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Acquired Brain Injury – An S-LP Point of View

In Kate’s own words: “I was in a car accident. I have a brain injury. I have ataxia throughout my body, but predominately on my right side. I also have trouble speaking, but if you think I’m going to let that stop me from living my life, you are sorely mistaken. I wouldn’t trade my life with anyone or for anything. My parents would have liked this not to have happened, but I wouldn’t change a second of my life. I wouldn’t have met half the people I’ve met without my injury. I’ve made lots of friends that I wouldn’t have made, and I wouldn’t have had this chance to tell you my story.”

Mary-Ellen Thompson, PhD, CCC(SLP), S-LP(C), Regd. CASLPO

For the past 13 years, my life as a speech-language pathologist has been enriched by the challenges of providing services to an amazing client: Kaitlyn Woods.

Kate was injured in 1999 at the age of four. She was in a coma for over a month. She returned home after spending four months in acute care and inpatient rehabilitation in Toronto. Kate’s prognosis was very guarded.

Meeting Kate
I first met Kate in November that same year, when she had just returned home from the hospital. She wasn’t talking and was crawling through her house. She was a very determined little girl and she was very fast! Her mother and I quickly realized that if she was sitting in a chair, she had nowhere to go. Kate and I spent many hours at the dining room table. She learned to talk again but her speech was mostly unintelligible due to severe ataxic dysarthria. I soon realized the potential she had. This was the beginning of the challenge of working with Kate, a child with average intelligence, an acquired brain injury (ABI), severe dysarthria and limited intelligibility of speech (>20%).

Returning to School
Kate returned to school very gradually, first with her walker and then for many years, wearing her helmet. In the school system, we met many teachers with hearts of gold but it was challenging to teach a child with limited intelligibility of speech, slow response time and poor motor control. It was even more difficult to accurately assess a child like Kate. She was often placed in the lowest academic groups because very few knew what she was saying or writing. Even by grade 8, Kate’s intelligibility of speech was only 50% but she succeeded academically. Still, it was difficult to make long-lasting friends. Some students openly expressed jealousy because they felt that she received too much attention — would they really want to trade places with Kate?

Our Model for Successful High School Integration
When Kate started high school in 2008, we developed a presentation for her teachers and the school. In the presentation Kate explained how others can effectively communicate with her to increase her chances of success.

In grade 9, she had a rehabilitation team, which included an occupational therapist (OT), speech-language pathologist (S-LP), neuropsychologist and a rehabilitation support worker (RSW). Lisanne Mitts as RSW and myself as S-LP have both remained constant throughout her high school years. The original OT has now retired and the new OT has addressed issues at home but felt that the school environment was well taken care of. Dr. Joanna Hamilton is Kate’s neuropsychologist. Together, as her rehabilitation team, we presented the model for successful high school integration of a student with ABI in 2009 at the Ontario Brain Injury Association (OBIA) and at the Brain Injury Association of Canada (BIAC) in 2012. This model was based on a collaborative approach with the school and co-operation between all parties.

The ultimate goal was to build and maintain an informed community that could support an ABI student in a regular classroom. We compared this model to the traditional approach used in most schools.

Kate continued to challenge her treatment team and chose to take drama classes, not once but twice during high school. Suddenly, improving her intelligibility of speech really mattered, as she needed to appear on stage with her peers. In addition, Kate’s cognitive-communication and executive function skills continued to grow.

What Kate Taught Me as an S-LP
Kate has enriched my professional and personal life and taught me many things about rehabilitation and recovery. The model we have developed has allowed Kate to participate in volunteer jobs and co-op placements. We have also placed a version of her story on her iPad using a text-to-speech app. As she looks forward to college, we will once again share her message and successful communication strategies with her colleagues and professors. While our goals have changed during the past 13 years, we have never wavered from our long-term goal of making her the best she can be!