Welcome to blog post number T W O !
As this blog develops, one of my hopes is hear the voices of my clients talking about their experiences of living with an acquired brain injury.
What better opportunity to give voice than in brain injury awareness week 2020. I am really pleased to welcome Tom Holden as the first client contributor. He shares his experience of gaining employment when recovering from a brain injury.
Tom was involved in a cycling accident in July 2017 but following rehabilitation was able to return to university to complete his studies. Tom has dysarthria and asked Communication Changes to provide therapy to improve speech intelligibility. We were able to work through a series of exercises from the good old DDK rates right through to preparing a brain injury awareness presentation that Tom will be able to deliver in a range of contexts.
Over to Tom,
I started my final year of university in September 2018 which is when companies release their graduate scheme application process. I did apply to a few but the most helpful thing I did was to make a list of the graduate schemes that I wanted to apply to the following September. Fast forward 12 months and I was ready to hit the ground running with my applications!
The challenges I faced and how I negotiated them:
A lot of companies include a one-way video interview in their selection process. I found this particularly challenging as you only get 30 seconds from the time that the question appears to when you have to start your recorded answer. This was a particular problem for me as during my time in hospital, we discovered that the introduction of time pressure had a resulted in my brain going into a meltdown and not being able to function. I negotiated this by researching common questions and preparing answers which I could adapt if required. This helped because instead of spending 30 seconds floundering for an answer, I already knew the rough answer I was going to give, and I could spend the time thinking about how I could adapt it.
I also noticed that the computers audio distorted my speech and reduced the clarity of the words that I was saying. As the video interview only gives you a short amount of time to make an impression, I was worried that I wasn’t leaving a positive one! Therefore, I spent a lot of time practicing my answers in my own time into the computer’s video camera. This allowed me to listen back to it and identify any areas that I found problematic. A very useful tip that Mary gave me was to actively slow down when saying a pair of words that are commonly said together. My speech was only going to improve if I tirelessly practiced and corrected the things that I noticed were wrong! Recording my answers in this way was very beneficial. I think that it is vital to practice these in my day to day speech not just the therapy sessions. Practicing these video recordings also allowed me to see what I looked like on the screen and if there were any distractions in the background. It is well worth checking the lighting as this can drastically change your appearance.
One of the schemes that I applied for was the Business Graduate Scheme at Williams Advanced Engineering. I was invited for an assessment day which included an interview in October. I was nervous as not only was I aware that my speech could occasionally lose clarity, but it was also my first ever face to face interview! I remembered the techniques that Mary had taught me in our therapy sessions and took a few deep breaths to avoid getting too flustered.
The additional tips that I would give for anybody trying to improve their speech, whether it is for an interview or just in day to day life, would be to:
Initially I was struggling to produce certain sounds and pairs of letters but with lots of practice I managed to improve in these areas. Also, the more I practiced the more I became aware of words and phrases that tripped my speech up. Therefore, I could implement the techniques that I had learnt to improve my speech more naturally in day to day speech and in interviews. It is well worth practicing in front of other people and asking for their feedback! This improves your confidence on the day and helps you to project both your voice and your appearance.
2. Own the brain injury
Initially I was worried about how the interviewer would react to learning that I had a brain injury. I was comfortable talking about my brain injury and portrayed it in such a way that it highlighted the positive aspects of my character. Focus, commitment and resilience are some of the key personality traits that the interviewer is looking for in potential candidates and there is no better example of this than in your battle back against a brain injury
Throughout my recovery I kept the dream of regaining my independence at the forefront of my mind. I thought of every little improvement as a small step in the right direction and it is the accumulation of all these steps that result in the bigger improvements and you achieving your long-term goal!
A huge thank you to Tom for sharing his story and the value of speech therapy in preparing for the interview process.
For those who are wondering, Tom did get the job! He starts in September 2020 but in the meantime he is working on the frontline in a local supermarket.
2019 was, for me, a year to celebrate two significant milestones; two decades since qualifying as a speech and language therapist and one as an independent practitioner. It has been a time to reflect on the changes that unfolded, both in my practice and within the profession.
By way of illustration, I have a strong memory of delivering a presentation as an undergraduate during a module on acquired communications disorders. The topic was ‘subclinical aphasia’ as experienced following traumatic brain injury (TBI). This short label powerfully indicates how little was understood about communication difficulties following TBI back in the early 1990’s. We borrowed knowledge from the field of stroke and had a limited grasp on the myriad clinical features experienced by our clients. Fast forward to today and consider Sheila MacDonald’s 'Model of cognitive-communication competence’ which helps us to “[conceptualise] the full range of communication impairment after acquired brain injury“ (2017). This model draws together the many and varied clinical features involved in communication following TBI. This gives a theoretical background to what I see every day in practice - that the experience of cognitive communication difficulties is as unique as the individuals involved, influenced by their personal context as well as the injury.
Coming back to my presentation all those years ago, it sticks in my mind because it was one of the earliest opportunities I had to explore the barriers that existed for people with TBI as they tried to re-engage with their life roles. As the profession has developed in its understanding and management of people with brain injury, so have I. I have been able to work at every stage of the pathway from ITU to post acute rehabilitation. I now spend my working days alongside people who are living with cognitive communication impairment, together with family, friends, and sometimes their colleagues, as they aim to re-engage with social, work and leisure roles in their own community.
My goal is always to encourage and support my clients to live life to the full through the creative development of therapy programmes drawing on the evolving evidence base. Keeping up-to-date with research and other developments can be challenging enough but more so, working independently with less readily available spaces to share ideas with colleagues about application of theory in practice. Technology helps; Twitter is a fantastic window for discovering what colleagues are thinking about and doing in their work, almost in real time. Webinars provide remote access to more regular training and discussion with colleagues. Peer groups provide a safe space to have face to face discussions with trusted colleagues. The ever burgeoning body of blogs and vlogs allows speech therapists to share their ideas more widely, however, to date, I have not been able to find any fellow speech therapists blogging about their experience and practice in the area of cognitive communication following TBI.
2019’s milestones provided not only an opportunity for reflection but also the catalyst for seeking a new challenge. Having failed to discover anyone writing about the topic that interests me so much, I decided to become the answer to my own google search. In writing this blog, I hope to share some of my ideas about practicing as a speech and language therapist in the area of cognitive communication competence and invite conversation about how we as a profession can continue to address the needs of our clients creatively, especially as they return to family, leisure and work life. Where possible, I will give a space for my clients to ‘Give Voice’ by way of focusing on the most important people in this discussion and to provide hope for those who are starting out on their journey of recovery.
Amongst the topics I hope to explore are ways to explain the complexities of cognitive communication competence to clients and their families (especially in relation to clinical assessments), new research into the role of the cerebellum (van Dun et.al. 2016) in social communication, the broadening view of Diffuse Axonal Injury (McDonald et al. 2019) and what all this might mean for my clients.
I hope this piques your interest; please watch this space for blogs in the coming months and feel free to join the conversation using the comments box below.
Sheila MacDonald (2017) Introducing the model of cognitive-communication competence: A model to guide evidence-based communication interventions after brain injury, Brain Injury, 31:13-14, 1760-1780, DOI: 10.1080/02699052.2017.1379613