More Than Words

Nearly two years after Steve Abendschein suffered a stroke, his wife, Tara, remembers a moment that represented major growth in his recovery: During a therapy session at UCF’s Aphasia House, the former civil engineer, who was 38 at the time of his stroke, found the math problems to be too easy and asked to move onto more reading.

While strokes typically affect those age 65 and older, fewer than 15% of the adults who experience the traumatic medical event are under 45. One of the most common side effects, which Steve has dealt with, is aphasia, the inability to express, use or comprehend language due to damage to the brain. He also struggles with apraxia, the inability to express voluntary movements to produce speech; alexia, difficulty understanding written language; and impaired function of the right side of his body.

Shortly after Steve’s stroke in late 2019, Tara — who was 35 years old and 30 weeks pregnant with their second son — recalls having a breakdown in the intensive care unit. She remembers thinking that her husband would never be able to teach his kids to ride bikes, read them bedtime stories and that the suburban New Jersey couple would need to move to a house in the country with ramps. Over two years of physical and speech therapy, Steve’s worked toward regaining his abilities with Tara by his side every step of the way. In late December 2021, Steve took his two sons on a bike ride near the home they’ve lived in since before the stroke. He helps Tara read to their sons at night. Tara says his progress is thanks, in part, to UCF.

“It was a lot all at once to accept that our life — his life — was always going to be different,” Tara says. “But the life that I imagined during those early days in that ICU is not the life that we’re living now. The life that we’re living now is pretty darn close to what it was before the stroke.”

“I hear more full sentences. I hear significantly more spontaneous language, and none of that was happening really before Aphasia House.”

In the 10 months following his stroke, Steve completed traditional outpatient speech rehab in New Jersey. Last year, the couple was looking to boost his speech abilities and found the UCF Aphasia House — which provides an intensive, comprehensive therapy program that was established in 2010 to help those with aphasia reach their goals. It’s one of several specialty centers associated with the UCF Communication Disorders Clinic, which provides cutting-edge diagnostic and treatment services to people of all ages with communication and hearing challenges. The FAAST Center (Florida Alliance for Assistive Services & Technology) and UCF Listening Center are two other specialty centers associated with the main clinic.

During spring of last year, Steve completed his first in-person program at Aphasia House’s location in Research Park near UCF’s main campus. The six-week program includes several four-hour sessions of customized evidence-based intervention and is administered by graduate students under faculty supervision. By the end of November, he completed his second telehealth program from the comfort
of his home in the Garden State.

“I would say his speech has improved tremendously,” Tara says. “He is able to … enjoy reading again. It’s slower than what it was before the stroke, but he certainly is able to understand and do it. I hear more full sentences. I hear significantly more spontaneous language, and none of that was happening really before Aphasia House.”

The therapies patients complete through the Intensive Comprehensive Aphasia Program are just some of the offerings from Aphasia House. They also teach caregivers and family members helpful strategies to communicate with their loved ones. There are support groups to help patients and their loved ones cope with the emotional challenges of the disorder — such as when patients feel like they’re alone in their struggles or through moments like Tara experienced in the ICU — and to let newcomers know what they can expect to face with their loved ones.

“With aphasia, you’re dealing with an acquired disorder,” says Amy Engelhoven, who has served as director for Aphasia House since 2017. “The psychological response to that can be very traumatic, for both the patient and family. Our support groups help to address these needs and empower patients and caregivers with strategies to cope, communicate and connect again.”

Aphasia is just one example of the many different communication disorders that impact people’s ability to fully participate in their environments. About 5% to 10% of Americans may have communication disorders, costing the United States approximately $154 billion to $186 billion annually, according to the American Speech-Language-Hearing Association (ASHA). Across the UCF Communication Disorder Clinic’s range of services, graduate students gain the hands-on experience needed to become speech-language pathologists. Students must complete 400 hours of direct clinical contact, 25 of which are done in observation at the undergraduate level and the remaining hours are completed during the two-year graduate program at UCF. The university has one of the largest master’s programs in the nation with about 200 students a year, 100 of whom earn clinical experience within the UCF clinic each semester, says Debra Knox, who has led the UCF Communication Disorders Clinic since 2013. The program is ranked No. 55 in the nation, according to U.S. News & World Report.

“The program’s size provides us with the benefit of having experts in most of the nine disorder areas of practice within the American Speech-Language-Hearing Association’s classifications,” says Knox. “So that is something that makes us unique because we have experts in every one of those clinical areas. We receive referrals from the community, from other speech-language pathologists, physicians and other professionals.”

The American Speech-Language-Hearing Association’s Big Nine:

• Articulation
• Fluency
• Voice and resonance
• Receptive and expressive language
• Hearing
• Swallowing
• Cognitive aspects of communication
• Social aspects of communication
• Communication modalities

Before the pandemic, Knox estimates the clinic served 800 to 1,000 patients a year, which included preschoolers who received speech language and hearing screenings at local and private schools and childcare facilities. Now the clinic serves about 400 clients a year, with 50 to 60 evaluations annually and about 300 sessions of therapy a week. Like most graduate programs and healthcare centers across the nation, the Communication Disorders Clinic has had to adapt and provide some services online. It’s allowed the program to serve patients who may not have had access before while providing a benefit to students, too.

“I’ve had some really wonderful clinical experiences here,” says Kristina Cawthon, a graduate student who entered the field after studying opera and experiencing her own vocal issues. “I appreciate the opportunity to gain experience providing teletherapy as well as in person because that’s going to be an integral part of our field going forward.”

On top of its clinical services, the Communication Disorders Clinic faculty, staff and students are conducting research to move the field forward. Some of that research is conducted through the FAAST Center and UCF’s Augmented and Alternative Communication (AAC) Lab, which provides a range of support technologies for Floridians with disabilities.

“It’s always our goal as therapists to find out what’s meaningful and functional for our client. Whatever our clients are interested in or is emotionally relevant to them, they’re more likely to want to be engaged with.”

Currently, FAAST Center Director Jennifer Kent-Walsh and faculty colleagues Nancy Harrington and Carolyn Buchanan ’12 are overseeing two clinical trials funded by the National Institutes for Health. Both studies provide supplemental technology to help local preschoolers strengthen expressive language skills. One is geared toward children with Down syndrome, and the other focuses on kids with a wide range of speech impairments.

“At any given time, we have a team of about a dozen students who are funded or volunteering on our grant projects,” Kent-Walsh says. “The opportunity [for UCF students] to immediately apply what they are learning in their classes within our center and contribute to the knowledge base guiding clinical practice in our lab is invaluable. It is how we feel we can best prepare the next generation of clinicians and clinical researchers — by having them as active and valued members of our team.”

The center also partners with local organizations on its adaptive toy program, which uses a 3D printer and other technologies to modify toys for children who have physical disabilities, contributing to their development.

Whether it’s the help FAAST provides to patients and their families, the innovative research the AAC Lab is at the forefront of, or the chance to see students grow into the capable speech-language pathologists they dream of becoming, Kent-Walsh says she finds her work beyond rewarding.

“Children who have significant speech impairments don’t necessarily get the same opportunity to just play around with language as children without speech impairments do,” Kent-Walsh says. “One of the things that often happens with children who have very significant speech impairments is that their ability to communicate, or even how smart they are, is grossly underestimated. By teaching these kids to functionally use AAC technologies, we are making sound investments in their futures to ensure their educational, social and longer-term vocational outcomes.”

Through the UCF Listening Center, faculty, staff and students care for patients of all ages with hearing loss in tandem with the FAAST Center, audiologists and local schools.

“The Listening Center is more than just a place,” says Linda Rosa-Lugo, the former director of the center. Rosa-Lugo, who recently retired, estimates she helped train 3,000 speech-language pathologists in the 27 years she taught at UCF. “It is a conduit to partnerships in the community.”

One of the center’s patients is Britt Garcias, a 24-year-old enthusiastic Knights fan who is often recognized at football games and on Twitter. Britt was born with Down syndrome and lives with sensorineural hearing loss, which can occur when there’s damage to the inner ear, as well as apraxia. She has developed a strong relationship with the football players — most notably McKenzie Milton ’19 — coaching staff and other members of Knight Nation. People will stop her to say hello, hug her and take pictures. But through each interaction it’s been difficult for her to communicate. Even the roaring sounds of a fan-filled Bounce House can be muffled.

“The way that she interacts with everybody, she was struggling so much,” says Jan Garcias, Britt’s mom. “Not only at football games but in all aspects of her life. Sometimes it takes her so long to get the word out she gets frustrated. The [football players] have learned to wait for her to finish what she’s saying. She’s teaching them she has a disability; it might take her a second to get something out, but what she has to say
is important.”

Providing Britt and other patients the strategies needed to become participants in their environments is ultimately what the staff at the Communication Disorders Clinic are dedicated to providing — particularly Janel Cosby ’04, an audiologist who delivers services through the Listening Center, and visiting clinical instructor Kelly David ’08 ’13MA, who have been working with Britt for two years. Twice a week for 50 minutes, David, along with graduate student Olivia Musgrave ’20, work with Britt on speech therapy. They’ve found success incorporating her interest in football into exercises, such as identifying football players by their name and position, sequencing game-related events and sharing narratives. She’s also learned to sing the alma matter.

“It’s always our goal as therapists to find out what’s meaningful and functional for our client,” David says. “Whatever our clients are interested in or is emotionally relevant to them, they’re more likely to want to be engaged with. The biggest change I’ve seen is Britt being able to be more engaged during conversations and advocate for her communication needs. For her to be able to say, ‘I didn’t understand that, can you help me?’ to get the clarification she needs, so she can continue to be part of that conversation instead of just a bystander.”

In therapy, it is important to know what sounds Britt can and cannot hear. David and clinical educator Whitney Haas have worked with a set of speech sounds, using loud and quiet ones to determine where Britt is having the most difficulty. She struggles most with quiet sounds, but thanks to a new hearing aid Cosby fitted her with in October 2021, her hearing has significantly improved. The custom black and gold hearing aids are among the highest quality on the market, automatically adjusting to whatever environment Britt is in. Up until Britt’s hearing aid fittings, the center has worked virtually with her. That moment when Britt could hear clearly, Musgrave says, affirmed why she’s pursuing this field, and that she wants to work with patients who need long-term care.

“Kelly was sitting the farthest away with a mask on and started talking. Britt recognized her voice, leaped out of the chair, ran to Kelly and hugged her for so long,” Jan Garcias says. “I started to cry. It was so amazing. I sing UCF’s praises, but in my opinion, I can’t sing them loud enough. To have a university the size of UCF care about her means everything.”

Part of the Communication Disorders Clinic’s success is the high-quality graduates who completed their training here. Many of the faculty within the School of Communication Sciences and Disorders earned their degrees from UCF. Some alumni run their own private practices in Central Florida, and others are lead speech-language pathologists in Orange, Brevard and Volusia county schools. Several alumni — like Daniela Berrios ’15 ’17MA, who was selected as a Distinguished Early Career Professional last year — have even earned recognition for their work from ASHA.

Berrios is a bilingual speech-language pathologist who specializes in working with children with hearing loss at the University of Miami Miller School of Medicine’s Debbie Institute. In 2021, she earned a designation as a Listening and Spoken Language Specialist, a rigorous certification that only 35 individuals in Florida and about 1,000 worldwide hold. Nationwide, there are about 218,310 speech-language pathologists, audiologists and related professionals, according to ASHA.

“I really owe everything to UCF,” Berrios said in a 2021 article from UCF’s College of Health Professions and Sciences. “I’m doing something that matters, and I’m doing something for my community.”

Other alums are helping train speech-language pathologists across the nation. Bernard Rousseau ’98 ’00MS is chair of and a professor in the Department of Communication Science and Disorders at the University of Pittsburgh School of Health and Rehabilitation Sciences (SHRS), where the graduate speech-language pathology program is ranked third in the nation, according to U.S. News & World Report. His experience at UCF not only laid his foundational knowledge in the field, but it also has given him a framework for developing an instructional program.

“UCF always did a really nice job of aligning those things that you learn in the classroom with those hands-on skills, experiences and competencies that you gain and acquire in the clinic,” says Rousseau, who is a fellow of ASHA and serves as associate dean of Equity, Inclusion and Community Engagement for Pitt’s SHRS. “A lot of the faculty I learned from during my undergraduate program were also faculty that I learned from during my graduate program. So in many ways the experience was very consistent across undergrad and grad.”

At Pitt, communication science and disorders students obtain their clinical experience through the university’s medical center, including its rehab centers and clinics, and external sites in the community. While there are benefits to community-based clinical training, which UCF students also complete in their last semesters of the graduate program, Rousseau recognizes the advantages of training through an on-campus clinic.

“There’s a uniqueness to an on-campus speech and hearing clinic experience — having faculty and staff provide supervision and the opportunity to work closely with them in the facility,” Rousseau says. “That is definitely something that I have benefited from in terms of my experience at UCF.”

At UCF, the School of Communication Sciences and Disorders is part of a new healthcare hub that aims to advance education, research and patient care in Orlando. Created in 2018, the Academic Health Sciences Center merges expertise from the College of Health Professions and Sciences — which the clinic is a part of — the College of Nursing and the College of Medicine to provide interdisciplinary insight for patients, faculty and students. The partnership allows speech-language pathology students to continue to evolve in their education and training to meet the demands of their dynamic and everchanging fields — and provide the best quality care for patients.

“Regardless of the setting, whether it’s a school, clinic, hospital or skilled nursing facility, our graduates join each patient on their journey to reach their own goals,” Knox says. “Our work is extremely rewarding because it empowers people to connect with their world.”