It has been almost a year since I started my last clinical placement in graduate school. I was going to be going back and forth from California to Hawaii to finish my last practicum placement in one of the top rehabilitation facilities in the US. The pressure was real and let me tell you the experience was one of the hardest 8-weeks of my life. I had no time to focus on one thing because in the midst of those 8-weeks I was also preparing to take the biggest exam of my life (The PRAXIS), finishing a portfolio to sum up the last two years of my graduate career, flying across the country to present my research, and take grand rounds. What a crazy insanely exhausting time!
So how did I prepare? Studying for the praxis helped a lot. I felt comfortable and secure with my knowledge of dysphagia and swallowing treatment at that point from being in SNF two semesters before. I would say start there. Brush up on consistencies and textures along with swallowing maneuvers and compensatory strategies. The next critical thing to know is the signs and symptoms of aphasia based on the area of lesion. I might give you a heart attack right now but believe it or not I was NEVER asked the TYPE of aphasia. I was never told to prepare treatment based on the type of aphasia. This had me super confused but be aware that every SLP has different approaches to treatment, so your supervisor will have their own way of approaching treatment for aphasia. For me it was knowing the hierarchy to treatment based on the deficits present. See my page Aphasia Hierarchy for more information there. The next thing and the topic I felt completely unprepared for was cognitive deficits and treatment. Below i’ll chat about what tools to use for assessment but as far as treatment there are some great applications to use on an IPad/tablet and go now and buy the game BLINK, you won’t regret it. As far as evaluation reports and session notes, this will all differ based on the type of EMR system the hospital you are at is using. And have fun learning that! lol
Depending on your placement you will either be in inpatient of outpatient. Let me start with saying I was in an acute rehab inpatient setting. This meant that once the patient was discharged from the hospital they came directly to us for PT/OT/ST and ongoing medical care and then typically to outpatient for ongoing rehabilitation services. SO this post will tailor to those going into an acute inpatient setting.
4 things to be prepared for:
- How to review history/charts for the patient: As the patients come in you’ll be expected to see any that are coming for a stroke or TBI. Any others will be on orders from the doctor. Review hospital SLP notes and any history that may give you reason to believe they need to be evaluated by speech. Also review the chart in their room…always.
- Performing a bedside evaluation: This will include performing an oral mechanism examination to assess the strength, speech, and range of motion of the components of the oral motor system and watching the patient eat/ drink a variety of textures and consistencies. Depending on why they are there further assessment will occur targeting the points below.
- Assessment of cognitive abilities: If the patient is coming in with any form of a brain injury you will need to assess cognitive function. Usually using an assessment tool such as the MoCA (Montreal Cognitive Assessment).
- Assessment for aphasia: you’ll be assessing expressive and receptive speech, reading, and writing. Look for what they can do. Again refer to my The Aphasia Hierarchy for all the guidance.
Random stuff that you’ll want to be aware of:
Depending on the hospital you may be expected to perform transfers for the patient, if so the facility will provide you with training on how to do so. Something that I got slapped on the hand for frequently was remembering bed and wheelchair alarms. DO NOT FORGET TO MAKE SURE THEY ARE ON when leaving the patient if they are not cleared to walk on their own. Which brings me to my next point, read the patients chart to be aware if they are able to walk on their own or be left unattended. The last thing you want to happen to you is to be yelled at by a nurse for leaving a patient alone in their room or at the dining table who should not be. PS. be KIND to the nurses. Also, be prepared to work alongside OT and PT and collaborate with them. This all sounds simple right but in the midst of IT ALL these “little” things are easily forgotten.
Terminology to be familiar with:
- left/ride side neglect
- HOH- hard of hearing
- passy-muir valve
- BI vs. TBI vs. ABI
- flaccid vs. spastic
- cerebral vascular accident (CVA)
- degenerative disease
- divergent naming
- executive functioning
- motor speech disorder
I can’t say that my experience in the placement was the most pleasant but it showed me that I am capable of so much more than I thought. That even through negativity I was capable of showing up and putting my best foot forward every day. So if you have an experience that leaves you feeling defeated some days or even in tears. Just know you CAN and will make it through. If you have an amazing experience, be sure to show gratitude to those supporting you along the way.
There is TONS more I could have talked about but I think nearly 1000 words in this post is enough! Don’t forget to have fun and get to know your patients even if they are only there for a short amount of time.
Good luck speechies. You got this!