Speech-Language Pathology: More Than A Language Coach

When many think of speech-language pathology, their perception may be limited. You may remember a speech-language pathologist helping children pronounce their ‘r’s and ‘th’s in your elementary school classes. You may think of a speech-language pathologist as someone who assists children and adults in overcoming stutters or other speech impediments. Lindsey Wineholt, CCC-SLP, UT Health Austin’s Speech-Language Pathologist for patients with degenerative dementia disorders, wants you to know that the scope of a speech language pathologist is much broader than you might think.

The Role of Speech-Language Pathology in Alzheimer’s Disease Care

“We are speech-language pathologists so of course we handle speech and language,” says Wineholt. “But our true specialization is communication as a whole, and cognition is very much in our scope of practice. Things like memory, attention and executive function impact your ability to communicate with other people, and therefor how you navigate the world.”

Wineholt focuses on much more than the act of speech in her role as a speech-language pathologist for those with degenerative dementia disorders. She works with her patients to overcome cognitive inabilities to improve communication, daily functioning, confidence and the ability to enjoy conversation and time spent with their loved ones.

The Social Impact of Speech-Language Pathology for Alzheimer’s Patients

“Word-finding,” or difficulty choosing or recalling the right word to express a thought, is often one of the first symptoms to appear in many patients with Alzheimer’s disease. Word-finding is also one of the most frustrating symptoms of the disease. It outwardly affects the way one communicates and inwardly affects one’s confidence in their ability to socialize with others. Some degree of word-finding difficulty is expected in aging populations. Many Alzheimer’s disease patients, however, experience a constant inability to express themselves and it becomes incredibly frustrating and embarrassing.

“Alzheimer’s disease patients often isolate themselves because talking to people is just too embarrassing,” says Wineholt. “My patients will stop playing cards with their friends, stop going to church and stop attending the daily or weekly activities that keep them social and active.”

In addition to word-finding, keeping track of a complex conversation that takes turns and quickly jumps from subject to subject (as most organic social conversations do) can be nearly impossible for many patients with Alzheimer’s. Other symptoms of the disease including apathy, exhaustion and memory loss are compounded by language difficulty, making Alzheimer’s disease an isolating experience.

Treatment and Outcomes

For Wineholt, treating cognitive communication symptoms of Alzheimer’s disease is not about a cure. It’s about improving patients’ quality of life as they move through the experience of the disease and empowering patients to maintain dignity, independence and social interaction.

“Unfortunately, I cannot bring back a patient’s memory. Although I wish I could, we know that the disease will continue to progress,” says Wineholt. “What I can do is two things: I can retrain patients to remember certain pieces of information over time and I can give them tools to compensate for their memory loss.”

Among these tools is a “memory communication book” of Wineholt’s own creation. The book acts as a one-stop-memory-shop for patients and is individualized to include any information the patient struggles to recall. The book is pocket-sized so patients can carry it with them at all times and is organized by tabs to seamlessly extract information.

“I ask patients to review their book every day to keep the information they want to remember at the forefront of their brain,” says Wineholt. “We include personal information like name, address, phone number and family’s names and contact information. But we also include information that promotes conversation, such as likes and dislikes, hobbies, where they went to school, what their profession was, their pets’ names, and so on and so forth.”

The book contains pictures (of the patient’s house, family, etc.) and helps patients to maintain social interaction with their loves one by allowing them to discuss their interests and reminisce on old memories. In addition to working with patients to create individualized memory communication books, Wineholt teaches patients how to put them to use and measures the success outcomes. Patients should become completely comfortable using the book in every day life. For example, when a patient checks into an appointment and cannot remember their address, do they automatically reach for their memory communication book? As Wineholt meets with patients, she keeps a tally of how often they use the book in conversation, in addition to other compensatory tools, to track progress and adjust the treatment plan as necessary.

Wineholt’s work does not begin and end with her patients. According to Wineholt, how the care partner communicates and interacts with the patient is just as important as treating the patient themselves.

“I include the care partner in every step of treatment,” says Wineholt. “Patients with Alzheimer’s disease often have comprehension issues, meaning they have difficulty understanding language and complex sentences. I create communication goals for care partners like simplifying language, writing down key words in a conversation and slowing down speech, and measure the success of those goals with quantifiable data. How the care partner communicates is equally important to how the patient communicates when it comes to progress.”

A common misconception regarding patients with dementia, and Alzheimer’s disease in particular, is that patients cannot learn new things. According to Wineholt, this is simply not true. Although it may take time and compensatory tools, patients with Alzheimer’s disease are capable of improving their communication and maintaining an active social life.

“The best part of my job is witnessing my patients’ confidence improve over the course of treatment. Slowly but surely, my patients start going to church again. They start going out for coffee. They start attending their weekly poker game again. They re-learn to participate in the activities they love and communicate with the people they love,” says Wineholt.

At UT Health Austin, we believe in every patient’s right to enjoy their lives. Along with the rest of her care team, Lindsey Wineholt improves the lives of persons with Alzheimer’s disease one step at a time.