Back to Basics Med SLP

Trained Common Sense

Posted on October 3, 2020     Leave a Comment

Thanks for checking out this space as I chip away at many years worth of notes and thoughts on my beloved profession. I am humbled to work in a profession focused on helping others. When describing my day-to-day, it is often followed by looks of “you do what now?”- you never think about speech, language voice or swallowing until you suddenly or gradually can’t do them anymore. In graduate school, I was drawn to the distinction between habilitation and rehabilitation. Growing up in a family of educators meant habilitation was second nature. Ergo, focus on improving your pedagogical skills and you will teach someone a skill they have never mastered before. Rehabilitation is different. Think of your loved ones; something unexpected happens. Suddenly they lose skills they once possessed. It’s a different model, a different way of thinking and your clients or patients are all >20 years old. Some are >90 years old.

“Science is nothing but trained and organized common sense”. -T.H. Huxley

I seek to summarize, over several posts, a favorite book of mine within the SLP world. In fact, it’s the SLT world as Dr. Carmel Lum is based in the UK. He is a neuropsychologist and he published Scientific Thinking in Speech and Language Therapy in 2002. My first reading of his book was on the heels graduation about to embark on my Clinical Fellowship within a post-acute brain injury facility focusing on community re-integration for adults. Lum argues that a “profession who claims science must accept a set of agreed principles, guidelines and criteria for defining knowledge”.

Graduate schools focus is often on the anatomy & physiology along with theoretical models to understand the different areas within our profession. The theoretical basis of Speech-Language Pathology is a combination of “psychology, medicine, linguistic, and….sociology”. To be a SLP is to be a scientific professional with a legitimate role as a researcher. There is a need to “accept the scientific identity or there will be confusion” leading to a multitude of other potential roles you could fulfill as a SLP. Are you a clinical scientist gathering data, examining the evidence and changing your approaches over time or are you a “caregiver, teacher, remedial educator, spiritual healer or heart-on-your-sleeve” person. This is not to say SLPs do not given care, teach, or remediate. But to follow the model of a clinical scientist you must be able to speak to why some diagnostic or treatment methods are more valid than others. I attended a course at ASHA 2018 in LA hosted by SIG 3 and loved that every piece of treatment advice was brought back to the theoretical underpinnings that made it make sense.

If new treatment methods are adopted based on the principle of face validity versus an understanding of the theoretical underpinnings, we have a problem as a profession. Medicine is always an art and a science. That’s why it’s called “practicing medicine”. I don’t expect cookie cutter models and everyone doing the exact same thing; however, knowing your systematic review conclusions and using the basis of scientific knowledge is integral to evidence based practice. Though our graduate school background exposes us to research methods and statistics, the application of these ideas within clinical contexts has not quite made the leap. When is the last time you used a McNemar test on patient data to assess whether or not they have improved? Do we need to do this or are patient reported outcomes on VHI-10 or EAT-10 enough? Be a detective for your patient’s sake.

Stay tuned for more musings on this topic as I meander through the chapters of this book.