Día Dos

Buenas tardes, readers!

After a hearty breakfast at our hotel, we made our way to Universidad National Autonoma de México (UNAM) at Unidad de Investigacion en Neurodesarrollo. At UNAM, research is conducted through the evaluation and treatment of infants with motor, language, and cognitive deficits, but the main focus is on motor therapy.

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They utilize a therapy model called “Katona,” which focuses on developing motor reflexes and improving motor planning. Katona is an intensive program that requires infants to participate in therapy for three times a day and also requires parents to incorporate these practices at home. The researchers at UNAM believe that the improvement of motor patterns facilitates better language and attention development, which differs from what we have observed in the United States where we don’t place as strong of an emphasis on the link between motor movement and language. It was interesting for us to explore a different perspective and see how that translates into treatment for language.

During this time, we had the opportunity to observe several of the physical therapists working with infants using this Katona therapy model. In our first observation, a physical therapist targeted control of head and neck movement as well as core strength for sitting with a 6-month-old infant. The main goal was to increase her muscular tone to help with her other motor patterns. We then observed a 2-month-old infant born at 40 weeks. The physical therapist also targeted core strength through sitting, as well as targeting arm and leg movements through crawling and walking reflexes.

The focus on parental involvement in therapy at UNAM was one of the areas we admired the most. Parents are referred to UNAM by their pediatricians or gynecologists when certain risk factors are observed including low birth weight of the child, concerns with fMRI results, high levels of bilirubin, if the child was born via C-section, and evidence of sepsis. Due to the intensive nature of Katona, the families require a reliable form of transportation to UNAM every day. Dra. Carlier informed us that many of the families travel by bus, but that UNAM has a van that picks families up for those who can’t afford transportation or who live far from the center. The Unidad de Investiagacion en Neurodesarrollo is a public institution and UNAM functions as a non-profit organization within it. This means that UNAM raises funds each year to provide services for families. Since they are a non-profit organization and do not take insurance, UNAM pairs parents with a social worker to determine the cost of treatment based on their socioeconomic status.

We spoke to a psychologist at UNAM who is doing research on maternal mental health and bonding to see if these areas impact neuropsychological processes in infants. We were informed that parents are referred to the psychologist when their child has behavior/psycho-social concerns that inhibit them from doing language therapy at the center and at home. They are taught strategies on how to implement boundaries to facilitate successful therapy. We really enjoyed hearing how the fields of psychology and speech-language pathology work collaboratively at UNAM. This interdisciplinary approach is something we learn about in graduate school and are striving to implement in the United States. We found it incredibly beneficial to observe how this collaboration operates here in Querétaro. We witnessed great respect between all of the professionals and each other’s disciplines and willingness to refer to a practice outside of their scope. We’ve participated in interdisciplinary events with graduate students in other professions back at GW and we were excited to witness the same level of collaboration here at UNAM.

After speaking to the psychologist, Dra. Carlier talked to us about the language research, evaluation, and therapy done at UNAM. One of the studies she is focusing on includes documenting event related potentials (ERP) in 12 healthy, full-term infants and 12 pre-term infants where they are presented with syllable and tone discrimination tasks. It is hypothesized that children who are unable to discriminate between the syllables and/or tones during the tasks are more likely to present with learning disabilities and attention deficits. We’re eager to read about the results of this study once it is published!

When it comes to evaluation at UNAM, Dra. Carlier listed the assessments that they use including: CELF, PLS, MacArthur checklist, and Bayley Scales of Infant and Toddler Development. These are assessments that we’ve given in the GW clinic as well. Dra. Carlier introduced us to Licenciada Andrea Amaya, who is a part of the team that assess the children with language disorders. Children from 3 months to 36 months undergo a language evaluation every 6 months to track progression. Since transportation is limited, the goal at UNAM is for parents to come in at least twice a month for their children to receive language services. The language services mostly consist of parent training to facilitate language development in the hone. The researchers are currently developing a manual to help parents with language stimulation that includes all the protocol that is used at UNAM. We discussed how beneficial a similar protocol would be when working with families in the United States.

At the end of the tour, Dra. Carlier commented on how often parents do not understand the importance of language intervention at an early age and how it can affect school age language. To overcome this issue, the researchers at UNAM require parents to go to the psychologist, so they can explain the importance of early intervention. We told Dra. Carlier that we have similar obstacles in the United States when it comes to educating families on our roles as speech-language pathologists and the importance of early intervention. In graduate school, we are taught that the interdisciplinary collaboration between professionals should be the standard of care; however, in the United States we’ve observed that it often isn’t the case across settings. At UNAM, we were able to see the ideal standard of care which we hope to implement as future speech-language pathologists in the United States.

We want to formally thank Dra. Carlier for showing us around UNAM, discussing her research with us, and answering all of our questions about practice here in Querétaro. Some of the most importance pieces of advice she gave us were to always engage in evidence-based practice and to always critically think about the treatment we’re implementing. We’ll be sure to follow this advance as we pursue our careers as speech-language pathologists.

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After UNAM, we went to the university, had a lunch of tortas (sandwiches) which were muy deliciosas, and then headed to the first day of our language classes since arriving in Querétaro.We split into three groups: beginner, intermediate, and advanced.Both of us were in the intermediate class where we had introductions, delved into verb conjugation, and came up with case history questions we would ask a Spanish-speaking client. All of the classes focused on defining and discussing different concepts in the field of speech-language pathology. Our beginners learned different syndrome names in Spanish and the incidence of these syndromes in Mexico. The advanced class researched statistics of the incidence of speech and language disorders in the United States versus those in Mexico. We are all very excited to see what the classes during the rest of the week entail!

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Now we’re off to eat dinner and head to a salsa class!💃🏽

Hasta luego,
Shilpa and Erika

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