Can you please tell me a bit about yourself? You can start wherever you’d like to.
I am Katherine Noyes, and I am a speech language pathologist living just outside Portland, Maine. I am also a Certified Brain Injury Specialist (CBIS), which means that I have completed extra education specific to brain injuries and neurorehab, and I specialize in helping people with brain injuries. I am also a registered yoga teacher. I have been practicing as a speech language pathologist since 2011, and I have worked in a variety of settings. Most of my experience is in healthcare, working with people with neurological disorders, both in the outpatient and inpatient rehab setting. But I have also had some experience working in the schools as well! I have worked with kids in kindergarten past highschool. I really love the neuro rehab and brain injury community. I love how meaningful the goals are that I am working on with people. People have a vision of what their life used to look like and what their goals are for how to get where they are right now to where they’d like to be, whether that's where they were before or this new goal of where they’d like to be.
The yoga piece came in because I started practicing yoga when I was pregnant with my son. I had not really done much yoga before, but I did it when I was pregnant as a way to give myself an hour or two a week to take care of myself and I loved it! I found it not only helped me focus on taking care of my body, but I felt this big difference in my mind as well, like a mix of being calm but also energized. LoveYourBrain is an organization that offers yoga programs for people with brain injuries. They offered a program in the Portland area that I was able to participate in, and I realized that yoga and mindfulness could be very beneficial for a lot of the people I work with. So long story short, I ended up doing yoga teacher training and then I did a LoveYourBrain-specific yoga teacher training so that I can adapt yoga and mindfulness for people with brain injuries. And then I started up my own private practice: Lotus Speech and Wellness, with a business partner, someone I had gone to grad school with, who also had similar interests, but who practices in another state. So that’s the short story about how I came to where I am and how my practice is a mix of speech therapy for adults with neurological impairments, but also trying to tie in a more holistic approach with yoga and mindfulness.
How have you seen yoga to benefit the TBI survivors you have worked with?
You can adapt yoga so you're doing it either in a chair or a gentle yoga on the mat. LoveYourBrain is a good resource because not only do they offer yoga programs for people with brain injury and their caregivers, but they’re also doing research around how yoga and mindfulness can help people with brain injuries. There’s more info on their website, but they’ve found it helps with the social connection piece, with quality of life, and with cognitive skills. For instance, someone who is working on following directions or memory, yoga is nice because often you start with a simple sequence and you build upon it and repeat it. So, there's many potential benefits, in addition to just the fact that yoga and mindfulness can really just make you feel good, by focusing on the moment and your body and breath.
What does the training to become a CBIS look like?
A Certified Brain Injury Specialist is something that professionals who work with people with brain injuries can become. I was working for an outpatient neurorehab clinic at the time, and they had everyone in the whole clinic become trained. At the time it was an in-person course, and we learned a lot about brain injury and had to write an exam and then have to do a certain amount of continuing education each year. So it demonstrates expertise and background knowledge in brain injury. And I think that's helpful because there are many SLPs or neurologists or physical therapists out there, which is wonderful, and most people have at least some background in brain injury, but if you're someone who is a brain injury survivor and looking for services, it can be nice to know that this person actually does specialize and has a little more experience and knowledge in this area.
Can you please tell me a bit about your role as a speech language pathologist?
This is one of the things I love talking about; we were talking before the interview started and I was saying before I had my own private practice I didn’t realize how little people knew about speech language pathology and the scope of how it can help people who have had a brain injury. I think one of the problems is that usually it's just called “speech” therapy, and so understandably, people think it's just helping with your speech: articulation, like how I’m saying my sounds; maybe disfluency or stuttering; or voice. Many people also think of word finding, if people are having trouble thinking of the word that they are trying to say, which is certainly a big piece of how we can help people after a brain injury. Speech language pathologists also help with all kinds of cognitive and communication skills, so if you're having trouble with attention or focusing, short term memory, executive function skills - so planning, organizing, problem solving - that all affects communication. And you can see when you start looking at all the different cognitive-communication skills, those are so important for work and school and for your social roles with your family and with friends, so that's a realm that we can support people after a brain injury. One of the things that I love the most is that it is also so individualized. Each person is coming to me with different life experiences and different goals, and so the therapy is so meaningful. We are talking about what it is that you specifically want to be able to do and then that's what we are working on.
How do you take into account an individual’s history?
So we usually start with an assessment. A big part of the assessment is a conversation, an interview, where I am learning about what someone's life looked like before the brain injury, how and what they’re doing since their injury, and what their goals are now - things they want to get back to or start doing. So the assessment piece is where you get a lot of that information, and of course that conversation can continue into our therapy sessions. There are also what we call ‘formal assessments,’ where we are going through some memory testing and word finding tests. But I often find that it's more the conversations where I get the real information about what our plan will look like.
What does a typical session look like for you?
It does depend on the person and what we are working on. I do all teletherapy right now. I purposely chose that as my model because Maine is such a big state and there's lots of resources in the Portland area, but as you leave the area there's fewer resources, and I wanted to be able to provide services throughout the state. I also started my practice in fall of 2021, which was during the pandemic, so I thought that model would be good. My clients log on by clicking a link and we'll be in a session. Usually I start by checking in on how the week went, what went well; usually I've given them some strategies or different things to try, and so I hear about how that went. And then we’ll troubleshoot how to tweak things, maybe I'm teaching another strategy to try, maybe we are practicing it a little bit in the session, making a plan for how they'll use that strategy.
I think it’s great that you adopted an online model for your meetings; we conducted lots of interviews over covid, and so many of the survivors were talking about how they felt so isolated because they couldn't leave their house, visit friends or family, or have meetings with healthcare workers or support groups.
Yes I agree. There were definitely some people doing teletherapy before the pandemic, but it was not as common. I actually was recently gathering some feedback from some of my clients about why they choose teletherapy. And I think it's so accessible from wherever you are; people don't have to take the extra time to drive somewhere. And to your point too with the isolation, I think that there are a lot of support groups that all used to meet in person and now they are virtual and that can be a really good resource for people as well.
Did you observe the pandemic to have a negative effect on the survivors that you worked with? And if so, which aspects contributed to this and how did you find that people could combat this?
Yeah I think what you mentioned about social isolation is probably one of the big ones. So I will say that having online communities has made a big difference for people. I think within my work at the hospital, at the inpatient setting, there was a time too when they were not allowed any visitors and I think that was very isolating. It's hard for the patients, but also their families. I think that, at least in our area, now there's more visiting hours available, which is good. I think that in some ways, the pandemic made it a little harder to access healthcare, but on the flipside, now there's more teletherapy and telehealth available. One question that we have in the states is health insurance covering telehealth. It continues to be covered by insurance, but there's still that question, if the pandemic ends, are they still going to cover it. And we hope that they will because it's been such a great resource for so many people.
So if they decide to discontinue the coverage, do you think that you will move to in-person?
If insurance stops covering telehealth, I would really look into perhaps offering one or two days in person somewhere. I would still keep my model because I have clients that would not be able to get to me; it may be because of distance but also because some people with brain injury aren't able to drive. So I would really have to be thoughtful if they changed the rules on how I could still provide my services to most people.
What is the most rewarding part of your job?
I think that the most rewarding part of my job is helping people get back to doing things that are meaningful to them, whether that’s being able to communicate with their loved ones, or getting back to work, or school, or doing more of their daily activities. To me that's the most rewarding thing, is seeing people improve their quality of life by participating in more activities more independently. And when I meet with someone I always say that this is a partnership.. I do a lot of asking questions and seeing what's going well and what's hard and really customizing it, so you feel like you're working on meaningful goals.
What is the most challenging part of your role?
So the first thing that came to my mind, which again is more a State's thing than Canada, is health insurance. It's such a barrier that I've learned more about since starting a private practice. I think so often people think of health insurance and healthcare as the same thing. But health insurance typically does not cover as much therapy as someone could really benefit from. And so that is really frustrating as someone who is trying to help people. And again just being a business owner, dealing with the insurance side of things is frustrating. I have a close colleague who works as an SLP in Canada, and it's interesting to compare our experiences and how things are different just because of the different healthcare systems
One thing that I offer to help bridge the gap of what insurance will cover is cognitive wellness. Lets say your insurance will cover twice a week, but you want more, you could pay privately to work with me an extra day a week. Or if health insurance covers therapy for three months, and you want to continue because it's been helpful and again insurance says you're done, but that doesn't necessarily mean that you've made all the progress you want, then you can continue to work with me through that sort of a wellness program.
That's great that you offer that! I can imagine it being so hard for survivors because they have made so much progress, but aren't at the level that they are expecting to be at, and then they are just cut off.
Yeah and the research shows that you can continue to make progress. And I think that the other piece that is so important to talk about is the role of the family, friend or caregiver, and that there is some important education that can happen too. I can talk with a caregiver either during a session with my client or privately, and have a conversation with them about how they can support the person with the brain injury.
I am happy to be a resource to people. With my license I am limited to only working with people in the state of Maine, but please feel free to visit my website and blog for more information and reach out if you have specific questions.
I am very impressed with the work your organization does. I think that this is such important work; advocacy and awareness for brain injury is so important. People often say that it is an invisible injury. Especially if health insurance is saying you're all better, people can start to lose hope and I think it is important to advocate for yourself or find a trusted family member or friend who can help advocate for you as well.
Resources:
Lotus Speech & Wellness: https://lotusslp.com/
Lotus Speech & Wellness Instagram: instagram.com/lotus_slp
Lotus Speech & Wellness Facebook: facebook.com/lotusslp
LoveYourBrain: https://www.loveyourbrain.com/