Hi, everyone, and welcome to The Missing Link for SLPs podcast. I’m Mattie, your host, speaker, and very passionate speech language pathology advocate. If you are new to the field of speech pathology, or just want to stay fresh, this podcast is for you! Here I will share with you my wisdom and experience of more than 23,000 hours of one-on-one skilled intervention working around the world as an in-the-trenches medical SLP. And now as an assistant professor for an accredited CSD program, I want to help you see the big picture of what you’re doing and connect those small dots of what you know and how to apply it in your practice. Those missing links, helping you be the best, most confident and most effective SLP you can be! There’s no better time than now to freshen up. You totally got this.
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Hi and welcome to this edition of the missing link for slps Podcast. I am with Dr. Lynn Fraley today who’s a good friend of mine, and she is a neuro psychologist. I’m excited to have her here today to explain to us what goes on in her world as a neuropsychologist. Welcome, Lynn. Thank you, Mattie.
I am happy you’re here. So a lot of the students I work with do not know what a neural psychologist is. Would you explain to us who you are, what your credentials are, and what you do?
Sure. Okay, so technically a neuro psychologist is a PhD in clinical psychology that has additional specialty training, usually a couple of years depending on how you do that. I happen to do my specialty training as part of my PhD program, so I didn’t have to do it as a postdoc as much. What that means is, in addition to the clinical psychology curriculum, spend roughly two years of education focused on brain structures and brain functions, and what that means in terms of psychological functioning for patients. So it’s the regular therapy type information with neuroscience added to it.
So excellent. And you are Dr. Lynn Fraley. What is your scope of practice as a neuropsychologist? Who do you see? What types of patients do you work with?
Well, as a neuropsychologist, I’m also a clinical psychologist. So my practice has been around for 21 years this year, and I started my life as a developmental specialist. So my practice ranges from early childhood like 2, 3, & 4 year olds on into the geriatric population. Our oldest patient right now is 82 years old, and it’s a full spectrum practice. So in addition to knowing science specific things, like head injuries and dealing with things like ADHD and brain structural problems, we also have all the the whole spectrum of regular clinical psychology things like mood disorders and depression and anxiety and eating disorders and that sort of thing.
personally specialized as a trauma therapist early in my career. So we get a lot of suicidal patients here and a lot of people who have gone through all kinds of traumatic experiences of war veterans or survivors or witnesses of violent crimes, but also people who have survived things like car accidents and things that have crushed their brains. We do the most here, which is not typical for neuro psych practice, to combine clinical psychology, more like clinical psychology informed by neuropsychology.
So what that means is we do a lot of work and helping people understand how to sustainably change their neural network so they change the way their brain functions which affects how they feel and how they function. For example, bipolar patients have the ability to eliminate the symptoms that go along with their mood disorder if they know how to construct the neural network that will support healthier brain functions so that they can live their lives without the medication without experiencing those symptoms and can be healthy and happy again. So we do a whole lot of that kind of work here.
Typically, probably the majority of the neuropsychology field is involved in conducting assessments, writing reports and interpreting those results. Forensic neuroscientists do that a lot in terms of assessing damages from car accidents or head injuries and the outfall or the the fallout of strokes and assults or exposure to toxic substances. Most neuroscientists that I know of do not do clinical practice as well. In most neuroscience today, they don’t do as much of the spectrum as we do here.
So I know, as a speech pathologist that has sat on onccussion teams, a state concussion board and worked with many concussion patients, we often get reports from a neuropsych. Ccan you share us what types of assessments might be on that neuropshychological evaluation and insights from the evaluationthat it would be helpful to a speech pathologist?
Sure, I think, I think would probably be the most effective to go back that out what kinds of assessments a neuropsychologist uses? There are dozens of assessments you can choose from. So it depends depends on the referral question a lot. So let’s say there’s a concussion involved. The assessment will depend on what part of the head was hit.; in terms of what brain section you want to assess. Generally , there’s some there are some tried and true favorites out there in the clinical psych end.
We have MMP for personality assessments, and that’s kind of the gold standard for neuropsych. There’s a whole standard batteries of tests. It’s up to the individual neuropsych, whether they use a standard battery or whether they put their own together specific to the evaluation.
I think the biggest difference there often comes between whether you’re working for an agency or if you’re in private practice. So what the neuropsych will do is bring the person in, hopefully under circumstances where we’re going to get the best sort of response and best kinds of answers, and then interpret those test results in terms of what the test results tell you about what part of the brain might be injured. What part of connection which connections in the brain might be injured, whether they’re repairable or not are questions we ask. What the odds on that are and that has a lot to do with the type of the severity of the injury or the concussion and the age of the patient. So the normal cycle gets specific,
I’m looking at memory or speech and language things or auditory things or processing reasoning or any of the executive functions, and then try to assess whether those are going to be treatable and to what degree they’re going to come back. This has changed a whole lot recently with the massive movement towards understanding neuroplasticity and what that means and we’re just now really starting to actually apply what we’ve known for a long time, which is brains can reconstruct themselves if we treat them appropriately. So what you get from your question, there’s a concussion team and you send someone out for a neuropsych assessment who will get a battery and test results in a written up. It shows you what’s injured and how badly it’s injured and how likely it is to recover.
One of the things I enjoy most about you is, you are able to take a simple subject and explain it well. We were talking the other day about or this just before we jumped on here. Tell us your “bean” story.
Right. So being in the process of practicing clinical neuro psychology, it’s very much like being back in kindergarten or first grade, when you planted those bean seeds in those little Styrofoam cups and the teacher gave you a cup and a little bunch of dirt and you pushed your little seed in there and covered it up. The teacher told you that that little hard chunk you put in the dirt was going to turn into a plant that actually made vegetables you can eat, if you would just give it sunlight and dirt and water, and you totally believed it. And so for some days you water, the dirt with no evidence of anything at all, until the day comes that you’ll see is sprouted. Everything you thought was going to happen actually happened and then the plant grows and you get beans, and it’s wonderful.
And that’s very much like working with a patient in in repairing whatever sort of brain damage has gone on or reconstructing neural networks. Tell the patient there is this brain that you can’t actually see. And that if we apply consciousness and if we apply certain activities to it, and we move in a certain direction, that this brain is going to grow networks, and we will know that because you will feel better your symptoms will go away. But very much like that being said you water for a while and you’re kind of trolling a while but then the day comes when a patient walks in says, “I remembered where I put my keys. And I slept through the night and I haven’t had a panic attack.” It’s like seeing that first little belief coming through the soil and you’re like, “Oh, this is it, we’re good. It’s going to be great.” And from there, it just goes on once a patient learns how to manage their own brain function that way, truly, there’s there’s nothing they can’t do in terms of getting themselves to think and feel the way that they want to so they can live the life they want to live. It’s pretty fun.
That parallels so much of what we do in our speech pathology world, because we will have patients who come for example with word finding difficulties and they have troubles even walking up to a counter to ask for, you know, where’s such and such located in the store. And when they start a therapy session with us, it’s like that being it’s planted in the soil. Well, we tell them that their brain is going to get better. We give them strategies, which is like the water and and the sunlight. And we then teach them how to use those strategies. And in a world that’s functional for them, I see a lot of parallels with what we do, which is why it’s exciting.
That’s exactly right. That’s why that would happen even more often, if more neuropsychologists and clinical psychologists, actually, after doing the assessment, made a treatment plan and work with that patient. I think, at least in this part of the country, that doesn’t happen a lot, because mostly because insurance reimbursements. And speech pathologists are the ones who are reimbursed in cognition and cog-com. while neuropsychs are not. So most neuroscientists don’t do that, which is fine.
I mean, it’s great, and it’s wonderful that there is this overlap, because essentially, we’re doing the same kind of work. I do different assessments than you do but we both are doing the same thing in terms of trying to repair a brain that is struggling somehow. So I don’t really think there’s a great big gap between us. I think the letters after our names are different. And the classes we took might be different. But if we sat down with the same group of people, we will probably be doing a lot of the same things.
Well said, the neuropsychologists I’ve worked with in the past add more depth and dimension to what I can test as a speech pathologist. You as neuropsych, test more areas than I may and in more depth and you’ll give me more specific directions on how and what this patient can actually do or not. So we do complement each other well.
I think what neuropsych might offer that is a little bit different than yours too, is that understanding of that relationship between brain structures, which has vastly changed since the Human Connectome Project has come along. We know now that the whole brain talks to all of itself all of the time. So it’s not possible you can have a like a focal lesion in just one place where you can see there’s tissue damage here. But what that means in terms of disrupting the connect the communication pattern within that brain is much bigger and much more complicated than that. So most neuroscientists who will do a more of a global look at what is being affected with an understanding and an injury in one part will affect function in another part that might be really discreet and something that you miss if you didn’t specifically test for it.
That reminds me of the video you told me about when I first met you,the video on neuroplasticity that The Legend Devlopment Center made. How can our listeners find your video?
You can go to YouTube and put in Legend Development Center. And if you pull itup, there are two videos in there: one which is written more for educators and one that says social skills and neural plasticity. If you pull that up, it will, in a nutshell, explain how we’re taking concepts that we know and putting them into practice in terms of helping people, children in particular, rewire their own. With the belief that if we brought up children, people to understand how to manage their brains and care for them, as much as they understand how to manage and care for their physical bodies, we would very likely not have so many people in clinical psychologists offices, getting help because they would know how to remediate those things themselves.
Well said! It’ss a good educational video that I’ve shown some of my adult patients even though there are children in it, but it’s educating the patients we work with on how to help their brain heal, and how to help their keep their brain healthy. So, yeah!
You are developing and growing until the day you take your last breath. So we really need to get over the cultural belief that young brains are somehow more flexible and more plastic than older brains are. It’s not exactly true at all. If that were true, I wouldn’t still be working and making up new things all the time. Older brains are different than younger brains, but every brain is a plastic brain, and every brain responds to conscious demand. So it’s a very exciting field to be in. It’s a very fun work to do. And I think that it’s a little daunting to say a neuropsychologist. I mean that’s a lot of letters. You could win a Scrabble game with that one. It’s mostly a person who cares about helping someone else get better who has spent some more time studying about how brains working safley. That’s pretty much it.
What words or recommendations do you have for a new speech pathologist who is learning to read a neuropsychological report or wants to maybe meet and reach out to a neuropsychologist? How does she begin to decipher that report and then realize that neuropsychs aren’t so scary and intimidating?
Well, I think she should do is just pick up the phone and call. Most of us sit here in our offices, largely unaware that people don’t talk to us because you think we’re intimidating and scary and I realize all the letters seem like a lot. But neuropsychologist, generally speaking are avid learners and been in school a long time and they love to discuss their topic like anybody does. Who’s got a career like that? And so, to pick up the phone and make an appointment, say, Can I buy you coffee? Will you talk to me for half an hour so I can be better informed, and I can better understand your reports.
I can’t imagine anybody who wouldn’t jump at the chance to do that on my end, because it sometimes is frustrating when we know we put reports out and we know that it’s sort of foreign material to a lot of people. Sometimes the terms aren’t all that familiar. Sometimes what we mean when we’re interpreting them isn’t all that familiar. And it can be difficult to put it in everyday readable language without missing some of the details. So to have somebody who actually is interested, and wanting to know how to understand and neuroscience report better, is like a rare and happy find. So I would encourage anybody to pick up the phone and call and say that you just talk to me for a little bit. Then I can understand you better, because that’s on my end of it. That is one of the biggest hurdles to get over is to take this knowledge that you have that would be really helpful and make sure people understand what you’re saying, in a written report, which is tough, tough to pull off a lot of times.
Right. Well said. Any last words, any stories you want to share with us before we are done?
What I would like to say is approach your neuropsychologist. Remember, that’s just a person there, who’s been in school for a long time, and who is happy happy to have a conversation because behind the neuropsych part is the psychology part. Psychologists are famous for talking forever. That’s how we make the connection. So you should never be afraid to have a conversation with somebody who talks for a living. Just forget whatever it is that scares you. Sit down with the person and ask what you need to know. I’m positive you’ll get the answers you want.
Dr. Fraley, you are absolutely wonderful. Thank you for taking the time to talk with us today.
I hope today’s conversation has created some aha moments for you and motivated you to become a better SLP, continuing to connect some of those missing links between what you know and how to use that knowledge.
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