The Benefits of Speech Therapy with Hilary Booco
Show Notes:
It can be immensely frustrating to want to have a conversation but not be able to find the right word or fail to even get the words out fast enough. But all is not lost, if you can work towards getting your point across, you’ve communicated! Today’s guest is speech therapist Hilary Booco. Hilary has a Master's Degree in Speech Language Pathology from George Washington University. She has spent her career focused on treating neurological issues including post-concussion syndrome, dementia, stroke, and neurodegenerative disorders. In our conversation today we cover what a speech language pathologist does, what it looks like in post-concussion treatment, what the objective of speech therapy is, and Hilary shares some great advice for people currently struggling with word-finding and stuttering. You don’t want to miss this, so tune in today!
Key Points From This Episode:
• Hilary shares her own post-concussion story and process.
• How she became interested in speech therapy: through her own experience.
• You don’t necessarily have to see a doctor before you start with therapy.
• Hilary shares more on what a speech language pathologist does and can specialize in.
• A typical therapy session for a concussion survivor with a speech language pathologist.
• Broken into four cognitive domains: memory, attention, language, and communication and executive functioning skills.
• When you should consider seeing a speech therapist: getting you back to pre-injury function.
• Tips for people who have difficulty with word-finding: it gets worse the more anxious you are.
• She explains circumlocution: describing the word you want to say.
• Retrieval fluency, and how it’s not a memory issue.
• Stuttering; your mouth is moving faster than your brain is.
• Parting words from Hilary: being active, don’t overdo it, and advocate for yourself!
Connect with Hilary:
Website: Colorado Brain Recovery
Email: info@coloradobrainrecovery.com
Phone: 720.644.0893
Follow Post Concussion Inc on Social Media to stay up to date on the podcast
Transcript - Click to Read
[INTRO]
[00:00:05] BP: Hi. I’m your host, Bella Paige, and welcome to the Post Concussion Podcast, all about life after experiencing a concussion. Help us make the invisible injury become visible.
The Post Concussion Podcast is strictly an information podcast about concussions and post-concussion syndrome. It does not provide nor substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or another qualified health provider with any questions you may have regarding a medical condition. Never disregard professional medical advice or delay in seeking it because of something you have heard on this podcast. The opinions expressed in this podcast are simply intended to spark discussion about concussions and post-concussion syndrome.
[INTERVIEW]
[00:00:58] BP: Welcome to today's episode of the Post Concussion Podcast with myself, Bella Paige, and today's guest, Hilary Booco. Hilary has a Master's Degree in Speech Language Pathology from the George Washington University. She has spent her career focused on treating neurological issues including post-concussion syndrome, dementia, stroke and neurodegenerative disorders. Welcome to the show, Hilary.
[00:01:25] HB: Thanks so much for having me.
[00:01:26] BP: So, to start, could you tell everyone a bit about your own post-concussion experience? And then what interested you in speech therapy?
[00:01:34] HB: Yeah, so I had a concussion when I was in my first semester of graduate school for being a speech language pathologist. It's one of those things where it's just this freak thing that happened. I was rushing to go to work at the time, I worked for an eye doctor while I was in school, and I basically opened a door into my head. I bent over at the same time as I opened the door to my bathroom and just boom, whack, it hurt. I had said some choice words. And then I walked to the metro, went to work, took the train, walked home. The whole time I was like, “Man, I have a headache.” But I hit myself with a door not, a big deal.
Finally, I talked to my dad, and he was like, “Are you laying down?” I said, “Yeah.” “Go stand up for me.” So, I stood up and I got really, really dizzy. He was like, “Okay, I think you should see somebody”. I did the classic, immediate post-concussion thing where you don't have very good judgment. Since I had just moved there, I didn't have a doctor. I drove myself to the ER thinking nothing about that, like I've never drove in that city really before. And then I took my anatomy textbook with me because I had a test the next day.
So, I'm sitting there in the ER, reading a textbook, and the physician finally comes in and she's like, “No, I will give you a note. You do not have to take that test tomorrow.” They diagnosed me with a concussion and sent me home. I was having terrible headaches the week following that. I I didn't feel like myself. I felt nauseous. So, I ended up going back to the ER. Again, I didn't have a doctor and they referred me to a neurologist and what I'm finding out, what I found out then, and what I find out for most of my patients, I called the neurologist. They said, “We'll see in three months.” “What? But I have a concussion. I have a head injury.” And they're like, “Yup, everybody else does, too.”
So, it was a really interesting time, because I was already in graduate school for speech language pathology. I knew I had wanted to go into that just based on I really like languages, I took a lot of languages in school. So, it was interesting to be part of a program that really does understand concussion, but still realize how difficult it was. I ended up getting a vision evaluation. They tested me and said that I was reading at an eighth-grade level, which was shocking to me, like trying to absorb graduate school material and basically my eyes were reading at an eighth-grade level, very, very hard. Trying to get accommodations was harder than I thought.
It's one of the things that really even pushed even further to go into the neuro aspect of speech language pathology, and I can really empathize with people. I'm really big advocate of getting accommodations letters early, trying to tell people this is – you have to follow up on it. These are the things that you can be approved for. It's very common that you're waiting on a doctor for many months, and that there's things to do in the meantime, before you can see the neurologist to check on it. So, that's kind of my story. It's one of those like, freak things you'd never – it wasn't a car accident. It wasn't a sports injury. But it took me about a year to fully recover because I made the decision to stay in school, and I was still working at the time. So, doing all of that while also trying to recover from head injury, as many people can attest is not the easiest thing to do.
[00:04:44] BP: For sure. It's really not easy, especially when you keep going because I think that delayed a lot of my recoveries because I just didn't stop, and stop playing in sports. A lot of things I didn't stop and it's hard just holt your life and then do therapy. Especially, people that still don’t understand because you look okay. So, there's that aspect too. I get the doctor thing. I think there was one doctor I've seen, it was a year, 13 months was what the appointment was booked for. I was like, “Wow, okay.” So, I'm sitting in a doctor's room, and you're telling me a year and a bit from now, I will see this other doctor. You want me to see him? Interesting how to happen.
[00:05:30] HB: It's crazy. Because people think that they need to see a doctor before they initiate therapy, which, unless there's an insurance issue with that, it's more often not the case. I don't always need to have a referral from this physician to see a patient. So, it means that I can start treating them before – basically, you don't just sit there for 13 months and hope everything's fine and gets better on its own. Because you can do work in the meantime, and then ideally, hopefully not even need that appointment. But it's a system.
[00:06:02] BP: Yeah, I find COVID has made it worse.
[00:06:04] HB: So much worse. Nobody went to the doctor, and now everybody's trying to go to the doctor. Things are pushed. It can be really, really difficult to know that the care is out there and to know what you need to do. I honestly had no idea about vision therapy when I had my concussion and it was only because I worked for an eye doctor. She told me, “Hey, go see this vision therapist. He’s going to test you.” I’m like, “Why can't you test me?” She goes, “Well, I'm just an optometrist. Your vision is fine.”
[00:06:29] BP: It’s different.
[00:06:30] HB: Your eye health is fine. You see 2020 still. So, I was just thinking, well, this is something – she’s being overly protective of me. And then I found out, man, I had some serious, some serious vision issues going on, which did help to validate why school was so hard, because that vision therapy appointment was probably not until at least six months after.
[00:06:51] BP: Yeah, for sure. Well, it's kind of nice to get like reassurance that something's wrong.
[00:06:56] HB: Right. Yeah, there's a reason I think things are hard. I clearly had an excellent support system with my professors. We joked. When I actually saw the neurologist, I had an MRI and we used my MRI pictures in neuroanatomy class that semester. It's like, “Well, here's Hilary's brain. Let's take a look at it.” Clearly nothing was wrong with my brain, since concussions don't show up in the MRIs. But it was kind of interesting to see that.
[00:07:23] BP: So, do you want to give some details of what a speech language pathologist does? Just so people have some background.
[00:07:29] HB: Sure, I'd love to, it's actually quite a very generalized degree. A lot of people when they hear speech therapists, they think that I'm going to work with kids with autism or kids who can't say Rs. That is a completely appropriate thing for a speech language pathologist to do, it’ just not what I specialize in.
So, in general, we can do things we can do pediatrics, we can do adults, geriatrics, we can focus on neurological diseases, things like autism and ADHD, articulation, social pragmatic disorders. People who maybe saying things that they shouldn't, could be seen by a speech therapist. Stuttering is another one. It all is really kind of dependent on what you decide to specialize in when you're in grad school and what you spend your career doing. But I'm technically trained in all of it. And then I just have a lot more training and expertise within the neurological world.
[00:08:23] BP: Okay, yeah. It's definitely interesting, because I think you're right, a lot of people just assume they hear that kids go to speech therapy, and then if you've never been around like the brain injury community, you wouldn't know that there's a lot more, actually, that they can do. So, it's important to know that you can benefit so many other people.
[00:08:43] HB: And it's so interesting, I have a one year old whose speech delayed, and it's like, I clearly knew that he was delayed, I knew what the milestones were, and I was looking at him, but I didn't know how to treat him. I've never worked in early intervention. I didn't really specialize in pediatrics in any way. I don't think I've ever treated anybody younger than 12. So, it was like, “Oh, my kid needs speech therapy. He's one.” I don't know how to do it. I have a degree in this, and I don't know how to do it.” It's been so nice having the speech therapists that we see. She's teaching me so much, and vice versa. She'll ask me questions about things. And it's like, wow, we have the same degree, and just have completely different practical experiences out there.
[00:09:26] BP: For sure. So, when a concussion survivor comes to see you, what can your typical therapy session look like?
[00:09:33] HB: Yeah, so we always start with the clinical intake session, which is really let me get to know you, what's going on with you. We do talk about the injury itself, how did it happen? So, that gives me good information about kind of the force of the impact. And then we talk about what are the symptoms. I will always cover physical and emotional symptoms as well. I don't treat them, but because if you have a headache, I know that you're going to have cognitive difficulties, so I always want to know how's your sleep? Do you get headaches? Do you have flight sound sensitivities? Stuff like that? Are you in any other new therapies, PT, vision therapy, that type of stuff?
And then a lot of background. So, I want to know prior history. It's important to know if there were prior concussions, or if there were history of learning disabilities, it's not to say that it will necessarily change how I treat the patient, but it's just helpful to know, kind of what was the baseline beforehand. Talk about education and occupational history, and then we get into, “Hey, what's going on now? So, what's hard for you now?” And I break it into four cognitive domains. We have memory, attention, language, and communication and executive functioning skills. That's a big buzzword for us that most people have never heard of before.
So, executive functioning is really the skills that you might need to run a company. You need good decision making and planning, time management, problem solving, all those really high-level things that we do day in and day out, just kind of get classified as executive function skills. And then from there, I tell them, this is how I think I'm going to be helping you. I do end up doing a lot of education in that first session. And then we go from there based on whatever the frequency I feel like is appropriate and just keep checking in. Sometimes we'll do testing depending on whether that's appropriate or not. We have objective testing measures we can give. Sometimes I think it's not necessary or it's not appropriate at that time, and we'll just start based off of their subjective symptoms.
[00:11:34] BP: Yeah, it's actually quite a lot more than I think people would think when you say, like, everything you go over, before you even start writing just that first appointment. It's really common with a lot of situations. You go into that first appointment, it's more like a get to know you session and you need that.
[00:11:51] HB: It is, yeah. It's that building rapport. Sometimes I'm open with the, “Hey, I've been there before. I've had my own concussion.” Sometimes I'm no. Depending on if I think the patient would benefit from hearing it. I always ask the question, it's like, “Okay, you're here for your cognitive therapy evaluation. Do you know what I do?” And I would say, “99% of the time people say, no, I have no idea why I'm here.” “Okay, well, let me tell you why.” So those are typically an hour long. I spend an hour with my patients for the first session to just listen to what they're telling me and then tell them what is my role in that recovery.
[00:12:28] BP: Yeah, well, that all sounds really great and we have so much more to talk about. But everyone you can learn more about Hilary and her work at coloradobrainrecovery.com. With that we're going to take a break.
[BREAK]
[00:12:45] BP: TheraSpecs are therapeutic blue light glasses for people with brain injuries, post-concussion, headache, and photophobia. They filter up to 25 times more of the light that causes pain and other symptoms, making them more effective than typical blue light glasses. So, fluorescence, screens, or sunlight feel too bright, or trigger your symptoms, try TheraSpecs, risk free for 60 days, and see if you can find the protection and relief you need. Visit theraspecs.com/bella and use code Bella15 for $15 off your order.
[EPISODE CONTINUED]
[00:13:23] BP: Welcome back to the Post Concussion Podcast with myself Bella Paige and today's guest, Hilary Booco.
So, something I wanted to ask was when should someone consider seeing a speech therapist? Because a lot of us think if they're having trouble speaking, and that would be when they would come see you. But otherwise, when else should they come see you?
[00:13:45] HB: That's a really good question and something that we are trying to educate kind of just the general public and physicians about. More often than not, I'm not treating speech. I don't necessarily treat people that are having difficulty talking. Word finding is one thing, for sure, with concussion, but it's a lot of the really high-level things that you would do within memory or attention. Things like multitasking get really hard. Things like using your working memory, which would be something like tracking your whole schedule in your head for the day or rearranging your schedule and something pops up and those high-level executive functioning skills that we talked about.
Those are the things that I actually treat the most. I always tell people, it's like the day before the injury, you are functioning one way, and then the next day, you are not functioning in that way. My job is to really try to help you get back to whatever you were doing beforehand. So, you might be able to go to work and take care of your kids or go to school or something like that, but it might not be as easy as it was before. There's always something that you can do to help support your recovery during that time. So, the sooner the better. Absolutely.
I love seeing patients who are just super, super like fresh off of an injury, that really acute stage, because typically it means you require fewer sessions. Because I do a lot of stuff about not pushing through your symptoms, how do you do what you need to do while you're recovering. If you don't get that in the acute stage, you are kind of setting yourself up to have worse symptoms as you go along. And then clearly, that takes a little bit more time to get better. That's not to say that you cannot get better if I don't see you a week after your injury.
I've seen patients many years past their injury, or people who have repetitive head injuries over time. It's like, “Well, my last injury was years ago, but I'm realizing I'm having these issues, and somebody told me about cognitive therapy, I think it can help.” So, there's no wrong time to be seen. It's really just, you kind of have to be aware of what's going on with you, and then open to the fact that there is something happening, but know that there's support, and there are things that you can do out there.
[00:16:03] BP: Yeah, and I think it's so great that there is so many different options to come. It's not just for speech, but something you did mention was the word finding and that is something we talk about a lot, because a lot of people have a lot of trouble with it. Even I have trouble with it some days, and especially if I have a bad headache, I go to talk and I go, “I don't even know what we're talking about now. I don't know what was I talking about. My brain is blank.” So, do you have any tips for individuals who have difficulty with word finding?
[00:16:34] HB: Yes. So, there are some really good strategies. But the biggest thing that I want people to understand is that conversation is about communication. It doesn't matter if I don't find the exact word that I want. If I can get my point across, then I've communicated it. That's one of the biggest things I tell people because word finding only gets worse, as you're more and more anxious about the fact that you can't find the word that you want to say. You will not be getting it. So, there's kind of a window of time where you're good that you can't find the word. And then if it takes too long. I mean, you're just going to build yourself up and it's just not going to happen.
When you are encountering a word finding issue, one of the best things that you can do is to describe it. We call that circumlocution. So, if you've ever played a game like taboo, or headbands, or heads up or something where you basically have to describe something to somebody else without saying the word and they have to guess it, that's pretty much word finding strategy in a nutshell. I actually will give those games as homework to my patients to say, “Hey, you're working on something really functional, but go have fun with your family and do this game.”
So, if you're trying to describe, “Oh, it's that person in the movie, and he was in this movie, and he's married to this actress.” And I go, “Yeah, I know who you're talking about.” It doesn't matter that you can't necessarily find that right word. Other things you could do is basically try to say another word. So, if I say, “Hey, Bella, what did you have for breakfast this morning?” And you go, you're trying to get to the word banana, but you tell me you had fruit, that works, too. I'm probably going to leave it there and say, “Oh, that sounds delicious.” And even if I say, “Oh, cool, what kind of fruit that you have? And I'm really interested in your breakfast.” You have had some time to kind of have that successful communication exchange where you answer the question with fruit and then that anxiety level tends to kind of reset, and so then you're more likely to be able to get to banana if you needed to.
[00:18:32] BP: I really love getting your point across because, like you said, it doesn't matter if you say the wrong word or a word in relation to it, because as long as they understand what you're trying to communicate, that's the important piece. It's important to remember that because, like a lot of us, you beat yourself up for forgetting a word or saying the wrong word. There were a few times where I'd say a word that was completely unrelated to the conversation and I don't actually know why. That just came out of my mouth.
[00:19:05] HB: Yeah, and that's to do with like that access. So, word finding, in the scientific terminology is the word retrieval fluency. It's about going to retrieve the word in your brain. So, it's still there. I like to tell patients it's not memory, you haven't forgotten the word, you didn’t forget the name of your grandchild. But in that moment in time, you couldn't go get it. And then it's the fluency aspect of it, too. There's a time component to conversation.
If you ask me a question, and I go, “Uh”, there's only so long that I can have this like awkward silence before I need to say something or it looks weird. So, that's kind of part of it, too. You might be able to get it but you're not getting the time that you need to get it. So even sometimes giving yourself some more time is a really helpful thing. Like if you get asked a question, I do this a lot with interview skills. If you get asked a question and you're not really prepared to answer it yet, repeat the question. So, if this say, “Hey, Bella, tell me about one of your strengths?” And you're kind of frozen. Instead of just dead silence, you would say something like, “Oh, that's a really interesting question. Thanks for asking that. One of my biggest strengths is that I.” You have all of that time where you basically said nothing. But you're able to think about the question and not have just this dead silence. So, you gave yourself a bit more time to think is also another strategy.
[00:20:26] BP: Yeah, that's really great. Thank you so much for sharing all those because it is just a really common thing that a lot of people tend to get frustrated with. And another thing that is really common is some people – we had this conversation before, they think they have a stutter and a lot of the time you said that's not the case, because it's about your speaking faster, then your brain is producing words, essentially. So, if you want to explain that a little bit?
[00:20:56] HB: Yeah, so I never want to like invalidate the fact that somebody tells me that they have a stutter, because stuttering is what they're doing. But it's not like a developmental stutter. I don't treat it the same way as I would a fluency disorder, which is something that we see a lot of kids or sometimes we'll see after somebody has a traumatic experience. Those strategies are going to be things like addressing the blocks in your speech and using easy onset. I don't do that at all with my patients, because it's more about the fact that as you said, your mouth is moving faster than your brain is.
So, we're dealing with a processing speed issue, which I would say, pretty much anybody who's had a concussion can state like, yes, I did not process information as quickly as I did before, and hopefully it got better. It's really just like, you know what you want to say in your head, but just those thoughts are just not coming out as quickly as your mouth thinks that they can. And so, the easiest thing to do is actually just slow down your rate of speech a little bit. If you speak a little bit slower, you give yourself a little bit of time, you're less likely to stutter, because you won't be stumbling over trying to find the words. You're able to find the words and then you can express them.
[00:22:09] BP: I really like that. Yeah, just slow down. That's a really common thing with head injuries.
[00:22:13] HB: Yeah, I was about to say, that’s most – attention, slow down. Memory, slow down. Executive functioning, slow down/ It's allowing yourself to just accommodate the change in your processing speed. I always tell people, your processor slowed down a little bit, your brain did, but the world around you doesn't slow down. So, if you try to do everything exactly the same way that you did before, you're going to be stumbling over yourself. There's just you know – slow down is a very easy thing for me to tell people, it's not necessarily the easiest thing to implement. I know that when we talk about very functional, specific examples, when I talk to a patient about it.
[00:22:52] BP: Well, everything you've said, so far has already been so helpful. But is there anything else you would like to add before we end today's episode?
[00:22:59] HB: One of the biggest things is just know that the education that is out there about concussion is still kind of lagging behind the times. There are so much newer research out there that shows that things like sitting in a darkroom for two weeks is not what we want to be doing. We actually want you to be physically active and cognitively active as you are, especially physically, if you're allowed by your doctor. If you have an injury, clearly don't exercise. But using the brain is what we want to do. But there's a way to do it so that you're not overdoing it. That's going to be the biggest thing is don't overdo it. And just think about, if something is bothering you, figure out who can maybe help you with that. Because as you mentioned earlier, there's so many people that are there. There's vision therapy, there's physical therapy, there's vestibular, there's counseling, there's cognitive therapy. There are so many things out there that you could be using to help support your recovery and to make it as fast as it can be.
Don't be afraid to ask for it, even if your doctor doesn't necessarily know what cognitive therapy can do. If you say, “Hey, I really think cognitive therapy would be helpful for me.” That doctor will very likely write a prescription and say, “Yep, go get evaluated by a cognitive therapist.” So, it's hard to be the patient, to be the one that's injured to go and advocate for yourself. But unfortunately, it’s post-concussion and that’s what we're dealing with right now until the world gets on board with what post-concussion looks like.
[00:24:25] BP: Yeah, it really is.
[00:24:27] HB: Just to advocate for yourself and if you think something is wrong, there probably is something wrong, and it can be addressed.
[00:24:33] BP: Yeah, for sure. I just wanted to say thank you so much for joining us today. Because it is true. advocating for yourself is one of the biggest things with concussion, especially because nobody's seeing what you're going through. So, if you're not going to advocate for yourself, no one else is.
[00:24:52] HB: Exactly, yeah.
[00:24:54] BP: So, thank you, just so much for sharing all of your insights and work with concussions.
[00:24:58] HB: Yeah, thank you very much for having me. I appreciate it.
[END OF INTERVIEW]
[00:25:06] BP: I just wanted to say thank you. The podcast is just over six months old and I couldn't be happier with the response. If you truly love the podcast, please consider leaving a tip in our support the podcast tip jar, found at the bottom of our episode description. All tips are greatly appreciated, and help cover costs of the show.
[OUTRO]
[00:25:29] BP: Has your life been affected by concussions? Join our podcast by getting in touch. Thank you so much for listening to the Post Concussion Podcast and be sure to help us educate the world about the reality of concussions by giving us a share. To learn more, don't forget to subscribe.
[END]
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