Hi, I'm Carrie, a stroke survivor and bind member,
and I'm Kezia stroke survivor as well, and a bind member. And today we are going to be introducing Karen Stoll, who is a speech language pathologist and a board of director of BIND. She's has her experience in as a speech therapist for brain injury survivors and also for spinal Cord survivors. So, welcome so much.
Welcome Karen
Thank you guys for having me today. I'm excited to be here.
Welcome to Bind waves, the official podcast of the Brain Injury Network of Dallas. I'm Brian White, BIND's executive Director. On each episode, we'll be providing insight into the brain injury community. We'll be talking to members and professionals regarding their stories and the important role of BIND's Clubhouse. We work as a team to inspire hope community and a sense of purpose to survivors, caregivers, and the public. Thank you for tuning into bind waves. Let's get on with the show.
So, um, right now that you're with us here, can you tell us a little bit about yourself and your career and how you even became a speech language pathologist?
Okay, well that's a, that's a lot. Yes. So I'll try to, I'll try to be brief. Um, so I have been a speech and language pathologist will be 17 years this may, which is
Oh wow.
Really hard for me to believe that I'm that old, to have that much experience. um, I guess to answer your question about why I became a speech therapist, I never thought I was going to be a speech therapist. My mom was a speech and language pathologist, so I always knew about that as a career option. Um, so when I was in college, I was struggling a little bit with what I wanted to do and I put my sights on audiology. So audiology and speech and language pathology.
It's the same, um, bachelor's degree. and my, uh, senior year of colleges I was applying to audiology programs. My dad was diagnosed with a laryngeal cancer, so that left one of his vocal chords paralyzed and also left him with a pretty significant dysphagia, which is problem swallowing.
So that kind of changed the course of my career path and I became very interested in swallowing disorders and voice disorders, and that, um, steered my ship in a different direction towards speech and language pathology.
Oh, wow. Yeah. I, I'm gonna be learning a lot about you today. This is our first time meeting in person. And I'm like, she's a board of director. And I'm like, well,
it's, I don't really know much about her either, so I'm gonna be learning all about her too.
Ask away. Ask away. Yeah.
So now I'm curious, um, what does, what, what do you do as an audiologist?
Well, I am not,
no, I know you're not. But now that you said,
so what does an audiologist do?
Yeah. I've never heard of that.
So an audiologist is a medical professional who, um, their main focus is on hearing, oh, like, perhaps maybe, um, helping a patient who has a cochlear implant, getting that calibrated correctly, and that is probably not the right term to use. I'm not an audiologist. And then teaching them, um, how to then apply what they're hearing to what the sound is.
Oh, okay.
So sometimes audiologists will work in that capacity. They'll also work with helping people with hearing aids and just different disorders of the ear.
Okay. Mm-hmm. Interesting. Like I said, I didn't even know that was a thing. Um, but, so I know like you're a Baylor's Scott and White and you're not, you used to work with brain injury survivors, but now you're working with spinal. So that just got us curious. Mm-hmm. So what's kind of, is it similar like. Speech therapy problems or speech problems between brain injury and spinal cord, or is it just totally different?
Um, well, it's a, I think I'm gonna answer that in two different ways, if that's okay. Yes. So, um, I work with patients who have spinal cord injuries with a co-occurring brain injury. Oh, okay. So a lot of what a person with a spinal cord injury needs to be able to do if they're not able to move their arms is to be able to direct their care. So can they instruct a caregiver on, can they remember the steps to instruct a caregiver on how to perform and. Intermittent catheterization.
If they're not able to physically do that on their own, that's a way to avoid their bladder. Or do they need help to remember the steps to do a bowel program because their body may not be able to have, um, bowel movements on their own anymore. um, that type of thing. Okay. Also, different abilities to just direct their care for other, other things. Um, a lot of swallowing issues in that population, especially if the injuries in their neck.
And sometimes voice disorders as well, if they can't generate enough power because perhaps the, um, muscles that we use for breathing are impacted from their spinal cord injury. So some of it's very different, but some of it's very much the same. Just maybe more, um, applicable than sitting down to do like a worksheet like you might have done with mm-hmm. your speech therapist and acute care or inpatient rehab.
Yeah, I think that's really interesting because we, um, have had various speech, uh, therapists come in and talk about speech therapy and I think that as brain injury survivors and the, um, the people that. most currently that I have experienced or met here at Bind. A lot of it is aphasia and, um, our difficulty communicating. So I think it's really cool to be hearing about like, swallowing and like different issues, especially for spinal cord, um, survivors.
Can I just say, Yeah. I don't want to hear about the swallowing. I had to do thick ened liquid, so
I'm so sorry. Yeah, it's no fun.
No. So I understand about the swallow.
It's no fun. It's no fun.
Yeah. Um, yeah, I, I think so too. Sorry. No, no. But you're right. I think like, I think at some point, maybe all of us. Or the major, or many, many of us had to do that. Stuck in the hospital. Yeah.
Yeah. But it's not something that the speech therapists enjoy either. We don't enjoy telling someone, sorry, you have to be on this liquid. That looks like Yeah. You know, jello.
And I, I, I do appreciate that all the speech therapists that I had that made me add it, that they promised me that they had tried all of them. Oh, yes. So it makes you feel better to know that they actually tasted it. But I quit drinking coffee. It was so bad. I was like, mm-hmm. I don't just drink water. That's fair.
That's fair. Interesting. Yeah. Interesting. Did you really have to taste everything? She just said it. Mm-hmm. so I'm like, what? Mm-hmm. in
In graduate school, that was what our professors, where I attended school, had us do. They said, if you're going to be prescribing this for your patients, you need to know what, what you're asking them to do. So it was our, where I went to school, it was required. Mm-hmm.
Wow. Interesting. Oh my gosh. Wait back to what we were talking about was fine. Sorry. I know. I apologize. I got you. I'm like, in my head I'm like, wow. Well that's good. Good that you were, you had to do that to be feeling like you understand what we are going through as brain injury survivors. Um, but I did like how you connected, uh, spinal cord injury and if it happened like on your neck and like on your brain, cuz a lot of them, uh, and this is just a question too.
Mm-hmm, um, just through personal experience or meeting people. is it like something that you can be diagnosed with or can someone literally tell you because you've had a spinal cord injury, you can also include that into the brain injury? And are they told
they're, so a spinal cord injury would be a separate injury from the brain injury. Okay. So my patients will have an injury, like a, a, an assault to their brain where they hit their head hard enough to cause damage to their brain, but they also may have been in an accident severe enough where, they had injury to the spinal cord, so the nerves within the spinal cord were damaged. Does that better answer your question?
Um yeah. Yes. No, but I guess so. Can you have a spinal cord injury without having a brain injury?
Yes.
That's kind of the, what we were wondering to you.
Yes. You can have a spinal cord injury without a brain injury. Okay.
Mm-hmm. Oh, okay. Yeah, I guess cuz I was just confused as to like the communication between your brain and your spinal cords. That is damaging a certain, obviously like physical like movement, but also like anything does. equal to being a brain injury. But you're right. I think that made it a lot more clearer. So thank you so much.
Oh, you're welcome. Probably didn't do a very good job of explaining it to begin with, so my apologies. Yeah, no, it's, it's good.
Well, and see the next thing we have on here is one that we talked about what we were gonna ask. So what are some of the other things that, you know, speech therapist has to work on or work with and like I have so swallowing down because mm-hmm. I know that's a big issue. Could you maybe, I guess, even though I said I don't wanna talk about it, explain for our listeners why brain injury and or spinal cord survivors have the swallowing issues and why that's such a problem.
Okay. So, It could be dysphagia or problem swallowing. Could be a dif, uh, could be caused by a multitude of different reasons, right? So, um, for someone that has a spinal cord injury, I'm gonna use that to start off with. Okay. Many of my patients who have had an injury, um, to their spinal cord also need surgery where? Sorry. It's okay. It's okay.
Where, um, as surgery is performed where an incision is made on the anterior neck, the trachea is moved out of the way, and then some of the other muscles that we use for swallowing are also moved out of the way to make a clear path for the surgeon to stabilize the anterior neck. Well, when we do that, there can be or not, we, I'm a speech therapist, I'm not gonna be doing surgery.
But when the surgery occurs, there can be, um, you can pull some of the nerves that we use for swallowing and you can also clamp down on the muscles that we use for swallowing. So that can, um, decrease the blood flow to that area. And then there can be swelling afterwards and just dysmotility or dis uh, the movement of the muscles just isn't very smooth and the swelling can prevent. full range of motion.
So when that occurs with a patient with a spinal cord injury, it prohibits the muscles from doing their correct job. And then food and fluid can get into the airway. And then if that occurs, we can develop a pneumonia over time, which can in some cases be fatal. Mm-hmm. Um, but it can also prolong hospitalization and, you know, pneumonia just really makes you feel really bad.
Yeah. Yeah. Interesting. Mm-hmm. Um, so you had mentioned you were gonna start off with a spinal cord, and then how does that. affect for brain injury survivors?
Sure. So for someone with a brain injury, it could be that perhaps you had an injury to your brain in the area that we actually initiate a swallow. So perhaps maybe the brains stem, which does a lot with, um, swallowing and also initiation of movement too. Um, you could also have an issue somewhere on the motor strip where you have trouble with. The muscles for swallowing or perhaps it's an issue with initiation.
So, um, at the point in time when you're having trouble swallowing, are you having a hard time with detecting that something? is in your throat that you need to swallow or could it be a coordination issue? So are you actually coordinating the muscles in a timely manner to swallow in a way that protects you?
I'm sitting here listening to, and I'm trying to think back like what was mine, and I don't really remember, but I do know, and I hope I say this word right, that I still on occasion aspirate, which to me just means it went down the wrong pipe. And that's what we always say. Yeah. Because as a, and I guess that's what it is in your brain, when you've had a brain injury, mine was on the right side, so somewhere in there it affected where I, yeah.
I was not swallowing properly, and so I was on thickened liquids. Mm-hmm. and pureed foods.
Oh my goodness. I'm so sorry. Yeah. That's terrible.
I know. It is. I tell everyone I made the mistake one time. I, you know, you're trying to be different, and I ordered a Pureed Hammond cheese sandwich. Oh. I don't know what I was thinking, but I did not eat it.
I don't blame you, it does not sound like that. Taste very good.
Yeah. So, and I think I only had to do my swallow test twice before I passed. That's to get back on's.
That's really good.
Regular food. That's, but I do, I know I still aspirate sometimes and I'll be at the dinner table and my parents start freaking down. They're like, Carrie, put your hands over your head. Oh, hi mom. Have you met me? My left arm doesn't raise over my head and I just go just, I'm just like, you know, gimme a minute. It'll pass, it'll pass, you know? Well, I will say that most adults aspirate at some point during the day, regardless of brain injury or spinal cord injury.
It's just a normal part of being a human. Um, our esophagus is right next to our airway, so it's a poor design in my opinion. I didn't design the body but it does lead us for, um, open for aspiration to occur even if there's no problem. Yeah, with swallow. Yeah.
I actually, while you were talking, uh, Carrie, I was like thinking, I was like, wait, that was my question. Um, so one of the things that I was wondering about is, we always talk about like the side of the brain that we ended up damaging, you know, like, um, Carrie's at the right side, mine was on the left side. So like what really affects like, um, uh, like the, the function of like swallowing correctly, what is, or what, what would affect there?
It's, um, it's, that's a very difficult question to answer because the area that we use to swallow is kind of all over the brain, all over it. Okay. So, That, that's how, I guess, how I would answer that question. Yeah. Since you can have a left hemisphere stroke or a right hemisphere stroke and have trouble with following depending on where Exactly, exactly it was. Yeah. Mm-hmm.
Okay. Like I said, learning every single day, especially on Thursdays, because the podcast is on Thursdays So anyway, um, so I think that, like we were talking about, like, and Carrie mentioned it a couple of times too. Mm-hmm, um, Like, it's really hard to be swallowing and like to be following instructions, of course, uh, like from people when you're not at that point yet.
Um, so before moving on, I do want to recommend people that while you're listening to us, make sure to like us on your all forms of platforms, whether it be Spotify or youTube, whatever. Make sure to like us and tell other people about us. Um, make sure to like, and subscribe and blah, blah, blah, blah, blah, blah, blah. DO IT. Okay. So back to what we were talking about.
Um, so how would you communicate with others and especially if like they're in the hospital in the really hard accepting moment. How, how do you engage other, um, survivors to, listen to you you know, and follow the instructions and do the best that they can.
Well, I mean, in my opinion, this is Karen's opinion.
Karen's opinion, yes.
Karen's opinion,
that's what we're looking for.
Um, I think you have to meet the person where they are, you know? Right. You have to realize that what they're going through is very difficult for them, and their goals may not be the same goals that my goals are. So I want to make sure. my goals match what my patient's goals are because if they don't match, it's gonna be, we're gonna be competing against one another. And not working together as a unit. I think education is important.
If, if I'm explaining to my patient, this is, this is where things are now, this is what you need now and this is how we're going to get to your goal, that typically helps the situation more so than if I go in and say, this is what you have to do. Right. Because it's ultimately your choice as a patient on what you do. I'm just gonna give you the tools to help you give, make, make it to your goals. Yeah. Does that make sense?
It does make sense. And I think, I'm trying to think back. I think for me, basically what made sense to me was they told me, you can choke to death if you don't do what we're telling you to do. If you get too much of something down the wrong pipe, then you can literally choke to death, and that's not what we want you to do. Yeah.
Yeah. And I think that also, um, you had mentioned too about speech, uh, pathologists, you do a lot of different things. I think, uh, we had also talked to other speech pathologists, um, how, like, how to manage like cognitively, like the issues that are more cognitive issues and how to encourage them as well, um, to be doing these. And I think that way you mentioned like, aligning the goals, you know, not mm-hmm. Not the doctor's goal, not the speech therapist, doctor's goal. It's our goals.
Right? Like as survivors and like what we do. Um, and do you also, this is just like, I think a you can do this. Okay. But, um, when you have patients, do you also talk to like their caregivers, their family, or?
Yes. So, um, first you do have to have, you know, if the patient is their own decision maker, you do need to get yeah, the permission to talk to their spouse or caregiver, their, their moms or dads, um, whomever that might be. But yes, I do engage them in therapy sessions. if the patient's agreeable to that because the injury's not only affecting the patient. Sure. But it also affects the family members and the family dynamics.
So, and sometimes if my patient's having a hard time remembering something, they may convey information that may not be correct. So I, you know, I wanna make sure that the family member also feels comfortable with any of the information or education that's provided.
Well, that's kind of what you mentioned in the beginning, talking about more of the cognitive side of speech therapy, especially being spinal cord survivors, they, and possibly brain injury. They have less lack of mobility with their arms to be able to, cuz I know a lot of the things we've heard in, you know, when we were talking about aphasia, it's like they encourage them to use their hands mm-hmm.
and to point and to do the mo, you know, I want a glass of water, so I'm gonna act like I'm drinking, you know? Mm-hmm. well, so that's a totally different way about going around speech therapy, I guess with right, that kind of issue.
So for spinal cord injury in, in Texas, there are really only two rehabs that can manage those patients. And that's Baylor downtown, Baylor Scott white Institute for Rehab at in Dallas. And then, um, tier Memorial in Houston. We're the only two model systems, spinal cord injury hospitals in Texas. So that being said, Um, what I do is a little unique as a speech therapist because of the amount of hospitals that are in the area that can provide those services. Does that,
yeah, that's interesting.
So it's not something that everyone, um, that every speech therapist would do. I know when I started. It's very unique. It is. It's interesting though. It is interesting and it's took a lot of outside learning. I bet.
So I guess one of the things too, um, so how did you hear about bind? I mean, we're glad that you did, but
Sure. So when I first moved to Texas, that was about 17 years ago. I don't believe Bind was No yet started. Um, but I through, you know, the medical industry, we'll call it that. Yeah
all the therapists know each other.
Yeah. We all talk, we all know someone that knows someone. Mm-hmm. Um, and then I met Alison Jordan through work and that's, um, but I had also met Valerie at one point in time through the Baylor system. So I knew about BIND and then got to know more about Bind, um, through my friend Allison. Okay.
Mm-hmm, we miss Allison.
Yeah, I do too.
For our listeners that don't know, Allison. is a previous board member and she has moved to Florida.
Yes. She's in Tallahassee. Mm-hmm.
But she is a big supporter of ours, and we do for You're listening, Alison. We love you. And we miss you! Sorry.
I hope she is listening.
that would be so fun. Yeah. Yeah.
Um, and how do you like being a board of director and how's that, how's that going?
Well, I'm so, you know, I've been on the board of directors for about six months, so I'm still kind of learning my role and where, where I can be the most helpful because, um, you know, it's, it's a new role for me and I want to be helpful and sometimes I'm not sure if what I'm doing yes or not so, you know.
Well, I definitely agree. I mean, I definitely, um, appreciate, you know, as a member of BIND, like the different perspective that you are having as a brain injury and spinal cord. It's like something that I don't learn about a lot about. I mean, in all honesty, brain injury overall, like I'm everyday learning. Mm-hmm. So definitely appreciate your perspective. It's, it's really interesting.
Thank you.
No, it is. And I, I guess I would just ask, um, it doesn't have to be necessarily just brain injury, but spinal cord. So what is like that one thing that you think that you would like everyone that has nothing, that they know nothing, about brain injury survivors that would be important for them to understand and know, like,
Ooh, that's a tough question, Carrie.
I know,
I guess not to assume that someone can't do something, because many times what I notice is people who aren't medical when they hear brain injury or spinal cord injury, they assume someone can't do something right and they over help where maybe it's not needed. So I guess the one thing I would say is don't assume that someone can't do something and allow someone to try. Yeah.
I think that's very good advice. So, well, Karen, we wanna thank you so much for joining us today and we've learned something new and that's always great. So also we are gonna get some information from you later.
Okay.
But if somebody wanted to, if they had more questions about, since spinal cord is so different and there's only apparently two places you can go, if you have a contact information that we can add into our show notes, we'd like to include that.
Okay.
Just in case someone wants to shoot you an email.
Perfect.
Yeah, and I, cuz I know you're at Baylor Scott and White downtown, so.
Yes. But again, we would like to thank you for coming and joining us for this episode, Karen. Um, and we would like to thank all of our listeners to logging on and listening to Karen and um, Carrie and I for this podcast.
And don't forget, if you'd like to contact us, you can email us at bind waves@thebind.org.
And like I said earlier, don't forget to like, share, subscribe, and also hit that notify button if you're on YouTube, uh, while listening to Bind Waves.
You can find us on all your favorite platforms. Thanks guys. Until next time! We hope you've enjoyed listening to Bind Waves and continue to support Bind in our nonprofit mission.
We support brain injury survivors as they reconnect into the life, the community and the workplace.
And we couldn't do that without great listeners like you. We appreciate each and every one of you. Continue watching. Until next time.
Until next time.