Speak Now

This week we sit down with Amanda Ahmed,  MA,EdM,CCC-SlP, to discuss the vital role of speech therapy in addressing communication challenges faced by individuals with Alzheimer's and other dementia-related disorders. Amanda, a speech therapist and owner of Summit Therapy Services, explains how speech pathologists can help improve communication, cognitive function, and overall quality of life for patients. They explore common misconceptions about speech therapy, the importance of maintaining dignity in communication, and practical tools and strategies for caregivers. The discussion also touches on insurance coverage for speech therapy services and the accessibility of these essential resources for families.

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Joanna Anderson & Sue Nicolaidis

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Transcript

Joanna (00:01)
Hey Sue. Hey, so we have a really fun guest today and I'm just going to do a little intro about her and then we'll jump in. So our guest today graduated from SUNY at Buffalo with a master's in communication disorders and sciences. She is an active member of the American Speech and Hearing Association and the Texas Speech and Hearing Association. She's also the owner of Summit Therapy Services.

sue (00:03)
Hi Joe.

Amanda Ahmed (00:12)
So our guest today graduated from senior.

She is an active member of the American Speech and Hearing Association and the Texas Speech and Hearing Association. She's also the owner of Summit Therapy Services. When she's not working, she enjoys spending time with her husband and two daughters, volunteering roughly, traveling anywhere new, and hiking and-

Joanna (00:29)
When she's not working, she enjoys spending time with her husband and two daughters, volunteering locally, traveling anywhere new, and hiking in the mountains she misses so much in Colorado. We're so excited to have Amanda Ahmed join the podcast today. Hey, Amanda.

Amanda Ahmed (00:39)
We're so excited to have Amanda on the podcast today. Hey, Amanda. Hey, good morning. Thank you for having me.

Joanna (00:46)
Thank you for coming on. So you are a speech therapist, although you're also like a boss lady.

Amanda Ahmed (00:54)
That's true. I have a clinic and we have two locations and we see all ages. So when I found your podcast, I was really excited. And I think this is something that everybody can benefit from.

Joanna (01:12)
Well, you and I had a really great conversation about a year ago about speech therapy for my mom that we'll get into in a second. But just to start out, why did you decide to become a speech therapist?

Amanda Ahmed (01:21)
Yes.

So I've always been interested in how people learn languages. And during my undergrad and graduate school, I worked with a lot of different populations, bilingual, bicultural populations. And I started thinking about how do people learn one language, two languages, three plus. And then if something happens, like if a person has a disability or if a person has a stroke,

how do they communicate, what does that recovery look like, and how do people help them? So I found the speech pathology program at the University of Buffalo and I just knew it's what I always wanted to do.

Joanna (02:09)
It's so cool. That's just, I mean, I never would have thought about that, but I always wonder like, how do people master more than one language? I can barely speak English.

Amanda Ahmed (02:11)
Thank you.

think you do just fine.

Joanna (02:23)
Thanks.

So when I started talking to you about speech therapy, which I knew nothing about, it's because my mom's place asked us if we wanted to start speech therapy with her. And I was so misinformed and uneducated about it that me and my sister were like joking, like, why would we do speech therapy for her? She's not giving speeches. She's not publicly speaking. don't really understand.

But the reason they asked us is because her words were starting to get a little jumbled. Sometimes a sentence, like I knew what she was saying, but the words were out of order. And then also she was forgetting our names and like forgetting things that she just has known her whole life. Like she was losing her ability to speak because of Alzheimer's. So after I talked to you, I was like,

Amanda Ahmed (02:58)
Yes.

Joanna (03:21)
Yeah, this would actually be really beneficial even if she's not at a standing up at a podium speaking. So I guess my next question, if you could explain to us, how does Alzheimer's affect someone's ability to communicate? And what can we expect over time if there's like no speech therapy involved?

Amanda Ahmed (03:44)
Right, that's a great question. And I wanted to backtrack a little bit first and say, yes, it's such a huge misconception about what does a speech language pathologist do. You know, pretty much people remember them from school, the people who worked on L's and R's at the end of the hallway. And like you said,

Jojo (04:04)
Mm-hmm. That's exactly right.

Amanda Ahmed (04:07)
You know, it's true and most people, we kind of joke in the clinic that yeah, we went to school for seven years for L's and R's. But as you indicated, we do a lot more. Speech pathologists have anything to do with communication disorders and anything that goes along with that, including feeding and swallowing, which we'll talk about in a minute. Also voice. So.

In the population we deal with that has neurological disorders like dementia or Alzheimer's or memory care. There are definitely things that speech pathologists can do to help. We help with the mapping and cognition of language. So that means that a person may speak perfectly clear, but maybe they're saying words that don't make sense or they have word finding issues.

We can definitely help with that. And we also help with the sounds and speech. So sometimes people might have speech that run together. They might have difficulty in communicating and have to rely on other things like using tools that they have or even signs and symbols.

I think it's really important to understand first what does it mean when we say memory issues and what are some signs and symptoms in the beginning and then when you get into more advanced care. And you know we always have people that say I have word finding issues or you know I misplaced something and I can't find it. Part of that is normal that happens to everybody.

I think when we start to get concerned about our loved ones is that when we look at something called executive function. So executive function are the things that we do every day that make our lives work. We use our phone, we use the remote control on the TV, we drive, we cook, and we do all the tasks associated with each of those things. So when you have folks

that you might notice some word finding issues or some slight forgetfulness or maybe, you know, leaving the stove on, leaving the sink on. When it gets to more serious things like if a person is upset because they've been trying to call you and you realize they've been using the remote control or they might pick up the remote control to, you know, talk into it, things like that, that's the type of thing that you might consider.

Okay, let's talk to a doctor about this. Let's get into neurologists and also short-term and long-term memory. You and I was listening to your podcast and I know you've talked about how people will remember things from way back as if it were yesterday. But they might forget, you know, they might not recognize their immediate loved ones, things like that. So speech pathologists can go into where

Jojo (07:04)
Mm-hmm.

Amanda Ahmed (07:17)
a patient is and establish kind of short and long-term goals to help them and help their family so that they can navigate their lives in a very functional, meaningful way. Because we want to maintain and help their growth and their language and we help with all kinds of things like that.

Jojo (07:37)
Yeah, that's the one thing I, well, one of the one things I just really didn't understand that, you you talked about that you could make a book for your patient with pictures of family and then going over their names. And I was like, that's such a good tool.

Amanda Ahmed (07:44)
talked about that you could use.

Yes. Absolutely. That's one of our favorite things that I always tell people we can do right away and it's pretty easy and it doesn't have to be complicated either. So say that you have, you know, a granddaughter named Joni. You can have a piece of paper that shows a picture that says Joni at five, Joni today. So.

then the person can kind of go through and say, OK, right? Because they might be looking for Joanie, how she was at five, but it's a quick visual reference for them. And no more than two pictures per person. Maybe, you know, I would say no more than five to eight people, whoever they communicate with the most, to help them with the time reference.

Jojo (08:43)
That's so fascinating. So we just got this new equipment for my mom's room where I can put photos on her TV. And I put a recent photo of Sloan. She had no, she didn't know who it was, but if you put a baby photo of her, she's like, that's Sloan. So it's so crazy how the brain works.

Amanda Ahmed (08:56)
should know what the steam level was, but if you could have played...

Yes, yes, so you could combine those. You could make those one image and label, know, Sloan 5, Sloan Today.

Jojo (09:10)
Mmm.

That's a really good idea. That's a really good idea. what else do you or why would bringing speech therapy, I mean, a speech therapist be beneficial for dementia patients? And like, what does it look like? and how long do you work with them? What does the whole process look like?

Amanda Ahmed (09:38)
Right, that's a really good question. So it can actually happen in stages and typically because speech pathology for people who are older, our parents age and older, speech would be called in if there's what we call a change in diagnosis or change in status. That could be for the better or it could be that you might notice that somebody is declining a little bit.

The speech pathologists would come in and do an evaluation. And typically an evaluation will cover short-term memory, long-term memory, number memory, executive functioning tasks, and kind of compile all of those and give an evaluation to the family, give that report to the family so that you have a baseline of where your loved one is.

And from there, we make long-term and short-term goals. And we take data when we see a patient. We might say, they would benefit from therapy twice a week or three times a week for a month. And then give them the tools that they need in their house to be successful in their lives. And we try our best to communicate with family as well.

So it's typically not a long-term thing for speech therapy, for memory care. But sometimes we do find that we come back for other issues like swallowing or voice. A lot of people don't know, but if you hear a voice change, if a person's voice becomes hoarse or if they cough or clear their throat after they eat,

Jojo (11:04)
Okay.

Amanda Ahmed (11:25)
that could indicate that there might be a little bit of a swallowing issue started. So then we would do, it's called a bedside swallow exam to make sure that they are safely eating and drinking. And if there's a question about that, then typically we would refer out for something called a modified barium swallow study. And that would help us decide like where to go from there. So we might see a loved one for a number of different reasons. Typically it's to help with

Jojo (11:45)
Yeah.

Amanda Ahmed (11:55)
the functional day-to-day tasks.

Jojo (11:59)
Okay, so is it also kind of like physical therapy at that point if they do have a swallowing issue?

Amanda Ahmed (12:07)
Typically for swallowing, would be split between speech pathology and occupational therapy. OT tends to work on consistencies of food and speech therapy works on keeping the swallow safe for a person. So we often work together on that. But yeah, typically if it's just swallow, then it would be a speech pathologist helping.

Jojo (12:13)
Mmm.

okay.

Okay. So Sue's mom, when she had Alzheimer's or dementia, lost the ability to speak altogether. Do you see that often or, is there anything a speech therapist could do about that?

Amanda Ahmed (12:51)
Most definitely we see that and oftentimes what we'll do is there are a couple things to do depending on what works for the person. One would be to have a communication board of the things that a person likes. If they're able to have a yes no sometimes we just use a yes no where we have you know green and yes and

a red block with no in it and we ask yes no questions and the person can point to indicate their choice. We also have picture boards or memory boards for people if and we put very practical things. you might have, you know, change position in bed, change channel on the TV, call this person. If a person is able to access files and folders to open them,

then sometimes they can have what we call an AAC device. So they can do that. And sometimes we just go to paper and have charts, laminated charts for them to make choices. And it's always a challenge, right? How do you help a person with their cognitive function? How do you help with planning?

Jojo (14:00)
okay.

Amanda Ahmed (14:13)
And being able to maintain a person's dignity at the same time is very, very important. And sometimes just having the yes-no board or, you know, helping them make those choices is life-changing for a person.

Jojo (14:28)
That's one thing that really... go ahead. No, go ahead, sir.

You Forgot (14:28)
I wish we would have had something. sorry. No, I'm just, we were never offered speech therapy. Like I've never had any of her doctors say she would have benefited from it or, and she had aphasia, like it came on pretty quickly. And yeah, we just never had any.

referral for that therapy, which makes me kind of bummed now. I mean, I did a lot of the words, like, I would have to write everything down to get her to kind of, you know, communicate that way. But yeah, kira kira ora.

Amanda Ahmed (15:04)
Yeah

Well, you know, it's amazing because to your credit too, a lot of times we'll go into a situation and I'll say, okay, so what are we doing today? What's working today? And a lot of times we'll find, you know, families have already done a lot of this stuff just out of necessity and it works really well. So we help guide and build and then it's a pretty short term thing because people have it figured out, you know, we kind of help with the structure of it.

For the referrals, yeah, you know, it's so important to make sure that where your loved one is that they're good advocates to know the services available and that sometimes physicians just don't know. They don't know these therapies, speech and OT and PT less, but sometimes we're lumped in together.

it's doctors might not do a referral. It would be a piece where you would say to a caseworker or, you know, the nurse practitioner or nursing staff at your office. What else can we do? Are there other services that our parents might qualify for? Because, yeah, a lot of times people just don't know what's available. It's a huge component to it. So advocacy for sure.

Jojo (16:28)
Yeah, that's one thing when I was talking to you about it, know, someone at my mom's place was like brought up speech therapy and I was real on the fence about it. But when you said, well, this is about giving her dignity back, then I was like, well, that means okay, I'm in, I'm all in. Even though, you know, she's declining, I still want her to have that dignity of remembering someone's name or having the tools there just to help her.

Amanda Ahmed (16:42)
Yes.

Even though she's declining, I still want her to have that dignity of remembering someone's name or having the tools there just to help her. But one of the reasons we were so like, I don't know about speech therapy is because we were worried about the cost. It's already so expensive, numerically. I'll tell you, like, you told me that most of the time, Medicare covers it.

Jojo (16:56)
But one of the reasons we were so like, I don't know about speech therapy is because we were worried about the cost. You know, it's already so expensive memory care. But I'll tell you, like, and you told me that most of the time Medicare covers it. And in our case, it did. We didn't pay one cent. Can you speak a little bit about that?

Amanda Ahmed (17:15)
And in our case, it did. We didn't pay one cent. Can you speak a little bit about that? Yeah, I'm happy to. think, yeah, a lot of times speech therapy is a benefit that a lot of people might not recognize on their plans, but it's definitely there. And in the ever-changing world of insurance that we have now, everybody's plan is different.

Part of that is knowing, okay, what is covered exactly? if a loved one is in a skilled nursing facility or a memory care unit, typically they'll have a coordinator or social worker that would be able to find that. you don't have to call. We find that sometimes calling reps, you may or may not get the right information, but the facility where your loved one is, they would usually know.

So they would be a really good resource to say, okay, tell me how much is it? And also, how many sessions are covered? And there's something I'll talk real quick about called a hard limit and a soft limit. And a hard limit means that, you know, they can't go over that. Once it's done, it's done for the year.

They might say one speech evaluation and 20 sessions, something like that. And then we kind of work with the families to see, okay, what do we have to work with? With the hard limit, we really can't ask for more. It's whatever the plan dictates there. For a soft limit, it means it's by medical necessity. So you can ask for more visits. So they might say, you know, 20 visits. Okay, is that a soft limit or a hard limit?

that's gonna be a real key to understanding what you can get for your loved one. So as long as there's medical necessity for the service, which in memory care units there definitely would be, then that would work that way. And also if we come back like for another reason for swallowing or something, those sessions may or may not start over because it's a new issue.

Jojo (19:15)
Mm-hmm.

I got it. That's yeah, that was what we did. I was already, I've already forgotten how we did this, but we had a caseworker or, and she managed all the insurance. We didn't have to do anything. Like, and she told us it was all covered. So another reason we were a little hesitant to do this is because like we've gotten to the point where we cannot take Gaga out of the facility. She gets freaked out. She's a hot mess. It's, it's like,

Amanda Ahmed (19:42)
That's fantastic.

other reason we're a little hesitant to do this is because, look, we've gotten to the point where we cannot take...

gets freaked out.

Jojo (19:58)
hurting cats, like two year old toddler cats, it's horrible. But her therapist met her at the facility every time. So it was perfect. It was like just a little extra activity for her to do.

Amanda Ahmed (19:58)
hurting cats that like two year old.

Absolutely, that and it's home care even if a person is in a skilled nursing facility it's still considered home care they do live there. Yeah that is the best to do and often we see a lot of really good results because we're working effectively where they are functionally every day and meeting them and it's such a nice

thing to be able to do to help somebody, especially with their dignity and their choices and their eating. I mean these are social things that we do every day. So yeah, home care is great for that reason.

Jojo (20:46)
so great. Well, I mean, I can't thank you enough for coming on and explaining this. I wish I would have known about this years ago. So when we talked, I was like, would you come on someday and talk about this? I think everyone who's in this situation needs to know about it. It's just such a great service.

Amanda Ahmed (21:04)
Well, thank you. It's an absolute honor and I thank you for everything that you do. This has just been really great.

Jojo (21:12)
OK, well thank you Amanda. So do you have anything else?

sue (21:16)
I I want to say I just went through this with another loved one and

Their speech therapist was so amazing and it was, I learned so much from, and she was having, started off with the speech issues and then it went into the swallowing issues. And this woman was so great with my friend and she would chew and kind of forget to swallow. And then she would, and her daughter would call it chipmunking. She would have all this food in her mouth. So they gave her some flashcards.

Amanda Ahmed (21:43)
Yes.

Yes.

sue (21:52)
So the dignity was not completely taken away. Like you would flash her. We literally just held up a card that said swallow and she'd be like, okay, like, and she would swallow. because meals were taking forever to get through. then, but just these tips and she would meet with Kelly. She was about like once every two weeks, I think they would meet up and

and they would watch her eat there and they'd go through all the swallow, and she did the swallow tests and everything. But it was a great resource and I didn't know anything about it when I dealt with my own mom, but like now knowing about it, it's definitely beneficial to take part of it. That's all. Yeah.

Amanda Ahmed (22:35)
That's fantastic. Yeah, I mean, when you think how much of our lives revolve around, you know, eating and being with people, that we want to preserve that as long as we can. And it's very helpful. It also reminded me to, people often ask me some tips for loved ones going through this. And, you know, as you know, it's always helpful to be agreeable.

people will have their minds made up about something that may or may not be to be as agreeable as possible with the person and kind of think, you know, it's kind of like the battle versus the war, like it's okay. It's okay. And also the difference between having a simplified message and not a simple message. And a simplified message would just be

You Forgot (23:17)
Yes.

Amanda Ahmed (23:30)
the same message but utilizing a few less words than you usually would without talking to a parent or a loved one as if they're a child. Because even if there's still a memory issue, they still know that they're an adult and they can still recognize if a person's talking to them as if they were a child. And that's a really hard one to do, but I always have people kind of practice in a mirror practice.

You Forgot (23:40)
Mm-hmm.

Amanda Ahmed (23:59)
the way we talk to ourselves, inner dialogue. When you do that, of simplify it, use a little bit fewer words to help so that it's simplified, not simple, to help maintain dignity. And also, you know, having a good support network and really just loving yourself and giving yourself grace through the process because it is tough and it does take a village for everybody, even us.

Jojo (24:30)
So good, so good. Alrighty, well, appreciate you so much, Amanda, and hope you have the greatest day and thank you for helping all of our loved ones, which just means so much.

Amanda Ahmed (24:34)
Well, thank you.

way to stay.

It was my pleasure. Thank you so much. Bye bye.

Joanna (24:46)
Alright, bye!

sue (24:47)
Thank you, Amanda.