Making The Connections
Two weeks ago I posted a blog containing an interview with Dr. Beal, Executive Director at ISTAR, on his research focusing on the links between neurobiology, genetics, and stuttering. After receiving a request for more posts on research being done by the faculty, I decided to contact Dr. Teresa Paslawski, Assistant Professor in the Speech Pathology program here at the University of Alberta. Dr. Paslawski brings a unique perspective to the field and to the classroom, as she has a Bachelor and Masters Degree in Speech Language Pathology, as well as a Ph.D in Neuroscience-Psychiatry. Coincidentally, Dr. Paslawski’s background and knowledge also has links to stuttering, and she will be giving a talk at ISTAR in December about the links between pharmacology and the treatment of speech disorders. I was lucky enough to be able to interview her about her perspective on this topic.
Adele: So two weeks ago I posted a blog on some of the research being done by Dr. Beal at ISTAR on the neurobiological and genetic links to fluency. You are presenting a guest talk at ISTAR next week on how fluency and stuttering links to another topic. Can you tell me a little bit more about that?
Dr. P: So the talk I’m giving is coming out my background- my Ph.D in Neuroscience. It’s also related to my interest in clinical education and what we can do to be better in this area. I had given a talk at CASLPA about Neuropharmacology for Rehab professionals, and then Marilyn Langevin [from ISTAR] had asked me if I would narrow it down to fluency. What’s interesting to me about fluency is that drugs have been used to work with fluency in the past with little success, but there are other things treated with medications, such as tic disorders, depression, anxiety etc. that can show up in the same population, so its worthwhile having clinicians understand a little bit more. People may not understand why a Speech Path would want or need to know about the drugs a person is taking, but it is super critical that we understand. Even something as a simple as dry mouth, which is common with a number of drugs, or if a client is too sleepy to pay attention, or if they are irritable, these all affect how well our therapy is going to go or how well our intervention is going to work. So, I think it’s helpful to us to understand these kinds of things just to be able to work more effectively with our clients.
I also think we can play a role in helping our clinical team understand how a drug is affecting someone, or perhaps ask if there is a better option out there for a client. We make observations that other people don’t make- we spend pretty intense amounts of time with our clients, certainly longer than a physician might be able to spend, and we observe different things, so we would notice things that other clinicians wouldn’t necessarily notice. This helps the team to paint a picture about what effects a drug is having- things the client wouldn’t even necessarily be aware of because they aren’t thinking about it or know which questions to ask.
What we are going to talk about next week is going to revolve around some of the basics about how neurochemistry and neuropharmacology relate to each other and about some of the drugs that are currently being tried out there. The drugs are always going to be changing, so reviewing the basics is hopefully more helpful than spending all of our time talking about specific drugs.
I know the Master’s program is busy and there is already a lot to know without having this focus, but I think we have a place in the discussion about pharmacological treatments and I think we need to have a bigger voice and not be afraid to say, “Could this behavior or observation be drug related?”, to talk to the pharmacist and the physician about what we notice, and ask what could be done differently.
Adele: I think we learn about the different areas an SLP would work in but we don’t always consider all these other aspects that we need to consider when working with clients, so its an important message.
Dr. P: And I actually think that we aren’t confident that we can [focus on these other aspects]. For example, we don’t always know if it’s okay to call the pharmacist and say “I just saw client X and I noticed her mouth is really dry. Could that be because of drug X, is there something we can change?” I think the beauty of speech pathology is our focus on specific aspects, but that still connects with so many other things.
Adele: So being aware that we can make connections with other professionals will ultimately help our practice because it will help with our client’s ability to participate and benefit from our therapies.
Dr. P: As well as quality of life! We can also help our clinical teams because of the observations we make. You think about a muscle twitch around the eye or something else really minute that other people wouldn’t necessarily notice. We are really good at observing- we have to be- we have to observe things that are small or subtle and make connections.
Adele: So the talk focuses on the effect that drugs can have on things like depression or motor issues, rather than directly treating stuttering with drugs. From an interest perspective though, do you think we will ever get to the point where we can treat fluency disorders with drugs, you said it hasn’t been successful in the past, but what do you predict?
Dr. P: My prediction is no. I think we will find better ways than drugs but drugs can be a stepping stone or support. You think of, for example, treatments for depression- some of the most successful treatments out there are a combination of drugs and cognitive behavioral therapy and neither of them is as good alone. In many cases, though certainly not always, drugs can been seen as a way to get onto your feet and the behaviour therapy helps you stay on your feet, and work towards not needing the drugs.
Drugs also teach us something about the system. If you take a drug and you get better or some symptom improves, and we understand how that drug works in your body, it teaches us something about the symptom or the disorder you are dealing with. So this is a really helpful way we can think of drug therapies- maybe a bit of a bonus- that they can teach us something about the diagnosis we are working with. Just like we use imaging methods as a tool, drugs can be both a diagnostic tool and a treatment.
Adele: What other speech disorders can benefit from pharmacological intervention?
Dr. P: I think if your client is on medication or is considering medication, you need to be aware of it. We haven’t been so lucky with medication to treat speech and language disorders per say, but we can focus on the things that support communication, e.g. memory, attention, even emotion, and we can contribute to the discussion of how drugs are affecting our clients, to support our clients being successful in therapy.
Dr. P’s talk is the last in the ISTAR 25th Anniversary and 2012 ISTAR-Alberta Network for Fluency Lecture series. It will be held at Corbett Hall, in room 3-30, on December 4th from 12 till 1 pm. The talk will also be broadcast as a webinar to allow you to tune in wherever you are. Click here to register ASAP, it is a free lecture, and promises to be a very interesting, informative presentation!