Speaker 0 00:00:01 Have you ever wondered how speech therapy can help your brain injury? A lot of us ask that question. I find that the many survivors I've encountered really don't understand what a speech therapist does after all their speech therapists and hospitals, schools, and in neuro rehab settings. So it can be confusing about how they can help you on your recovery journey. My guest today, Catherine No, is a speech and language pathologist. She's licensed here with me and the state of Maine. She's a delightful person and shares a little bit about how speech therapy helps someone after brain injury. She also considers herself a very functional and holistic practitioner that utilizes yoga and mindfulness in her practice. We talk about the intersections of mental health and what I often see with folks regarding anxiety and stress when they've lost some ability with their memory or their thinking. She talks a little bit about majoring in neuroscience and Spanish and how that influenced her to become a speech and language pathologist. Let's take a listen to this wonderful provider. Hi everyone. Welcome to the TBI Therapist podcast. I'm your host, Dr. Jen Blin shot, where we explore the heart of brain injury.
Speaker 0 00:01:48 Hi Catherine. Welcome to the TBI Therapist podcast.
Speaker 2 00:01:52 Hi Jen. Thank you so much for having me.
Speaker 0 00:01:54 Awesome. So I'm gonna kick it off and ask you, what is one thing about brain injury that people often get wrong?
Speaker 2 00:02:04 Ah, well, as a speech and language pathologist in brain injury, I think that there's a big misconception that all that we do is help people with their speech. So often I'll be talking to people about speech therapy and they'll say, Oh, but my speech is fine and I have to take a moment and explain that. We do so much more than that. So yes, we do speech and voice, but we also do word finding. We do attention, memory planning, problem solving, all those cognitive and communication skills.
Speaker 0 00:02:43 I, in the pre-interview I was sharing a little bit that I got to at my neurorehab program on my postdoc, I really didn't know what speech therapy was. Mm-hmm. <laugh>. Mm-hmm. It was, it was something I had to learn. And so even in my professional capacity, I didn't have a good sense until I had clients who were also working with a speech therapist and they were doing really great work and we would often share that work. So I had a question about when someone's in speech therapy, what I've noticed from my perspective is they can have some anxiety or some stress about when there's noticing changes in their cognition or their memory. So in their thinking or in their ability to like know who Sally is at the grocery store or know who the friend's mom is. So can you speak a little bit to that about strategies or help that you give folks after brain injury with that?
Speaker 2 00:03:41 Yeah, so changes in attention, memory, executive function, communication, those are all really common experiences after a brain injury. And there, I mean, we have kind of, as we say, there's a toolbox we have on all these different tools. One might work really well for one person, another might work for another. I often start by talking about attention with folks. I think that attention, so the ability to focus, whether it's just focusing on one thing or focusing on one thing, despite there being distractions, whether those are distractions in the environment or internal distractions like your mood or feeling tired. So attention really is that foundational skill for then being able to remember. So remember someone's name, like if you introduce yourself to them at the grocery store, or remember what it was you were supposed to get at the grocery store or thinking of the word that you wanted to say.
Speaker 2 00:04:45 So talking about some strategies to identify what might be distracting you is a really great place to start that we work on with people and speech therapy. Um, and then as far as memory strategies, we think of them as there's internal strategies. So things that we can do when we're trying to remember something new to really help it stick and be more meaningful in our minds. Whether it's associating it with something we already know, whether it's repeating it or maybe even visualizing it or picturing it in our minds. Yeah. And then on the other hand, there's these external or more compensatory strategies and that would be using a notebook, getting your phone out and asking Siri to REM remind you about something. And those internal and external memory strategies usually compliment each other and help memory overall.
Speaker 0 00:05:39 That's good. And then speak a little bit about, help people understand what executive functioning means and how you help folks with that, because not that's a really, I think, brain injury esque word that we use <laugh>, right?
Speaker 2 00:05:53 Right. Yes. So executive functioning, I think one way that it was described to me in the beginning that helps me understand is thinking about the, like ceo, the chief executive officer in a big company, and what is their role? So their role is to oversee everything. It's to make sure everything's organized. They're the, the problem solver. So executive function, that's those higher level cognitive skills such as the planning, problem solving, sequencing, the self-monitoring. Mm-hmm. <affirmative>, those things. And that can be impacted after brain injury. And so we will work with people who are having trouble in those areas. And we have planning strategies, we have organizational strategies. We, you know, at least in my practice, I try to be very functional and individualized. So I will sit down with my clients and we're talking about, all right, what is it that you're doing today at home or in the community? And maybe we're planning out their day using a planner. You know, it's can be pretty simple, low tech like that. Um, yeah.
Speaker 0 00:07:08 Yeah. I think sometimes what I see is there's a lot of anxiety or tension about the right system. Am I doing the right thing? Having the right calendar or the right app? And, and then I just think it gets into overwhelm with trying to figure out am I doing it the right way for my brain? Am I gonna like break it or something
Speaker 2 00:07:29 <laugh>? Oh yeah, I know. Well I think of course it's always what's right for you. And one of the biggest things that I recommend is let's not reinvent the wheel. If there was something that you used before your brain injury, let's stick with that. So I have some people who love their paper planners and we usually stick with a paper planner. I have some people who love their phones or have an iPad and like keeping things electronic. Let's use that. So I think the more familiar strategy was before the better luck you're gonna have getting back into using that to help.
Speaker 0 00:08:06 That makes sense. That makes a lot of sense to me. Okay. I'm just thinking about, and I was thinking of a metaphor as you were speaking about the CEO for executive functioning. I also like the conductor metaphor for executive functioning. So our brain has all these different sections, right? Or cognitive functions like attention could be the, the string section and then the wind section might be your memory. And oftentimes after a brain injury, they're not coordinating together, they're not playing music. They're, they sound like when an orchestra warms up. And I was a violin player by the way.
Speaker 2 00:08:42 Mm. I was a clarinet player, <laugh>.
Speaker 0 00:08:44 Oh wow. Wonderful. <laugh>. So we're not making music a lot of times if all those different functions are not working together. And I think that's what the, the conductor does. And that's often the last piece that comes together. And I think folks are really frustrated by, I've made this cookie recipe so many times at Christmas and I can't do it now. And it was just intuitive to them to make this maybe chocolate chip cookie recipe. And now they're just trying to figure they're messing up putting salt instead of sugar.
Speaker 2 00:09:19 Mm-hmm.
Speaker 0 00:09:19 <affirmative>. And it's maddening a lot of times to them that something that seemed like intuitive that they didn't really have to think about now is, is something they really have to relearn or think about in a different way. And I think that a lot of folks find that frustrating.
Speaker 2 00:09:34 Yeah, that's totally understandable. Yeah, I think with TBI, for a lot of people it seems like there's this moment right, where things change and you, they can't help but compare the life post-injury to the life pre-injury. Yeah.
Speaker 0 00:09:50 Yeah. And I wonder about that, that transition period when people start to use some strategies, they start to become more comfortable with using their strategies or strategies and when they're kind of okay with it, you know what I mean? I think the, before they think of their before self and just intuitively, I know how to make these, I'm using the cookie example, I know how to make these cookies and that's how I did it before and now maybe I have to use, I had to really print out that recipe and check off everything to make sure I put it in. And that's a transition piece that's hard to be in that messy middle of being okay with using maybe that strategy.
Speaker 2 00:10:35 Right. You're so right. And I think it takes a little while to figure out if that strategy is going to work well for you. You can't really try something just once and make a judgment if it's going to work or not. I, one thing I often say to my clients is that I think the biggest work in speech therapy is when we're not face to face. It's the between. So when we are together, we're working on strategies we can do as much as we can in that short amount of time. And then the hard part is when the session's over and they're taking those strategies and trying the different tools out and kind of working through those tougher moments and seeing, okay, could this work for me? Which again, that's why I as much as possible, like to take strategies that made you were already working to some extent before so it doesn't feel so jarring.
Speaker 2 00:11:26 I think another nice thing is there are, I mean think about the iPhone as a compensatory strategy to help you know, whether it's, you used to have the recipe memorized and now you need to look it up, or you used to be able to remember all your appointments, now you need to look it up. The nice thing is that this is a very commonly used tool that people use brain injury or not. I think that often helps people feel better about using those tools when it's something ubiquitous that's used in society, if that makes sense.
Speaker 0 00:11:59 Yeah, makes a lot of sense. I think almost everyone I know brain injury or no is using some kind of external calendar strategy or something like that just because I think we're, our brains are more overwhelmed in general from all the media input that we have now versus what we had, you know, even 10 years ago. It's just a dramatic difference and the, and the amount of input that's coming in for most folks. So I'm, I'm glad that everyone is using more of those I think cuz we need to in our lives now. So maybe I'll transition us to talking about what you do with regard to mindfulness and yoga, because I know you integrate that into your practice, so maybe you can speak to that.
Speaker 2 00:12:47 Yeah, so I've been practicing as a speech therapist for just over 10 years and I worked in a bunch of different settings. Um, both working with kids and with adults, but working with the brain and injury population is one of my, um, areas of clinical passion. And I've always tried to keep my therapy very functional, like I said. So really meeting people where they are and coming up with functional goals. What is it again that you do? What does a day in the life look like for you? What can we do to help you reach your goals? And that's what we're working on in therapy. And I had started my own personal yoga practice and I personally noticed some really nice impacts of that practice on my mental and physical life. I noticed that that time my mind became more still, I'm one of those people with what they call a monkey mind. So I'm always thinking about what do I need to do next and thinking about what I should be cooking for dinner, when am I getting my son and all those things. So I found that even just taking 30 minutes I could focus on myself. I was tuning into these little things that I hadn't tuned into before. I was feeling more calm. So I had started my own practice and then I learned about this wonderful organization called Love Your Brain. So shout out to them. They, they
Speaker 0 00:14:39 Seem so awesome.
Speaker 2 00:14:40 Yeah, they're great. They are this amazing foundation started by Kevin Pierce who was a professional snowboarder who sustained a really severe tbi and he found that yoga and mindfulness made a huge impact on his recovery. And so they started this foundation to be able to offer yoga and mindfulness programs to people with tbi. And they kind of knew from the experience kind of like how I can just feel that it helps me feel better. They knew that it was helping or he knew it was helping him feel better. And then they've actually started doing now some research to help support how yoga and mindfulness can actually change the brain and help after brain injury. So I um, was lucky enough to get involved with Love Your Brain. I did one of their yoga programs with them. I did a training with them and I actually did my own 200 hour yoga teacher training so that I could use yoga in mindfulness to support my clients in more of a holistic way.
Speaker 2 00:15:48 When they're struggling with these cognitive and communication issues. I think that incorporating yoga and mindfulness can really help support that. So that's kind of how my interests combined. And then when I started my private practice, now I'm able to offer both the skilled speech therapy and then also yoga classes. And I do primarily chair yoga that is accessible to the greatest amount of people and it's adaptive with modifications so that people can participate and get the benefits. And I think it's really, the other thing that I have really learned and I love to share with people is yoga is so much more than maybe what the first thing is that pops into your mind when you think of yoga. And maybe it's that like Instagram picture of some girl on a beach doing some crazy pose. And frankly, that was what kept me away from doing yoga until about five years ago. I could hardly touch my toes and still I hardly can touch my toes. But just the breathing and the paying attention to the moment and how you feel and you're that in like right now, experience is so powerful.
Speaker 0 00:17:05 Yeah. Talk to me about why that might be so important for someone after brain injury.
Speaker 2 00:17:11 So again, I think of yoga and mindfulness as another tool in the toolbox. It might be for you, it might not be, but I think it can be so helpful. One of the things that it does is it actually does help our parasympathetic nervous system. So we've got, after a brain injury, often we get in this fight flight freeze mode and it's this heightened sympathetic nervous system response. And yoga activates the parasympathetic nervous system, which helps calm us down. I think when I'm working with some people in speech therapy, sometimes they're, they can feel so stressed or anxious or you know, they're having trouble thinking of a word and instantly you can see them tense up and they're Yeah. Criticizing themselves and just, it's, it's a lot. And that's totally understandable. And I think that practicing yoga teaches you some strategies and just teaches your body how to calm down in the moment. Maybe it's taking a breath, being in that moment.
Speaker 0 00:18:23 Yeah. I just find it's very, very important for the work that I do as well as as a psychologist working with the population, I often see that as my first goal. So I'm not throwing anything cognitive at you. We're not working on your attention until I calm your nervous system down. Mm-hmm. <affirmative>. Cause I feel like oftentimes when I see folks they're just, they're just really in that sympathetic energy. They constantly feeling like things are dangerous. Maybe it was their injury, maybe it was a life threatening injury potentially. Or they thought it was, or their body thought it was, it doesn't matter,
Speaker 2 00:18:58 Right.
Speaker 0 00:18:59 If your body thought it was going to harm you or kill you, then you are gonna get into that sympathetic dominance. So I find that teaching them how to have the nervous system toggle, cuz that's what we really want the nervous system to toggle between sympathetic and parasympathetic. Cuz oftentimes they often think, but I, I have to always stay calm. No, you don't. If you're driving, I want your sympathetic on because you gotta pay attention to that road. So oftentimes they think if I feel a little distressed, that's not good because I think the body is just so out of whack, oftentimes after concussion. And so I also ask them, Please be kind to yourself. Your body's just relearning a lot of things. It's trying to recalibrate. So I often like that example of maybe recalibrating a car or an engine that has been really out of tune because something happened to it or something. So we, we have to really think about that, that things are misfiring and we have to help it a little bit.
Speaker 2 00:19:59 Yeah. So
Speaker 0 00:20:00 I'm gonna go back and ask you what your story is <laugh> and how you came to work with this population.
Speaker 2 00:20:08 All right. So when I was in undergrad I majored in neuroscience and Spanish, which are like seemingly very different things, but I was always interested in that overlap and did some research around neuroscience of language, but really ultimately wasn't sure if or how I would ever intertwine the two. And then I learned about the field of speech and language pathology and, and especially in the medical side of our field, there's a lot about how the brain is related to communication. So that's how I got into the, the field of speech and language. And I always thought I'd lean more towards the medical side. Um, but in our training we're trained to be able to work both in medical settings or school settings. And I did a clinical fellowship in Boston in outpatient neuro rehab clinic, which I loved. And then I moved up to Maine a couple years later.
Speaker 2 00:21:11 And since moving to Maine I've worked in outpatient neuro rehab again and inpatient neuro rehab, a good friend of mine from grad school, she has a very similar area of interest as me. She's been working in outpatient neuro rehab since we graduated. And we always would chat about things, but since we are in different states, never really could do, you know, we say, ah, be fun to do a private practice, but ah, we live in different places. And then the pandemic hit and teletherapy became something that was just very accepted and commonly seen. And I think I just, I texted her and said, Hey, now we could do a teletherapy private practice. And she was like, Yeah, <laugh>. And so we started getting ideas together. I did a yoga teacher training, like I mentioned she did a mindfulness training. We started building a website, social media practice, just to start to have a little bit of an online community around this idea of holistic, um, speech and language services.
Speaker 2 00:22:25 We also, both having been in the medical setting, we, we notice that whether due to insurance, I think for a lot of people, speech and language therapy happens for a little while and then the speech therapists will say, Okay, again, whether it's because of insurance or you learn the strategies, now you can do this, you've got this. And people go out and they some, you know, sometimes like great other times. And it wasn't uncommon for us to get some feedback that people still felt like, ah, there's little things I'm could work on, or I still don't quite feel back to myself, or I still haven't quite reached my goals. So I think that was part of our idea in wanting to start a private practice was also to fill that me. That makes sense. So yeah, we eventually, it took us a while. We really did it by ourselves for the most part to get the practice up and running.
Speaker 2 00:23:17 But we officially launched, uh, this past fall, fall of 2021. Here we are. So our practice is called Lotus Speech and Wellness, and we offer speech and language services to residents of Maine and Massachusetts and then yoga. And, and that's based on a limitation with our license. So we have to be licensed in the state where we live, where we practice. But the great thing about yoga is there's not that same restriction. So I offer yoga classes and people can participate from anywhere. Um, and that's one of the great things our, our model is the teletherapy. So a virtual online model so people can access from anywhere. And especially I know you're in Maine too, Maine is unique in that there are a lot of very rural areas and areas that don't have as easy access to medical services, including speech language pathology. So that's one thing too. We wanted to really increase accessibility to these types of services.
Speaker 0 00:24:23 Awesome. Yes. I, it's so needed, especially for like way up north and Maine
Speaker 2 00:24:29 Uhhuh
Speaker 0 00:24:30 Folks may not have access to speech therapy. So I think it really is helpful.
Speaker 2 00:24:34 Yes, yes.
Speaker 0 00:24:36 Awesome. Well, I'm wondering if you can share a couple tips, two or three or however many you want, really insights, knowledge about what survivors can take with them in their recovery.
Speaker 2 00:24:52 Again, it's so hard to make generalizations <laugh>. Cause I, I really try to get to know each person and where they are in the moment. I think, you know, the more I learn, the more we learn about brain injury, it's very complex. I think, you know, they were first doing brain injury research with these, with often men in the military and then just generalizing that to everybody and it was young men in the military and so expectations for how quickly people would recover or, you know, it was all based off that. And I just think there's so many factors that can be impacted. So just advocating for yourself as a patient and knowing that there are services out there. I know that they can sometimes be tricky to come by. Especially again, insurance is tricky. But I think knowing that we're learning so much more about the brain, about neuroplasticity, this idea that the brain can keep changing, you know, teams like you and I, I mean, I'm a speech language pathologist, your neuropsychologist, OTs, PTs, doctor, I mean we all, there's this multifaceted support system out there and that's, that is available to you.
Speaker 2 00:26:18 So
Speaker 0 00:26:18 Yeah, so advocating, knowing that it's complex and it takes time maybe
Speaker 2 00:26:23 Mm-hmm. <affirmative>
Speaker 0 00:26:25 That there is help, there are people that know what they're talking about with regard to your injury. I think that can be a hard process to find those people. One of, uh, the best, one of the things people tell me the most is when I make, actually make referrals for them, them, they come and I, I say, Oh, you know, I'm thinking you need speech, so why don't you go see Catherine mm-hmm. <affirmative>, why don't you go see this one over here for ot? Or something like that. And I don't think the general public or even a general practitioner may know that when they first see somebody with a brain injury. So I think it is important to see someone who has expertise and concussion and brain injury.
Speaker 2 00:27:06 Mm-hmm. <affirmative>.
Speaker 0 00:27:08 So you seen by the people that know how to treat those particular issues.
Speaker 2 00:27:13 Right? Yeah. Because again, I mean within speech and language pathology, I, part of my field, a huge part of my field is this SLP who work in a school with kids. Right. And that's very different from medical speech language pathologists and someone who works with people with brain injury is also different than someone working with, you know, on their, their voice or something. So I do think it does help to find someone who specializes if you can.
Speaker 0 00:27:45 Yes. Yeah. Okay. Are you ready for our closing round
Speaker 2 00:27:50 <laugh>? Sure.
Speaker 0 00:27:52 I like to end the podcast with something fun. Okay. So what is your favorite holiday food and who does it remind you of or what?
Speaker 2 00:28:02 So I was listening to one of your podcast episodes and I heard you say my favorite holiday food, which is Hispanic coppi. Yes. It's such a rare thing and I couldn't believe it when you said it, but my mom always used to make it for us. So that is definitely the one that I think of. It's the one that I made for Christmas dinner this year. It's good stuff. <laugh>?
Speaker 0 00:28:24 Yeah. I usually make it as like the appetizer for Christmas dinner. I made it for, I didn't make it for Christmas, I made it for Thanksgiving this year. It could be anyone Thanksgiving or Christmas, depending on mm-hmm. <affirmative>. Okay. What is one thing you would tell someone with a brain injury or concussion?
Speaker 2 00:28:42 You are hitting me with that one thing again. I mean, again, I feel like I'm a <laugh> saying the same thing, but I, I think it depends on the person I, I think brain injury. What I have learned from working with my clients who've taught me so much in being part of the community is that everyone's experience is truly unique. You know, that means your journey is different, your goals are different. I think maybe it's back to that piece that we were talking about before, advocating for yourself, finding professionals who will meet you where you are and work on your goals for your daily life as it is.
Speaker 0 00:29:32 Yeah, right. Awesome. Well, that's all I had for today. So thank you so much, Catherine, for being on the podcast. I hope to talk with you really soon.
Speaker 2 00:29:42 Thank you so much for having me. This was a pleasure.
Speaker 3 00:29:50 Thank you for joining us today on the TBI Therapist podcast. Please visit tbi therapist.com for more information on brain injury, concussion and mental health. The information shared on today's podcast is intended to provide information, awareness, and discussion on the topic. It is not clinical or medical advice. If you need mental health or medical advice, please seek a professional.