Speech-Language Pathology Community Clinic

In 2019, a brain injury ended Henry Hecker's career and deprived him of his ability to speak, but on a recent Zoom call, he was determined to get his voice back with the aid of two students in the Katz School’s M.S. in Speech-Language Pathology.

In separate half-hour sessions, Alexa Bliss and Joanna Pace patiently and enthusiastically guided Henry through exercises to reclaim his memory, helped him articulate words and phrases, and encouraged him to advocate for himself, with Julia, his wife of 34 years, nearby.

Read the story on the Katz blog.

While Dr. Michaela Medved’s approach to treating patients has been severely affected by the coronavirus, her job at its heart hasn’t changed. She still works in her clinical practice with children and adults to continue focusing on their therapy goals. In recent weeks, however, that has meant communicating with them over video as opposed to treating them at home or in the hospital. 

“I’ve been able to maintain a working relationship with my older clients in virtual sessions,” said Dr. Medved, a clinical assistant professor in the Speech-Language Pathology program at Yeshiva University’s Katz School of Science and Health. “But for clients who have feeding or swallowing disorders and underlying medical conditions, I haven’t been able to treat them because it’s dangerous for them. That’s been really tough.” 

A good share of the burden of care, said Dr. Medved, has shifted temporarily to the families of patients. But she maintains regular contact, guiding caregivers on how to administer treatments to her patients. For the past six months, she has been working with a 10-year-old girl, a pediatric stroke victim, in her home until the virus prevented her from visiting. To make sure, though, that the girl’s care continued uninterrupted, she gave the parents responsibility, albeit under her watchful eye, for improving the girl’s feeding skills. 

Using FaceTime, Dr. Medved showed the parents how to use a Neuromuscular Electrical Stimulation device, which is half the size of a smart phone, to administer an intermittent electrical current to their child during a meal. The current, delivered by two electrodes under the girl’s chin for half an hour, four times a week, is meant to strengthen her tongue and swallowing muscles. Even with the loss of in-person contact, Dr. Medved, by checking in with the parents regularly, has ensured that the girl is making steady progress. She’s graduated from eating puree to normal breakfast foods, like waffles. 

“We have remained in contact to discuss her progress as well as new foods and textures,” said Dr. Medved, “but I haven’t been charging anything because I don’t feel comfortable. I’m sensitive to the fact that these families have more than one child and are overburdened with home schooling.” 

Dr. Medved said that though teletherapy is a “wonderful” alternative in many cases, she emphasized that it’s not a replacement for in-person care for every patient population. She has found that teletherapy is most successful when working with older school-age children, adolescents and adults with a variety of diagnoses, including expressive and receptive language delays, articulation disorders, cognitive dysfunction and fluency disorders. 

“Though appropriate at times, teletherapy has been increasingly difficult to use with younger children—birth to three—older adults with compromised cognition, and patients with feeding and swallowing issues,” she said. 

Dr. Medved said the current lockdown is teaching her how to be flexible. She said healthcare professionals are now beginning to work through online platforms regardless of where their settings once were, and though teletherapy will undoubtedly become increasingly popular and more readily used and accessible, in-person therapy will always remain the ideal modality for providing therapy services. 

Since 2016, Dr. Medved has been with the Katz School and has taught courses in Clinical Speech-Language Pathology, Diagnostic Methods, Syndromes and Craniofacial Anomalies, Communicating with Patients and Families, and Stuttering and Related Fluency Disorders. 

She holds a doctorate in Speech-Language Pathology from Rocky Mountain University of Health Professions, and a master’s degree in Speech-Language Pathology and bachelor’s degree in Speech Pathology and Audiology from Lehman College. 

The Katz School’s master’s program in Speech-Language Pathology is one of the few in the country specializing in medical speech pathology, taking a multidisciplinary approach to diagnosing and treating speech, language and communication cases. Students graduate prepared to apply for certification from the American Speech-Language Hearing Association (ASHA) and for licensure in New York State. 

Dr. Medved recently published the article, “Adapting to the New Normal: SLP Adjustments in the COVID-19 Era” on the website of the Rocky Mountain University of Health Professions. 

She said she can foresee the important role that the medical speech-language pathologist will play in the rehabilitation of individuals globally. In order to serve those patients, she emphasized that it’s imperative that students be trained in the most up-to-date modalities for intervention, evidence-based practice and therapy options. 

“Though we cannot foretell the extent of the needs that will be required, we can predict that as patients recover there will be a need for the restoration of swallowing, voice, motor speech disorders and respiratory de-conditioning,” she said. 

Helena Goodman, a marketing manager at Yeshiva University, recently spoke with SLP student May Mahmoud about her experience at the Katz School of Science and Health. 

May Mahmoud is in her last semester of the Katz School’s Speech-Language Pathology program. Originally from Alexandria, Egypt, she currently lives in Brooklyn. May is bilingual in Arabic and English, and holds an undergraduate degree in speech-language pathology from Brooklyn College. Helena Goodman, a marketing manager at Yeshiva University, recently spoke with May about her experience at the Katz School of Science and Health. 

Q: How have you adapted your SLP practice during COVID-19? 

I used to provide services to children and geriatrics in person, but I transitioned to teletherapy and distance-based therapy as COVID-19 hit. It has definitely been an adjustment for my clients, as a lot of them have never worked with a pathologist remotely before. Yet, we have been able to continue to provide help to our clients, as the need does not stop. Many things have been put on pause during COVID-19; however, an elderly person recovering from a stroke does not have the luxury to stop his therapy. We continue to provide the care that is needed to help our clients in their situations. 

Q: Have you found anything that has made the transition easier? 

I have found that sometimes you need to compensate for the fact that you are not doing face-to-face therapy. Certain methods are much harder via Zoom, such as play-based therapy.  Children with autism cannot sustain eye contact and their attention, but as we transitioned I have found ways to supplement this. I use the shared-screen option for book readings and pointing to things. This has resulted in many of my clients gaining new skills from remote therapy; I believe that even the geriatric population is now learning a bunch of new skills by using these platforms. I also see the confidence they are gaining by mastering these platforms. 

Q: What are some of the benefits of the Katz program? 

The Katz program stood out to me because it was the only one that provided a medical track and an SLP education with an emphasis on working in a medical setting, as well as an educational setting. Without a medical background, you cannot work in a hospital or nursing facility. Many don’t realize that our field helps more than children, but those across the lifespan and with varying abilities. The Katz courses are incredibly specialized and specific, providing you experience in a variety of topics. Marissa Barrera also was a deciding factor. We spent over an hour on the phone before I was accepted. She was humble and personable. It just clicked—the cherry on the top for why I chose Katz. 

Q: What did you focus your research on? 

My investigation focused on “Assessment of Autism Spectrum Disorder in Bilingual Children.” Standardized assessments are often considered the gold standard for identifying diagnoses. This research examined the efficacy of standardized assessments in diagnosing Autism Spectrum Disorder in bilingual children. My long-term goal is to develop a standardized assessment for Arabic-speaking individuals. 

Q: Any advice for prospective students? 

You have to be passionate – that passion will give you the drive to work hard. It is not an easy program, but it will prepare you for the real world and work in the field. You have to be positive you want to be in the program: you are treating people who are in critical condition and you need the skills and patience to give them what they need. The ability to help them will come from that passion.

Research by recent SLP graduate concluded that the recovery pattern of expressive and receptive language skills for bilingual speakers can vary after a traumatic brain injury.

“Recovery can occur in different ways depending on the site of the lesion, the severity of the impact, the age of the patient and the success of the treatment methods,” said Christopher Almonte, who graduated in May from the Katz School of Science and Health. 

Receptive language skills have to do with the ability to understand words, sentences and the act of speaking, while expressive language skills are about producing speech. 

Children with a receptive language disorder struggle to process speech while engaged in conversation and may rely too much on reading facial expressions. Those with an expressive language disorder may rely on simplified messaging strategies that prevent them from translating more complex thoughts into language. 

The focus of Almonte’s analysis was on the likelihood of spontaneous language recovery for bilingual English-Spanish speakers compared to monolingual speakers, as well as which assessment techniques lead to an appropriate diagnosis of aphasia in bilingual speakers. 

Almonte, who immigrated from the Dominican Republic at the age of fifteen, originally wanted to be a journalist but decided to become a speech-language pathologist after witnessing their work when he was a teacher assistant in the New York City Department of Education. He transferred from Bronx Community College, where he was working toward an associate’s degree, to Lehman College where he went on to obtain a bachelor’s degree in speech-language pathology. 

“When I saw the work speech pathologists were doing with people with communication, language and feeding disorders, it was like my heart went right into it,” said Almonte. “I wanted to be that person who makes people’s lives better.” 

During his time at the Katz School, he was a graduate clinical extern at Kingsbridge Center, Riverdale Senior Services and P.S. X811, all in the Bronx, where he facilitated pediatric language-enrichment sessions, provided geriatric patients with timely therapeutic services, and administered one-on-one and group treatment to students between the ages of 14 to 21 with a primary diagnosis of autism, emotional disturbance and language impairments. 

At Ahava Medical in Brooklyn, the site of his last externship, he provided feeding and swallowing therapy to school-age children with Agenesis of corpus callosum—a rare birth defect—behavioral feeding difficulties and Down Syndrome. 

After he graduated, he was hired as a speech-language pathologist by the Bronx-based Important Steps, an early childhood program that provides therapeutic and diagnostic services to children with developmental disabilities. 

In the research analysis capping his Katz School career, Almonte cited a study conducted in 1997 by Michel Paradis that identified six different patterns of recovery for bilingual learners: parallel, selective, differential, antagonistic, successive, and blended (mix) recovery. 

Parallel recovery takes place when both languages are impaired and recover simultaneously. Selective recovery occurs when both languages are capable of being recovered but only one actually does. Differential recovery happens when one language returns to normal. Antagonistic recovery takes place when one language starts to recover but then regresses once the second language begins recovering. Successive recovery occurs when a language starts to recover only after the other language is fully restored. And in a blended (mix) pattern, recovery follows no one pattern. 

Almonte said there isn’t enough evidence on how to choose an appropriate assessment battery, however it’s important any assessment for bilingual individuals be sensitive to client experiences. He pointed to a study that found that a Spanish-speaking client who lived in Britain and had aphasia struggled to name a “hedge,” since they are unlikely to be found in Spain. The client’s inability to name the hedge decreased the client’s score in an aphasia battery.