Organic SLP: An attitude or a science?

When you think of how SLP's work; where we do our work; and about the processes and the goals for our work - is organic SLP, science? Can the results of clinical practice that stresses communication for relationship-building, over drill work to increase component communication; the use of environmental structures and cues to make it easier for a person to function well;  the primacy of applying component skills for cognition, communication and swallowing, in the settings where they will be used; where rapid acquisition of goal targets is stressed; where customer satisfaction is accentuated through teaching and obtaining frequent feedback - be replicated across ages, disorder types and treatment settings?? Is organic SLP, science??

I would say, yes - that organic slp IS built upon a scientific framework, and that its principles can be upheld alongside the practice of what I have called "mechanistic SLP".The clinician who uses organic SLP principles has her/his roots in mechanistic SLP; namely, the tools for impairment-based evaluation and treatment can and should be used. There are scores, hundreds of incidences where a person with a cognition or communication problem would only begin to change when slow, methodical and segmental training of processes occurred. Impairment-based training is the core of our field, and the skill sets inherent in our clinical training will always be in that bag of tricks we scour before each encounter.

There does remain a need in SLP clinical practice, for a skill set that brings the person served from an entry point of dependence to that of relative independence as quickly as possible; that allows the SLP in an interdisciplinary practice setting (e.g. with physical and occupational therapy, or with education and psychology) to assert her/his expertise as vital to the successful outcome of the person served; that models for all the professionals involved with a person, superior customer service; that constructs a strategy system allowing the person to say: I can do this in real life when I - , and that treats communication processes largely where the processes will be used day-to-day. How can these additional be measured and evaluated, as having met the tests of scientific method?

The SLP clinician has the skill set to operationally define organic SLP processes, and to write targeted goals for treatment after baseline status is clearly described. For example, the person served may gain attention of a caregiver from across the room, using speech and gestures in a noisy setting, 25% of the time. Barriers to the person performing this function include the noise level ( TV on, dishes clattering, chatter within the room, PA system occasionally carrying announcements, person's weak voice and impaired hearing). Treatment includes identifying the components controlled, then controlling them as possible. It also includes compensating for the variables that cannot easily be controlled. How would you help the person increase her/his skill?

Gotta laugh

In the recent post "Organic SLP", I hinted that this style of practicing speech-language pathology (SLP) was very different from a style that I called "mechanistic SLP". Where mechanistic SLP meets persons served  where their bodily functions breakdown, organic SLP deals with the needs of persons in real life situations. When it comes to dealing with stressful real life situations, such as a person served who is feeling anxious or depressed, it is the SLP who may often lead the way for the person's improvement. Sometimes, a good belly laugh may start the healing.

I once worked with a man who had had a stroke, done his rehab and gone home. He then had come back to our rehab center, after the trial at home had been disastrous. He had lost his skill with walking, and lost much weight in the bargain....and with his clinical signs of depression seemingly sinking him at the beginning, there was a need for immediate change in his focus.

Why did I feel I was the ideal person to get him refocused? I had made a reputation in previous jobs, as the staff who would take on the most challenging "patients" around. I had been kicked, bitten, wrestled, punched, slapped, cursed and threatened on the quest for better communication. I had dressed in drag with previous patients, when their level of consciousness was minimal. Singing and dancing at a level beyond all levels of propriety in patients' rooms, especially for people who have difficulty speaking, you can bring out the darndest speech!

I knew that, above all, helping activate the person's limbic system within the brain by communicating highly loaded emotional content - it would have good odds of prompting more communication. As I did when I wore dresses (and a prominent blonde/white mustache); when I made confetti from Post-It Notes and threw it over my OWN head when someone did well; when I organized a patient kazoo band to promote expiratory airflow;  - minimal advance notice and stealth were the key. Kickstarting the brain into communication, however reflexive. requires often a strong, unexpected stimulus.

The man in question had gone down for a deep sleep, following his morning treatment session. Deep sleep! No response to shaking the mattress slightly - so FWISHHHHHHHHHHHHHHHHH with some stretching and then blowing, four party balloons were inflated with the help of my well-trained lungs. Two were inserted in his canvas slip-ons, that rested in the seat of his wheelchair. The remaining two balloons were placed on his tray table. When I appeared during the later lunch hour, blowing up balloons for others within plan sight of his table,  - his laugh and smile were priceless!