You're an SL- What?: Life as an Inpatient Rehab SLP

           Hello! I’m Allie O’Hara, a speech-language pathologist working in an adult inpatient rehabilitation setting.  I completed my undergraduate degree at Oklahoma State University! GO POKES! My master’s was completed at the University of Tulsa and I’ve been working as an SLP for just shy of 7 years. I love being a part of the SLP field and having the opportunity to change people’s lives for the better every day.  I have had the opportunity to work in a variety of settings with adults with each one changing and shaping me into the clinician that I am today.  I was recently elected to VP Elect of Oklahoma Speech-Language Hearing Association and am finding my way through the leadership arena of the SLP world. 

Pistol Pete, myself, my husband, Dan

      While I was in school, I fell in love with working with adults. I had previously thought that I wanted to work with children, but after having adult patients in clinic, I knew I had found my calling.  I wanted to work in the medical world and I was willing to move anywhere to do it. The VA (Veteran’s Administration) hospitals throughout the country offer specific one-year clinical fellowships in speech-language pathology.   I applied for several of them and ended up getting a Boston VA Clinical Fellowship, which happened to be the #1 VA center in the US at the time. I loved my experience there and grew exponentially during my time with the VA. I was able to work in all different settings: acute, subacute, outpatient, I was a member of the palliative care team, working with HNC, ALS etc.  During my fellowship, I had the opportunity to work with MBS and FEES. I was able to attend Susan Langmore’s FEES course and learned when to use one assessment versus the other. It was such a unique experience packed with SO much information and opportunity for me to learn. I know I wouldn’t be the SLP I am today without my fellowship with the VA. 

After I completed my fellowship, I had such a passion for helping veterans. At the time, there weren’t VA positions available in Boston, so I accepted a position with the VA in San Antonio, TX. This VA is one of the five polytrauma centers in the US that serve active-duty military and veterans. I started working in the outpatient setting serving patients status post TBI and transitioned when a position opened in inpatient rehab. Being a polytrama center, all of my patients had several comorbidities. To be accepted to the program, patients had to have at least 2 comorbidities (for example, PTSD and TBI, or TBI and physical injury, etc.) I would never know what I was going to walk into each day which kept me on my toes and always made work exciting. In the rehab setting, about half of my patients were serving as active duty military that would come to us after a major injury while being deployed once they were stable. Often, these were extremely traumatic experiences for them, so they were working through more than just their physical injuries. The other half of my patients were veterans that came in after an injury that wasn’t combat related such as motor vehicle accident or motorcycle accidents. 
I worked with patients in the Emerging Consciousness Program as well. I would work with patients who were in a coma along with PT and OT to help them emerge from the coma over a 3 month trial period. We utilized the JFK Coma Recovery Scale to address auditory, visual, motor, oromotor, communication and arousal functions with these patients. Patients would come to us in a coma/vegetative state progress to “minimally conscious” then to “emerging conscious” based on the JFK Scale. Eventually they would progress to a level of consciousness that was the same as other rehab patients. Of the patients that I got to work with through the ECP, all of them were able to regain consciousness. 

I took on the acute setting when I moved back to Tulsa to be closer to family. I worked primarily in the Neuro Trauma ICU. I also helped in the stepdown ICU. I would follow trauma patients from admit to ICU to stepdown ICU to the main floor throughout the duration of their time in the hospital. I addressed dysphagia, cognition, language, speech, etc. with these patients.

I now work in inpatient rehab, which I’ll tell you a little more about below. 

I had initially started college as pre-med and even tried to be a business major but found out VERY quickly, that was not for me! A good family friend was an SLP so I had some idea of what the field entailed. I knew it was specific niche, so I was hesitant at first. I loved the idea of being a pediatric SLP utilizing the combination of language and science. I observed an SLP and that really helped me to try it on for size. Going to my early/intro classes solidified the decision for me to pursue a career as an SLP because I really loved everything I was learning. I genuinely enjoyed those classes. With an interest in pre-med, the combination of science and medicine with reading and language was the perfect mix for me. Knowing it’s a career that would allow you to have a family was another attractive feature for me. Grad school showed me incredible adult patients in clinic and I had incredible classes that showed me my love for adults that I didn’t know was there for me.

I currently work in a 32-bed inpatient rehab center that is part of a multidisciplinary Comprehensive Stroke Center. I love my current setting because I’m around very motivated, supportive, therapists who are motivated to provide the best evidence-based care. This setting combines acute skills and outpatient skills as it serves as a bridge between being stable enough to discharge from acute and being able to be fully functional at home. I primarily work with neurological conditions, stroke, and TBI. Our patients receive a minimum of 3 hours of treatment a day between PT/OT/SLP. Our team is constantly communicating and helping each other to make the most of the rehab experience for our patients. Whether it’s PT helping me walk a patient to therapy or me giving an OT the best communication strategy for a patient, we work really well together and have an incredible team. My favorite part about my job is the amount of time that I get to spend with my patients. I love getting to form those relationships with my patients and getting to see a patient go back to work, go back to their life. I typically see patients for an hour each day for 10-14 days of what is likely one of the toughest and most trying times in their lives. When you spend that much time with someone and help them to fight to get their life back, there’s an inevitable and undeniable bond between you. 

One of the biggest challenges for me in this setting is that every patient wants to get better faster than they are. So, keeping patients spirits high when they’re frustrated or feel that they should be farther along in their progress than they currently are can be challenging. This is also part of why I love my job so much. I help them cope by utilizing humor, making therapy as functional as possible, finding something that they love and are interested in working on. Sometimes, just being an ear to listen, helping them to process the extensive change that they’ve been going through is what they need most. When patients are in the acute setting, they may or may not be aware, may have limited understanding of what is going on or what has happened to them. By the time they make it to rehab, the dust has settled and they’re starting to understand the severity of impairment that they’re facing to overcome. This can be such an emotional process and I feel lucky to be a part of the team that helps them overcome this. 

There are SO many stories that could be “my biggest reward.” Overall, seeing patients succeeding with getting back to the things that they love is my favorite part. When you have a tough TBI patient who is at a Rancho 4-5, being creative to find something functional that works for them is a big challenge but also the progress that you see with those patients is the biggest pay off. I had a patient who came in to the Emerging Consciousness Program in a coma. Within a year later she was riding her rodeo horse, being around her grandchildren and able to communicate with them, thriving in life again.  I had a very young TBI patient in acute setting who wasn't expected to make it. After a few weeks, I trialed PMSV and helped him to find his voice again. He went to rehab and after a few months came back to acute care for another surgery. During his readmission, I was able to help him with his first meal in 4 months. 

One thing you could teach the world about our field? We don’t just work on speech! Truly, if I could help the world to be more aware of the breadth of our field, that would be the only (GIANT) thing I would teach them. The role we play in cognition, problem solving, and memory is so overlooked. People are starting to recognize our role in swallowing more and more, but there are other areas that they know nothing about. Many people have told me that they have no idea that we work on XYZ. I love any opportunity to educate others on all of the areas in which we can help our patients improve.

Thank you so much, Allie! I'm proud to share this incredible career with you and call you friend! I'll forever be fan-girling over your experiences as an SLP!

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