Melissa D. Transcript

Hi. My name is Melissa Del Pino. I am a speech language pathologist and certified brain injury specialist. I got started in the field, I think the field of speech pathology essentially chose me. I was just about nine years old when I learned about the field and it wasn’t particular to brain injury, but it was based around neurodivergent individuals and I fell in love with what speech therapy can do for people who have different brains and for the families of those who serve them. So I learned about speech therapy and the more and more I learned about the field of speech language pathology, the more I fell in love with it and was fascinated by what we do and the type of people that we serve.

So about three years ago, maybe four years ago now, I feel like the population of brain injury essentially chose me, and I was introduced to more and more people who have experienced concussions and who had experienced, you know, accidents, falls, sports-based concussions, all types of brain injury or mild traumatic brain injury. And I decided to dive deeper into learning more about it because I was finding myself serving so many people.

So that’s when I truly began to specialize in brain injury. I have had the experience of working with people with brain injury as long as I have been a speech pathologist. My very first clinical practicum I was working with people who had— I had one individual who had an accident, a motor vehicle accident. And that, when I think about it, it’s so interesting because it was like my first— I was a student clinician. It was my very first client and that was about 10 years ago now. So, you know, just to see how things have grown and developed, I just feel blessed every single day to be able to serve people who have experienced brain injury, because it’s essentially an invisible diagnosis. And if we know anybody who has experienced a concussion or if you have experienced a concussion yourself, you can attest to that. The idea that you might look seemingly okay from the outside, but there are so many different changes going on on the inside that can really impact your day-to-day experience and things look different.

Experiences feel different for the person, and sometimes individuals either are not believed or there’s a lot of bias around concussions, right? Whether it’s bias around a specific type of sport, gender bias, or any kind of funding that might be supporting the person who has experienced a concussion. There’s a lot of different biases that can exist. And aside from that, the effects of concussion are multifaceted, right? You can have all kinds of different symptoms that can be present with a concussion, and I think that is the hardest thing because it’s like no two concussions look the same. If you know one person with concussion, you know one person with concussion, and you can’t, you know, use what you’ve observed from one person and just kind of come up with a blanket approach.

And as difficult as it may be to be very personalized in my approach, and as a speech pathologist, that’s exactly why I absolutely love working with people with concussion—because I want the therapy to be very personalized and very meaningful and to support that person’s specific goals. And you know, when I was first starting off as a clinician, I thought about how important that was for me, because thinking of things from a family member’s perspective or thinking of things from like a patient’s perspective, I’ve always wanted any kind of intervention that I’m experiencing or that a family member is going through to be very personalized and very meaningful. And that’s why I had always prioritized that as a young clinician.

And then as I grew and became a more experienced clinician, I realized that desire that I had to have things be personalized and functional and meaningful was more than just, you know, oh, this is something I just really wanna do. It was because that is what our brains need in order to experience the type of growth and the type of development that is very lasting. Right?

And that’s neuroplasticity, right? That’s what we need as individuals in order to experience the most amount of cell growth or to create stronger connections across different regions of our brain. And so when I realized that this deep desire that I had was far beyond me and just what I like to do as a speech pathologist, but it spoke to exactly what the brain needs, I think that was the driving force for addressing my clients and then building a team that understood that as well.

I started my private practice, Speech Like Honey, four years ago now. And through my time of growing the practice and making new connections, I have been so blessed to serve so many more clients than I can even count that have experienced concussion and brain injury. And now it’s a very exciting time because we’re growing our team and we’re able to support more and more clinicians to have a very unique eye and a very particular way to address the different changes that can come after concussion.

So one of the things that I really found important to do was to create some more awareness around what it might look like, right? Because as a clinician, I always have that lens on and I’m always looking for maybe certain complaints that I might hear from a patient or comments that they might say, or comments that a family member might say. And I think having that lens is something that I’ve developed and grown as a clinician, but my goal is always to support others to have that same lens or to have at least a similar lens, right? So that way they can listen to someone who’s experienced a concussion and say, “Hey, you know, I think you might need to find some support for that symptom that you’re noticing.”

Because as we know, or as we should know, early intervention for concussion is vital. It can mean— it can make a difference between like a few months of recovery or years of recovery. So if we can identify certain symptoms right away, that’s when we’re able to really refer and get them the support that they need and get them a lot further than they would have if they didn’t have that support. 

So a few things that I had written down that are just really common types of phrases or complaints that I hear—like if we’re thinking of word retrieval, I might hear somebody say, “You know, I can’t find the right words,” or in a conversation, or they might be in the middle of talking to you and then they might have like a really long pause and they might even get frustrated like, “Man, oh God, it’s happening again,” right?

And then you might notice that that’s happening often. Or even like they’ll be in the middle of a conversation and then have a blank stare, and then they’ll just be thinking of the word that they’re attempting to say. It could be stress, but it could be something that’s indicative of word retrieval or word finding difficulties. And that’s definitely something to pay attention to. I see word retrieval difficulties come up so often.

Another one is just kind of forgetting names, dates, recent events, appointment times, right? Of course, being forgetful can be something that is part of us as humans, right? But if we’re noticing that these memory mistakes are happening more often, then that’s definitely something to pay attention to. And as a speech language pathologist, one of the things that I find often is that many people don’t quite know how we can support a person with concussion. They think speech pathology, and they think, “Okay, stutter,” or, “Maybe word finding,” or, “Maybe my sounds aren’t sounding quite right,” but they don’t think about the cognitive skills that are essentially the foundation of communication and cognition. Right?

And so cognitive skills could be attention, or it could be memory, or it could be processing information, planning, organizing. You know, like being able to say, “Okay, I have a lot that I want to say right now and I have to formulate it.” That’s sequencing, right? So all of these different types of foundational skills— that’s the foundation. They’re the cognitive foundation for communication. We address those skills as well.

And if you think about everything that we do in life, we need some form of cognitive skill that’s going to be involved, and all of our most meaningful interactions or our most meaningful memories that we have—we have communication involved. And so it’s really important to think about those smallest little changes or differences that we might notice after concussion that are related to communication.

You know, being able to stay focused or pay attention either in like a short amount of time or prolonged amount of time, or being able to—like if there’s an external distraction or kind of a lot of thoughts going on in their mind—being able to tune out distractions can become increasingly harder after concussion. And so we might notice someone who takes longer to do something that would typically take them less time to get done. So that’s definitely something to pay attention to. I’ve heard so many people say, “You know, I have trouble staying focused. Now it takes me longer to do this.” Those types of things or comments are really important to pay attention to.

Or even like, “It takes me longer to respond,” right? Like information processing. Being able to hear something that someone’s telling you, process what they’re saying, and then formulate a response to it. That’s another cognitive skill that’s very important for communication. Organizing your thoughts in a clear way, or even like a really fun one is pragmatic skills, right? Those are social skills. Being able to identify small social cues, like, “Oh, this person is very different now in social environments.” Or, “You know, when we get together as a family, I’m noticing that they pull away, that they don’t have as much to say with their family members after they had that concussion out on the field.”

So it’s really important to pay attention to not only how they’re doing academically, but how are they doing socially? What is it like among their friends, or what are you noticing when you’re communicating with like a child, for example, that has had a concussion? So that’s really important for parents to pay attention to. Another part of it is being more irritable, right? Or having like different changes in those types of social cues. Is it, “You know, my teenager’s just being a teenager,” or is it, “My teenager experienced a concussion and they’re a lot more irritable than they used to be?” So those are differences that we should definitely pay attention to.

And of course, I’m mentioning a lot of these things that I see as a speech pathologist from my view as a speech pathologist, but there are tons of other symptoms that are physical symptoms, emotional symptoms, sleep changes that can happen. And I mean, that’s why I say it’s multifaceted, right?

You can kind of think of them as like in buckets—like we have our physical bucket, we have our emotional bucket, we have our cognitive bucket, our communication bucket—and they might have like a couple of symptoms from each bucket. And that’s why it’s really important to create the awareness to know and look at the person or look at yourself and practice that awareness of like, “Okay, what buckets am I—what buckets do I have symptoms from?” Or, “What buckets is my child demonstrating symptoms from?” Because if we can really look at it that way, we can have a really good idea of how to get them the support that they need.

I think the biggest one is— I guess two other ones. So understanding complex information, right? We sometimes see a lot of concussion survivors who are in school or are still working, and they might have difficulty processing information, listening to someone. That could be attention, or that could also just be difficulties with comprehension and understanding things.

The biggest one that I think is the foundation is metacognition. And that’s essentially their ability to think about their thinking and reflect on what’s difficult and what’s different. And sometimes that awareness can be impacted. And so that’s why, again, it’s so important as the village to pay attention.

You know, I always go back to this phrase, “It takes a village to raise a child.” But my hot take is that it takes a village, period—at every stage, every season, every experience that you have as an adult. It takes a village. And so the more that the village understands, the more we’ll be able to support the person that needs that help.

And so if I’m giving advice to parents, my advice would be: educate yourself on those different buckets of symptoms and share that information with as many people in your village or in your child’s village as you can. So that way they can identify—maybe we’re not noticing a lot of symptoms in the physical bucket, and their coach said that they can get back to the sport, but we’re noticing some difficulties with their social communication or with their ability to follow directions.

That’s different than them just not wanting to follow my directions. I think it has to do with their comprehension. Or maybe they’re having some more difficulties with word finding. So important to pay attention to those different buckets and to ask for help because the help is out there and there are tons of therapists who are happy and eager to get you the support that you need.

So that would be my piece of advice as a speech pathologist and certified brain injury specialist. And thank you for allowing me to have the time to share that with you.