The meaning of true north
One of the most common questions an adult speech-language pathologist (SLP) will field is, “Why was I referred to speech therapy? My speech is fine”. Thus, we are constantly educating about what we offer, not just to the public, but other medical professionals. Across 17 years of practice, I would say 10-20% of my clients have had true speech issues, such as difficulty with vocal projection and the size of speech movements in Parkinson’s disease; or apraxia - a movement planning disorder that greatly obscures the person’s ability to form words accurately - due to stroke. Instead, the majority of my clients have language or cognitive involvement from neurological injury or disease. The language piece might address word retrieval; processing what others say; reading & writing; sentence formulation; social communication; or organizing ideas to effectively communicate what is intended. Cognitive rehabilitation might address executive functions - the conductor of the brain’s symphony; different forms of memory; different forms of attention processes; and visuospatial functions that are involved in broad communication. Medical speech pathology even broader and might extend to helping people with voice or swallowing. “Speech” definitely misses the whole enchilada.
When I first left the hospital setting, my private practice’s name was Neuro Speech Montana, and I quickly realized that this title was inviting the very communication breakdown with which we SLPs contend (ironic as a communication professional). I absolutely love working with my “speech-speech” clients: It is critical to translate the words in our mind to movement acts that others can decipher. But it leaves out a major portion of people with other specialized service needs.
It took 3 years to come up with a practice name that truly resonated. Adult neurological SLP practice has to be highly individualized to be effective. No two brains are the same, even if they have grossly similar topography. Because of how incredible neuroplasticity is (a property of the brain referring to its lifelong capacity to change according to input), everybody is wired a little differently. Our brains are largely a function of what we have experienced and what kind of pathways were laid down accordingly; repetition and intensity matters. Some pathways that haven’t been used much are like a bumpy backroad that hasn’t had any attention from the county; others are like a 5-lane highway.
Another thought I liked to share with trainees, when I had the privilege of mentoring, was that the brain does not live in a vacuum. One rehabilitation intervention might make sense in the context of person A’s life but be irrelevant in person B’s. Unfortunately where the healthcare system has gone, there is tremendous incongruency with individualized care. Current healthcare has become hugely volume driven, leaving little time for treatment planning; case conceptualization, processing sessions, and ultimately individualizing treatment. Brain functions are the opposite of something like a straightforward ACL repair rehab case, but neuro therapists are expected to somehow crank out care similarly. Each person’s communication and cognitive skills are extremely nuanced and unique.
Meanwhile, when not being an SLP, spending time in the mountains is a huge passion. I worked as a backcountry horse guide before becoming an SLP and I’m also an avid hiker/backpacker. There is a term in backcountry navigation, “true north”. True north refers to “north according to the Earth’s axis”, not magnetic north that you have to correct for when using a compass. “True north” also has a colloquial meaning; it refers to navigating life according to your personal values, beliefs, and purposes.
This idea of “true north” greatly resonated with my therapy and coaching philosophy. Therapy should be a true collaboration with the clinician as a guide and facilitator for someone’s journey with neurological diversity, injury, or disease. The client is the only one who can define what their “true north” looks like; it isn’t up to society, generic goals, their medical team, or others. Also, what we choose to spend time and energy on in therapy, let alone all of the effort a client puts in to practice their skills, strategies, knowledge, etc “in the wild” needs to align with what is important and meaningful to them. It is one of the highest honors in life to walk alongside with clients in this journey, being invited into their lives, and to provide navigational support for brain functions that lie deep in our identities. 🧠🫶🏻