Located in Anaheim, CA is a small speech therapy practice called Instrumental SLP, founded by Lyda Kongswangwongsa, an ASHA Certified Speech Language Pathologist (CCC SLP). It could be any other small speech therapy private practice, except for two big differences. The first difference is that Instrumental SLP specializes in adult speech therapy. Most private practices offer services mainly for children, but adults have different needs and problems to address. Adults need someone who specializes in speech therapy for adults. The second difference is that it offers the only Intensive Comprehensive Aphasia Program in California and the West Coast.
Intensive Comprehensive Aphasia Programs (ICAPs) are speech therapy programs for people who have aphasia. Aphasia is a language disorder that can happen after a brain injury or stroke and over 2 million people in the United States have aphasia. There are a handful of other ICAPs located across the country, many of them are big programs at universities or hospitals.
When asked why she thought she should offer this program, she says her “clients just wanted more”. She also wanted to give more. Traditional speech therapy is typically a 45-minute session 2-3 times a week. When Lyda was working as an employee for bigger healthcare companies, she would treat people with aphasia and she always felt like having more time with them would give better results. But working as an employee requires you to meet certain billing and productivity requirements, so there was little opportunity to explore this.
Lyda says she has always wanted to help people and choosing the career of Speech Language Pathologist has allowed her to do just that. Lyda spent seven years working in hospitals, skilled nursing facilities, subacute rehab centers, and home health companies in Southern California. She says she jumped around because she was always searching for more experience to improve her clinical skills. However, she felt a need for change because she became tired of struggling to get approval for the minimum number of sessions when her clients would benefit from more. In 2020 Lyda founded her company, Instrumental SLP, and she attributes her ability to provide services now to a broad range of people to all those years spent in different settings.
Lyda started Instrumental SLP with the vision of offering mobile instrumental swallow assessments to skilled nursing facilities because it can be difficult for patients to access these studies. Unfortunately, she began offering this service right before COVID lockdown started. After just a few weeks of talking with skilled nursing facilities every facility had to stop taking meetings and really could only focus on trying to keep their residents safe. In addition, she says “there was so much we didn’t know about COVID and doing an endoscopic assessment via the nasal passages was just not possible due to the risk of COVID exposure.”
Lyda was able to adapt and began seeing Medicare clients by telehealth. Before the pandemic, Medicare did not cover teletherapy. But because of the new pandemic emergency, teletherapy was authorized. Lyda was also now able to focus on building her vision of extended length sessions. So, her attention turned to her clients with aphasia. She wanted to provide longer sessions using research-based therapies designed to improve the abilities of those with aphasia. This level of service is above and beyond what Medicare covers, but Lyda says her clients really love this format. Research also indicated that teletherapy for intensive sessions could work for people with aphasia. So that’s exactly what Lyda started providing.
ICAPs typically offer several hours of speech therapy a day, several days a week, for several weeks at a time. Some of the big programs in the U.S. even do programs lasting for 6 weeks at a time. Lyda says her program isn’t ready for that just yet, but she is building up to that capacity. As far as her clients are concerned, Lyda says the progress she has seen since beginning these programs is substantial. “ICAPs are for people who want to see the most improvement possible in a short amount of time. People get tired of waiting for results, and with this format we get the intensity required for learning and neuroplasticity. This helps us achieve the best results possible for the deficits that are present. We test at the beginning and end of the programs so we can measure success. Everyone we saw last year showed clear improvement.”
Instrumental SLP offers therapy in a variety of ways – in-home, in the Anaheim office, or through teletherapy. ICAP sessions are held 4 days per week and last for 4 hours each day. Clients must meet program requirements in order to participate in ICAP, but Lyda tailors each program based on what the client will benefit most from. “Some people struggle with maintaining their attention and by the 4th hour they aren’t getting anything from the sessions. When necessary, we modify each program so that our client isn’t forced to attend sessions for longer than they can benefit from.” They aren’t always able to do this, but Lyda says she enjoys giving her clients the best program they can design. She also says not everyone can benefit from the teletherapy format, so she offers free initial zoom consultations to confirm if it’s a good fit.
Instrumental SLP utilizes a variety of treatment approaches to help their clients. These approaches have names like “Semantic Feature Analysis”, “Verb Network Strengthening Treatment” and “Abstract Semantic Associative Network Training”. Lyda likes to incorporate any approach that has research behind it with the potential to help her clients, including Interactive Metronome (IM). Interactive Metronome is a tool that addresses the deficits in neuro-timing that can come with aphasia and can impact speech, language, auditory processing, and cognitive function.
Lyda says the most difficult cases are when someone has global aphasia paired with severe apraxia. Global aphasia is considered the most severe form of aphasia. Apraxia of speech is a disorder that affects the brain pathways involved in planning the sequence of movements involved in producing speech. The brain might know what it wants to say but is unable to plan and sequence the required speech sound movements. Apraxia can occur after a stroke or brain injury and the co-occurrence with aphasia ranges anywhere from 65-85%. What’s more, is that anyone who has apraxia will also have aphasia. Lyda says that apraxia is frequently missed during the initial assessment at the hospital because there are so many other things happening all at once. When a client comes to see her, she says she always screens for apraxia because that impacts how she plans her treatment.
If a client has apraxia, Lyda says the treatment plan typically focuses on improving the apraxia first and then as soon as possible she begins targeting language. Part of the therapy is training both the client and their caregiver on using strategies for repairing breakdowns in communication and how to get the most out of what the client can do. “We try to focus on what will give the most relief the most quickly in the most real-world situations. I mean, can you imagine not being able to talk, read, or write? How isolating,” she says.
Lyda says she also works with clients who have only mild deficits but want help getting ready to communicate at high levels- specifically, they want to prepare to return to work. So, in therapy they work on practicing all the different scenarios someone might face like communicating with superiors or having hard conversations with employees. Lyda says she has even helped people who want to be able return to work using Java and JavaScript coding languages. “I am not a coder, but I can walk someone through the necessary steps to be able to better understand symbols and language. My job is to help them find out what they need help with, and to show them how to implement different tools to ease their transition back to work.”
One of Lyda’s goals is for people with aphasia to feel empowered in their recovery. “Feeling powerless is awful. I regularly ask my clients to do things that they don’t think they can do yet, just to try. I want them to recognize that even with language deficits, they can do so much.” The path to being more empowered starts with just asking and searching for more resources. Lyda encourages her clients to “be the squeaky wheel” and keep asking for help. Lyda also tells her clients about free resources like Speech Recovery Pathways, a non-profit organization founded by a stroke survivor and supported by speech therapists. They offer virtual aphasia support groups and virtual cognitive communication training groups for people with aphasia and their caregivers and can be found at https://speechrecoverypathways.org/.
Lyda also says there are some really great apps out there that people with aphasia can use on their own to help in their recovery. Lyda says her favorites are the Tactus Therapy Apps. “These apps were designed by a Speech Language Pathologist and were informed by research and evidence-based approaches. Plus, there are so many different ways to use them that they are a great investment.” Lyda does recommend consulting with a speech pathologist to get oriented and instructed on which ones to use and how to use them.
Lyda says she is excited to be the first one to offer ICAP in California, and that “surprisingly people in other states found out about us, so we got licensed in Washington State and enrolled as an out-of-state provider in Florida so we could help these people. I want to keep growing our program and provide even more as we grow, so it’s a really exciting time for us.” If anyone is curious if an ICAP is right for them, Instrumental SLP offers free initial consultation to help determine if they can help you. For more information, call them at (714) 683-0811 or visit the website at www.islppro.com.