How speech therapy (and a strong craving for apple pie) helps patients learn to speak and swallow more effectively

by Jann Gerrit Ohlendorf at September 28, 2022

Many of us don't realize just how perfectly nature has equipped us to speak to one another until we encounter problems doing so. Indeed, accidents or neurological impairments can make both speaking and swallowing difficult.

But despite these challenges, Jennifer Graubner has seen first-hand how speech therapy can help patients get back in conversation with the world around them – especially in the rehabilitation sphere. As a speech therapist in the Caspar Clinic team, she has insights on topics as diverse as how relatives can play an important role helping patients overcome speaking difficulties, to how the memory of home-baked apple pie can work small miracles.

 "I became a speech therapist to give myself permission to let out all of the words I wanted to let out. At least, that’s what my friends say about me! Fortunately, most people actually enjoy this," Graubner tells us. “But I also take a lot of pleasure in helping others and supporting them in rediscovering their strengths. That’s an important task of speech therapy. That said, I can also be quiet sometimes – when I listen to an audio book while on a walk, for example, or go on a long-distance run.”  

Let's talk briefly about the unpleasant diagnoses that lead patients to require speech therapy treatment. For example, a facial injury can limit motor skills and cause facial paralysis. Brain hemorrhages, traumatic brain injury after an accident, or even a stroke can also abruptly limit the ability to speak or swallow. Less obvious causes are certain neurological diseases such as multiple sclerosis. How does speech therapy address these different cases in rehabilitation and aftercare?

During the first conversation I have with my patients, I always ask exactly what happened to them, and how their symptoms have been treated during rehabilitation thus far. Often, they’re able to explain specific treatment techniques that I myself can implement during their digital aftercare. Ideally, I try to help my patients incorporate the theoretical treatment concepts from rehabilitation into everyday life, especially since their day-to-day life is often very different from what it used to be. 

Why is everyday life so different for many patients after rehabilitation?

Let me give you an example. Some time ago, a patient told me that she’d never thought about how many muscles are needed to exchange an honest, natural-looking smile with someone. In terms of motor skills, this is real physical teamwork: we’re able to laugh because of the help of a large number of muscles. 

Right. Most of us don't have to worry about the interaction of muscles when we laugh, or even when we swallow.

Exactly. But for this patient, it was suddenly necessary to learn to activate the appropriate muscles, and to target them with the correct proportions.

So how does speech therapy help patients target the right muscles? 

Well, in the case I was referring to, during our video chat, I showed the patient that it’s sometimes better to use more restraint and less strength. I suggested that she concentrate more on the perception of both sides of her face – which is to say, both the affected and non-affected halves. Without doing this, she tended to lose some control and overshoot her target.

Are speech therapists from the Caspar Clinic always in personal contact with their patients during aftercare?

Yes – in fact, our close personal contact as reference therapists is something that our patients really appreciate. After the initial consultation, I offer my patients an additional consultation to discuss specific exercises. Only then do we draw up a therapy plan which the patients can work through independently. I add specific instructions for individual exercises – for example, that they should always pay attention to forced exhalation during their swallowing exercises. Why is this important? Well, it’s only in this way that those who have difficulty swallowing saliva, for example, can ensure that liquid doesn’t enter their airways. The thing is that patients have already learned these basic techniques during rehabilitation, and aftercare is a chance to practice and perfect these exercises for continued improvement.

After this period of intensive contact at the beginning, phases of self-directed training follow, correct? If that’s the case, it must be true that, when it comes to speech therapy, self-motivation is an important factor for long-term success.

Yes, exactly. Sometimes, a burning desire to finally be able to eat your husband's homemade apple pie again can be the decisive factor in recovery. In general, independence and a strong sense of self-awareness are of particular importance during aftercare. I mean, I can’t sit on my patients' shoulders and whisper advice in their ears every minute of their lives!

Speaking of baking husbands: What can partners or relatives of speech therapy patients do to support them – and what kinds of concrete tools can help patients in their everyday life?

Getting relatives on board is great – and important. In practical terms, they can give those closest to them a sense of validation in terms of the improvements they’re seeing. Provided they understand what’s important, that motivation is useful across the board. To your second point, in terms of the oral cavity, even when success feels minimal – which is, unfortunately, sometimes the case – we at Caspar Clinic still have the power to help. For example, we can suggest alternative ways to facilitate interactions. There are aids like whiteboards or charts that both sides can then use. Today, of course, many use tablets for this purpose – which are also great communication tools. Plus, in our Caspar Software library, we have recipes for dishes that are easier to swallow—another practical example of how modern technology can help patients.

Let’s get more specific here. What does an exercise look like that can be used to strengthen the muscles in the oral cavity, and that also benefits those who are not undergoing treatment themselves?

To strengthen the lip muscles and harness the practical benefit of a well-announced pronunciation, there’s a particular exercise we love (I also demonstrate it in a short video). To get started, stand or sit as upright as you can, loosely close your lips, and make the following syllables as clearly as possible: ba..... ba.... ba... ba! Then, either vary the tempo or juxtapose another syllable for contrast: Ba, ba.... ba,ba,ba! Or Ba...Pa...Ba...Pa. After the exercise, relax your lip muscles by inhaling through the nose, letting the lips rest gently on one another, and then forcefully exhaling through them: Pffffffffff! 

Jennifer Graubner, thank you very much for this inspiring chat!