is concerned with the evaluation, diagnosis, and rehabilitation of persons with auditory and vestibular disorders.
Kellen McKillop: What is your specific program like?
Sarah Soriano: My Master’s program at the University of South Dakota is full of classes to make us, the students, skilled in our specialty. There are only nine people in my cohort, and it is a pretty competitive field to go into. Even though SLPs are in great need, the admissions into the school programs are limited because they are somewhat based on the average number of clientele. Each student needs to have about three to four clients of their own to work with each semester.
The classes revolve around certain disorders like fluency (stuttering), craniofacial anomalies (like cleft palates), language disorders (trouble understanding others or expressing themselves), cognitive issues, and dysphagia (swallowing disorder).
Most classes are on giving evaluations and diagnoses and how to interpret them. There are also classes on alternative communication for patients who cannot use spoken language to communicate and need special devices for them to express their wants and needs.
There is a set list of classes that students have to take to get their Master’s. You can’t get below a B in any class and have to get an A in all clinic settings. If these requirements are not met, it’s academic probation.
The last two semesters of the program are spent doing internships. In order to graduate you need 400 hours of clinic work. Most of these hours are completed during the two internships.
KM: How did you find your current internship?
SS: Finding my internship was hectic. From the first week in my Master’s program they talked to us about the internships we would have to do the last two semesters of the program. They told us to tell them the areas and facilities where we might want to work, but that they would do the rest. They did not want us making the connections. So I gave my suggestions.
But by some fluke, my coordinator ended up not setting up an internship for me.
She asked me to start making calls to people while she emailed other places. I called so many places and all of those places either did not have SLPs at their facility or already had an intern.
So I thought to myself, if I couldn’t live at my home and do my internship as planned, what other locations had people I knew and could live with? I have a family friend who has a house in Henderson, NV and started calling facilities there and something worked out at a life care rehabilitation facility in Las Vegas.
This internship mishap may have been a fluke error, but I think it’s important to note. Internships are an important part of the Master’s program. Even if your school wants to be in charge of finding your internship, don’t just sit back and relax. Continue to check in until you have an internship in place.
KM: What is a typical day like as an SLP intern?
SS: I arrive at 7:30am.
When I arrive, I get a schedule printed for me of the clients I am seeing that day. It says their name and how many minutes I am seeing them for. I’ll usually see someone during breakfast for the swallowing aspect of their therapy (if they need it).
After that it’s kind of hectic because I have to find all my other clients. This can be especially tricky when they are not in their rooms. You have to wander around the facility to find them.
When you are with your patients, you start by testing them to see what sorts of therapy you have to do.
KM: What goes into evaluating and testing patients?
SS: Most of the people in the facility aren’t just there for their speech or language. Often they’re referred to us by their nurse or another therapist (a physical therapist or an occupational therapist). A physical therapist might come up and say, “Can you check on so-and-so? He’s having trouble following directions.”
Then we have standardized screens/tests that we give that cover their attention, problem solving, how quickly they can name things, and memory recall ability. From there, depending on how they do on those sub-sections, we can kind of pick out, like, “Oh, they didn’t do very well naming these objects. They’re having trouble with word finding.”
KM: What are some tests and exercises you do with clients?
SS: They fall into a few main categories.
For Oral Articulation and Naming
There’s one man in the facility who had a stroke and every word he says sounds like “yes.” It’s not very enunciated, but he has all the intonations of speech. So, what he’s working on is oral articulation of other sounds as well as naming.
His SLP might show him a picture of an object and ask him what it is. If it’s a picture of a knife she might ask him if it’s an apple or a dog. Then, when she asks him if it’s a knife and he nods, she’ll tell him that he’s correct and then say the word “knife” really slowly, like, Kn-Eye-Ff. She’ll then have him practice repeating it back to her.
We also deal with dysphagia, even though it doesn’t necessarily directly relate to speech or communication. An SLP will test for levels of aspiration and (dysphagia) their swallowing abilities.
To evaluate this, you would give the client different types of food or drink consistencies. The thinnest consistencies are the most difficult to swallow. So, you might give them the thinnest possible (water) and then watch to see if they have problems aspirating this liquid (if it goes down their lungs and they choke). If this is the case, you’d move to the next stage which is a nectar-thick liquid, like syrup. That’s easier to swallow than water. This continues on to pureed food and then regular, solid food.
You’re seeing the highest the patient can go. Then once you’ve seen their capabilities, you’re trying to figure out what’s causing them to be unable to swallow. For example, a lot of the time it’s because the tongue is retracting and creating a seal. To combat this, you can teach them different techniques like tucking their chin, tilting their head, or practicing different exercises without food in their mouth to strengthen their muscles.
For Cognitive Issues
Sometimes there’s someone who is having trouble following directions. We’ll give them a list of activities to do, like pat your knees, cross your fingers, and yawn.
These are simple tasks and we take for granted our ability to do them. Some of the clients, a second after you give them these instructions, will totally confuse them. They’ll yawn and then cross their knees and try to pat their fingers. So, you just have to keep practicing with them.
Some Other Activities to Do With Clients
There are also a lot of games on the iPad that clients will play. Games for memory, problem solving, etc. The other day I played a game that shows you four words and you have to figure out how they’re related. So it might show you pictures of a phone, a block, blood, etc. and then the answer is “cell” because they all can be linked to that word.
It’s surprising, really. Sometimes you can do the most basic, simple thing that you think won’t make a difference but it does.
My supervisor is with me for the majority of the time. Either I am watching her working with clients or she is watching me. I have learned a lot these past two weeks and I have nine more left.
KM: What are your favorite parts of your internship?
SS: My favorite part of the internship is the people I work with. Both the patients and my supervisor and the other two SLPs there are all, for the most part, lovely. The patients that I have had so far have been sweet to me and want to get better, which is a great sight to see because I know not everyone will be this cooperative. My colleagues are very willing to help me learn and explain anything to me that I ask. I feel like I found a great place to do my first internship at.
KM: What are some of the challenges?
SS: One of the challenges is figuring out activities to do with certain patients with certain deficits because what could be good for one patient does not work at all for someone else. During clinic at school, I never had these types of patients before, so knowing the best thing to do for certain deficits is challenging. Also writing reports is a challenge, but I think it is a challenge for everyone who is starting out.
Another challenge is coordinating with Physical Therapists and Occupational Therapists if they [a patient] receive those services as well. It is all about organizing when you see your clients so you can be as productive as possible.
KM: What is the second internship requirement for your Master’s?
SS: The second internship is at a school. There are a lot of schools that need more SLPs to help out. I think that after I graduate, I want to work in a school setting. So this second internship will be really helpful for me to figure out if that’s really what I want to do.
The great thing about my Master’s program is that if after the second internship, I decide that a school setting is not for me, I can easily go into the medical setting.
Homework time! Interested in pursuing a career in this field? Do some research about all of the different job options. Start looking into schools to find undergraduate programs that will prepare you for your Master’s. If you’re already studying Communication Sciences and Disorders, ask your professors about ways to set yourself apart. Start researching different graduate programs available. The graduate programs are pretty competitive, so you’ll want to be prepared for that application process.
P.S. It’s okay if you don’t get into a Master’s program right away. Spend your off-time building up your skills. Ask a professional if you can shadow them.