#3. You play!🤔🙆

This article transcribes an individual therapist’s journey with paediatric clients in a school setting. It focuses on a particular aspect of speech therapy and does not represent the entirety of the profession.

It was one particularly bright morning. The sun was shining 🌞, the sky was a bright, beautiful blue and the birds were chirping oh so sweetly🐦🐦. It was one of those good days- if you know you know😉! I had just concluded my first therapy session and was preparing for the next one, when she said it. She had peeked into the therapy session and observed what was going on.

‘But you were just playing!’ she said.

‘You were playing with the child,’ she affirmed in a clearly shocked voice😯. Speech therapy sessions, like any other treatment sessions, are confidential. However, in the school setting, this can be easily compromised through bust-ins by overly inquisitive teachers or the peeping a thomases🙊😏 and this was the case. The client was known to us both. Her statement, which was loaded with query and somewhat accusation was interpreted like this; ‘Is that what therapy looks like?’, ‘This is what you studied in medical school?’, ‘Isn’t therapy supposed to be more medical?’ and, the greatest of them all, ‘You are paid to play!!??’ Interestingly, i was not irritated by her breach of my professional space or her curiosity, instead, I was amused. I was so amused by the fact that her statement and shock mirrored a similar experience that i had a few years back.

The memory is still so fresh💭. It was one of the first few clinical lectures that we had with this particular lecturer. The client was brought in, a child of about 4 years and each of us was instructed to assess the child under the scrutiny of the lecturer. I will not go into the hordid details of how my first assessment turned out🙅 but I will say that it was very awkward, sloppy and I knew it. At the end of the session, lecturer x pointed out one mistake that we (my classmates and i) all had committed, which was that we had not properly ‘engaged’ the child. When she later on demonstrated what she meant by ‘engage’ the child, we saw play🤷! This would later on become a source of bickering for us because we expected ‘more medical’ assessment methods and interventions as compared to mere ‘play.’ I mean, wasn’t there a better way to assess a child without having to ‘play’ with them. The whole idea of looking silly (or so i thought) infront of parents did not sound appealing at all. All this, this came from a point of ignorance, a tinge of pride and fear for what lied ahead. I had it all wrong…

Fast forward to today and guess who my favourite clients are, ‘The children!”😆😆😆.. It seemed like I was doomed to ‘play’ my whole career. BUT, i had got it all wrong the whole time. I came to this realization a little late- talk about the field being the actual teaching ground, huh🤔! It had never been just ‘play’ in the first place, instead, it had always been therapy/assessment goals and targets packaged in a beautifully wrapped present with a large bow🎁 called ‘play.’ Paediatric Speech and language therapy and play work hand in hand and this is why;

Play and language are intertwined. In the early years of life, the typically developing child is able to watch👀, listen👂, imitate👶, explore👣, develop symbolic understanding and grow vocabulary🗣 through the different forms of play in their respective stages. To say that play is important in a child’s life is an understatement, it is paramount, more so in the presence of a caretaker who will set the pace for these play sessions. This is further affirmed by the words of a certain wise man,

Play is often talked about as if it were relief from serious learning. But for children, play is serious learning. Play is really the work of chidhood.”- Fred Rogers

When offering speech therapy services to a child client, the average SLT finds themselves incooperating their goals/ targets in play based activities tailored to the child’s age. This means that it is not ‘mere play’ but structured speech therapy sessions involving play based activities or structured play! And guess what, it may not always be easy but most of the time, you are able to capture the attention of the child, the child /client will enjoy the activity, you are able to achieve your goal when the activity is followed through with according to plan🤦 and it is FUN!💃🕺🕺

So yes, I play.. when necessary but I do not play ‘fwaa’🙊, I play with structure, purpose, skill and evidence to back up my work. Yes, i will wear pants 90% of the time and yes, I get to enjoy the work that I do, impact the lives of beautiful souls as they do mine on MOST days…😅😅..its not all smooth.

Lastly, to the parents, engage and play with child as much as you can and if something is not right, seek help- we are here for you!

Till next time,

Cynthia🌼💕

#3 You play!🤔🙆

This article transcribes an individual therapist’s journey with paediatric clients in a school setting. It focuses on a particular aspect of speech therapy and does not represent the entirety of the profession.

It was one particularly bright morning. The sun was shining 🌞, the sky was a bright, beautiful blue and the birds were chirping oh so sweetly🐦🐦. It was one of those good days- if you know you know😉! I had just concluded my first therapy session and was preparing for the next one, when she said it. She had peeked into the therapy session and observed what was going on.

‘But you were just playing!’ she said.

‘You were playing with the child,’ she affirmed in a clearly shocked voice😯. Speech therapy sessions, like any other treatment sessions, are confidential. However, in the school setting, this can be easily compromised through bust-ins by overly inquisitive teachers or the peeping a thomases🙊😏 and this was the case. The client was known to us both. Her statement, which was loaded with query and somewhat accusation was interpreted like this; ‘Is that what therapy looks like?’, ‘This is what you studied in medical school?’, ‘Isn’t therapy supposed to be more medical?’ and, the greatest of them all, ‘You are paid to play!!??’ Interestingly, i was not irritated by her breach of my professional space or her curiosity, instead, I was amused. I was so amused by the fact that her statement and shock mirrored a similar experience that i had a few years back.

The memory is still so fresh💭. It was one of the first few clinical lectures that we had with this particular lecturer. The client was brought in, a child of about 4 years and each of us was instructed to assess the child under the scrutiny of the lecturer. I will not go into the hordid details of how my first assessment turned out🙅 but I will say that it was very awkward, sloppy and I knew it. At the end of the session, lecturer x pointed out one mistake that we (my classmates and i) all had committed, which was that we had not properly ‘engaged’ the child. When she later on demonstrated what she meant by ‘engage’ the child, we saw play🤷! This would later on become a source of bickering for us because we expected ‘more medical’ assessment methods and interventions as compared to mere ‘play.’ I mean, wasn’t there a better way to assess a child without having to ‘play’ with them. The whole idea of looking silly (or so i thought) infront of parents did not sound appealing at all. All this, this came from a point of ignorance, a tinge of pride and fear for what lied ahead. I had it all wrong…

Fast forward to today and guess who my favourite clients are, ‘The children!”😆😆😆.. It seemed like I was doomed to ‘play’ my whole career. BUT, i had got it all wrong the whole time. I came to this realization a little late- talk about the field being the actual teaching ground, huh🤔! It had never been just ‘play’ in the first place, instead, it had always been therapy/assessment goals and targets packaged in a beautifully wrapped present with a large bow🎁 called ‘play.’ Paediatric Speech and language therapy and play work hand in hand and this is why;

Play and language are intertwined. In the early years of life, the typically developing child is able to watch👀, listen👂, imitate👶, explore👣, develop symbolic understanding and grow vocabulary🗣 through the different forms of play in their respective stages. To say that play is important in a child’s life is an understatement, it is paramount, more so in the presence of a caretaker who will set the pace for these play sessions. This is further affirmed by the words of a certain wise man,

Play is often talked about as if it were relief from serious learning. But for children, play is serious learning. Play is really the work of chidhood.”- Fred Rogers

When offering speech therapy services to a child client, the average SLT finds themselves incooperating their goals/ targets in play based activities tailored to the child’s age. This means that it is not ‘mere play’ but structured speech therapy sessions involving play based activities or structured play! And guess what, it may not always be easy but most of the time, you are able to capture the attention of the child, the child /client will enjoy the activity, you are able to achieve your goal when the activity is followed through with according to plan🤦 and it is FUN!💃🕺🕺

So yes, I play.. when necessary but I do not play ‘fwaa’🙊, I play with structure, purpose, skill and evidence to back up my work. Yes, i will wear pants 90% of the time and yes, I get to enjoy the work that I do, impact the lives of beautiful souls as they do mine on MOST days…😅😅..its not all smooth.

Lastly, to the parents, engage and play with child as much as you can and if something is not right, seek help- we are here for you!

Till next time,

Cynthia🌼💕

#2 Autism??

Hello friend, oh am I glad to write to you once again. It has been a long while – one filled with inevitable silence, a certain extent of defeat and doubt. However, I am grateful for friends who hold us accountable. This goes out to to you, special one who knows herself 😉

The month of April is one of the most publicized months in the world of special needs and rehabilitation science. Why now? Well!!! it is autism awareness month. Autism to stand for Autism Spectrum Disorder (ASD)- a condition that has become seemingly more common in Uganda and the world at large. One wonders why! This could be attributed to knowledge, awareness and social media over the recent years. Different organisations, families and individuals all over the world that have had an experience with ASD will ‘light it up blue’-a slogan to mean the adornment or portrayal of the colour blue to create awareness, show support and spread the love.

I have something to say about ASD, something far from the condition itself – because that can be found on the snap of your fingertips. Instead I am going to talk about my experience with ASD as an individual. Different right! Well now, let’s hear it!!

A brief introduction on ASD – ASD is a neurodevelopmental disorder with which the affected individuals present with deficits in communication, social skills as well as repetitive behaviours. In simple terms, this condition is directly associated with the brain and individuals with this condition struggle to develop and maintain relationships, struggle to communicate effectively, have certain uncommon behaviours, for example, hand flapping, lining of objects, spinning, obsession with particular objects, to mention but a few.

I first learnt about ASD in my second year, second semester. It was one of those conditions that really intrigued me (pardon my geeky self). I mean, a condition that affects ones social skills, what! It seemed quite absurd, not to mention the fact that there is no known cause. The more I read about it, the further my interest deepened. Fast forward to my first internship experience, I got to encounter different children with different levels of ASD – yes ASD has levels ranging from high functioning ASD, formerly known as Aspergers Syndrome to mild, moderate and severe ASD. It was then that I understood that book work can never ever compare with the actual field work. I must say I was quite stuck for the first few days of that period of time. Each and every child I saw was different. Some spoke quiet well, others spoke a few words, some did not speak at all, some could sing, others could not, some could write , some could not, some were jolly, others did not express much emotion, some lined objects, others spun objects, others enjoyed to walk on surface edges, to mention but a few (Disclaimer:there is so much more that cannot be summarized within these lines). Never before had I seen a condition that could be so diverse and yet similar at the same time.

We were not taught how to warm our way into the hearts of our clients and I received the shock of my life when not one, not two but about three of the children I found at that internship place rejected me…ouch!! Was that even supposed to happen? For some peculiar reason, I thought that all I had to do was sit with these children and ‘help’ them and they would welcome me with open arms<chuckles to herself> Well, that was not the case! Like any other typical developing children or individuals, children/individuals with ASD have opinions and feelings too. They choose whom they like and whom they do not, whom they will play with, who will hug them, whose instructions they will follow. I learnt that i had to win their favour and oh boy was that tough:) I had to get creative, sing, play, be a child (as I was working with children), dance – anyone who knows me knows that I find it hard to dance in public. But I had to do it, I needed to pass plus there was the supervisor….

Over the weeks, I slowly warmed my way into the hearts of these children and they opened up to me…<yeyy with a victory dance>. It was then that I was able to really practice the little skills that I had. I learnt that the condition never defines the individual, that is why we do not say that ‘he/she is autistic’ unh unh. Instead it is ‘he/she has autism /ASD’ because they are individuals with feelings, opinions, strengths, weaknesses, dreams- yes they do. All they need is an extra dose of love, patience, support and finances(tough but true) The diagnosis is never the end of life, dreams or aspirations- no! There is hope, rehabilitation and this is what I would love you who is reading to take away from this piece. Uganda has been blessed to have various professionals who work in the rehabilitation process – speech therapists, occupational therapists, behaviour therapists and others.

Let us seek help, support, be kind and thoughtful and above all share the love. Till next time.

All my love,

Cynthia.

New beginnings

#1
Hello.. I am Cynthia Nagasha, a speech and language therapist and newly found blogger. This article marks a first of many more that are to come. I have written, rewritten, thought, corrected and adjusted so many firsts of this kind in vain. U see, I am quite the perfectionist. For some reason, I thought that the first article has got to be perfect. This was till I came across this famous Chinese proverb that happened to make mind blowing sense at that specific time;
A journey of a thousand steps begins with one step.

And so I begun…..

Speech and language therapy was not the profession of my dreams. I had no idea about its existence till I started to apply for courses at the university. When my venture for medicine proved futile, I started to look around and I fell upon it. It is a course and a profession I have come to love and be passionate about and it is from this passion that stems a desire to create awareness. ‘Why awareness?’ you may ask. Well, in a society where majority of the health diagnoses are treated with drug medication, therapy is still quite new despite the number of years it has been in place. We want an intervention that is quick, tangible and takes immediate effect despite the diagnosis and so when one says therapy, we do not know what to expect. Now, there are many types of therapy but, I will focus strictly on speech and language therapy. Written below is an excerpt of a typical conversation I have with different people in the event that I am asked about my line of work;

You; what do u do?
Me; I do Speech and language therapy/ I am a speech therapist.
You; Speech and language therapy? Do you learn sign language…can you teach me sign language?
or Wow… speech and language therapy…can u help improve my confidence as I speak?
or Ohhh..so u learn how to speak different languages? Could u teach me a new language?
or Hmmm.. Speech and language therapy…What do you do?
Me; (sigh..) well…(as my head works up a detailed and clear explanation)

The profession of Speech and language therapy (SLT) is very interesting and yet equally tasking in the event that we are to explain to a lay person( by lay I mean, one with no medical knowledge) what we do and how we particularly administer therapy. People generally know that a teacher educates; a lawyer deals in settling legal issues; a heart surgeon operates on hearts. Even with professions allied to medicine, many people have some basic understanding of some roles and may have a reasonable idea, for example, as to what a dentist does. But within our more abstract field, our role still remains comparatively unknown and poorly understood as illustrated in the conversation above.

So what is SLT??
Speech and Language Therapy or Speech and language Pathology (SLT/SLP) is a medical profession that involves the assessment, differential diagnosis, intervention with, and management of individuals with communication and swallowing disorders. Clinicians qualified in the profession of speech and language therapy- that is, after successfully completing a Bachelor of Science in Speech and Language Therapy/Pathology are called speech and language therapists or speech and language pathologists.
Speech-language therapists work with clients who may present with a wide range of issues. Our client groups consist of adults, children and adolescents. We refer to our patients as clients because they play a major role in the therapy process and without their effort and contribution, treatment and management of the condition at hand cannot go on. Within these client groups, the following are some of the common conditions that fall under our area of expertise;

In Infants and children we have; Infants with injuries due to complications at birth, feeding and swallowing difficulties, including dysphagia. Genetic disorders that adversely affect speech, language and/or cognitive development including cleft palate, Down syndrome, DiGeorge syndrome, Attention deficit hyperactivity disorder, Autism spectrum disorders, including Asperger syndrome, Developmental delay, Feeding disorders, including oral motor deficits, Cranial nerve damage, Hearing loss, Craniofacial anomalies that adversely affect speech, language and/or cognitive development, Language delay, Specific language impairment, Specific difficulties in producing sounds, called articulation disorders, (including vocalic /r/ and lisps), Pediatric traumatic brain injury, Developmental verbal dyspraxia, Cleft palate.

Adults; Adults with eating, feeding and swallowing difficulties, including dysphagia. Adults with language difficulties as a result of: Motor neuron diseases, Alzheimer’s disease, Dementia, Huntington’s disease, Multiple sclerosis, Parkinson’s disease, Traumatic brain injury, Mental health issues, Stroke, Progressive neurological conditions such as cancer of the head, neck and throat (including laryngectomy), aphasia. Adults desiring transgender voice therapy (usually for male-to-female individuals)

Some of the conditions that cut across both groups are;
Cerebral Palsy, Traumatic brain injury, Hearing loss and impairments, Learning difficulties including, Dyslexia, Specific language impairment (SLI), Auditory processing disorder, Speech disorders (such as cluttering, stuttering, Stroke, Voice disorders (dysphonia), Language delay, Motor speech disorders (dysarthria or Developmental verbal dyspraxia), Dysgraphia, Laryngectomies and Tracheostomies.

The beauty about the health profession is that we get to work together despite the various medical fields involved and this too applies to speech and language therapists. We are part of a multidisciplinary team that involves doctors, nurses, audiologists, behavioral therapists, occupational therapists, psychologists, psychiatrists, physiotherapists, teachers, special needs teachers and so many others. SLTs work in a variety of clinical and educational settings. SLTs work in public and private hospitals, skilled nursing facilities (SNFs), long-term acute care (LTAC) facilities, hospice, and home healthcare. SLTs may also work as part of the support structure in the education system, working in both public and private schools, and universities. Some SLTs also work in community health, providing services at prisons and young offenders’ institutions.
In Uganda and East Africa as a whole, Speech and Language Therapy is only offered at Makerere University College of Health Sciences, School of Medicine, department of ENT on undergraduate level and Uganda is really priviledged to have the most number of speech and language therapists in the East African region.

I must say, my profession isn’t an easy one. Sometimes am loving it all the way, sometimes am worried, sometimes I see results sooner than most, other times there is quite the lag but all in all it is a noble one, one that seeks to make a difference in each life it encounters.

Till article #2,
Nagasha Cynthia, SLT