Boy do we have a lot to write about today- we accomplished and learned so much during all of the activities we participated in.
After a yummy breakfast at our hotel, we got picked up by our faithful driver Antonio and went to our first site visit of the day- Centro de Rehabilitación Integral de Querétaro, or CRIQ.
This is a rehabilitation hospital in Queretaro that serves children and adults with motor and communication disabilities. CRIQ is a government funded medical institution where patients meet with a social worker to determine a feasible and appropriate amount to pay for services based on their income. We were given a tour of the facility by Lic. Ibañez, who is the director of communication rehabilitation here at CRIQ. In an introductory presentation, we learned that they use a multidisciplinary team model where doctors evaluate and assess patients and then send them to get the necessary therapy, whether that is physical, occupational, or speech therapy.
Both pediatric and adult patients usually have sessions at the center once a week, and they offer both individual and group therapy sessions. Therapists who see groups can see anywhere from 20-40 patients in one day! The pediatric groups typically include between 4-6 children. Caregivers of younger children typically accompany them to therapy so they can observe the techniques and activities that are being implemented by the therapist. Older children often attend therapy alone while caregivers have the option of receiving parent training courses during their child’s session, usually once a month. Then at the end of the session the therapist will update them on the child’s progress, and offer suggestions for supporting their child’s growth and development at home. Similarly, in the US caregivers also have the option of observing their child’s session. We thought that the provision of caregiver training which occurred simultaneously with the child’s therapy session was an effective and time efficient way to maximize therapeutic outcomes.
We were also given a tour of the hydrotherapy room, the physical therapy rooms, the occupational therapy rooms, and even a large comprehensive sensory room used to stimulate the visual, hearing, touch, and olfactory senses. One of the OT’s who explained the different aspects of the sensory room taught us that they use sensory stimulation in therapy because it can help drive neuroplasticity. We then went to the speech-language therapy rooms. We met 4 of the 8 therapists that provide speech services. One therapist specializes in adult communication disorders such as aphasia, dysarthria, as well as voice disorders, another specializes in feeding, swallowing/dysphasia and cleft palate, one specializes in pediatric speech, articulation, and neurologically-based communication disorders (like intellectual disability), and the last one we met specializes in pediatric language delay and language impairment not neurologically based.
While meeting the speech-language therapists, we had the pleasure of having an extended conversation with Señora Monica Sanchez, a highly skilled human communication therapist who currently works in pediatric feeding, swallowing/dysphasia and cleft palate treatment at CRIQ. Señora Sanchez is a highly skilled clinician who has worked in both adult and pediatric hospitals in a variety of medical settings. Prior to working at CIRQ she worked at a national cancer rehabilitation hospital where she treated adults with communication and swallowing disorders resulting from procedures such laryngectomy and palatal and mandibular resection secondary to oral and pharyngeal cancer. She has also worked in the ICU and NICU units of private hospitals.
In talking to Señora Sanchez we became aware of a variety of similarities and differences in the training and administration of therapeutic services that exist between clinicians in Mexico and those in the United States. Rather than completing a masters degree program in speech pathology, after completing her 5 year bachelors degree in human communication, she designed a comprehensive, self-directed program of study that prepared her treat adult and pediatric populations with a variety of diagnoses by acquiring a variety of professional certifications such as VitalStim, PROMPT, and certification in the administration of electromyography (this therapy consists of using electrodes to strengthen and stimulate muscles used for swallowing). We thought that this is similar to what SLP’s in the US do to fulfill the “continuing education” requirements mandated by ASHA after our general masters program. We were intrigued by how similar and yet how different our educational paths are. We also noticed a similarity in how physicians may not be fully aware of our scope of practice as SLP’s both here in Mexico and back home in the United States.
We then loaded back on the bus and after a quick debrief and nieve (ice cream) stop, we were off to our second site visit- Centro de Atención Multiple Helen Keller. Before we write more about what we learned here, we’ll provide some background: in the United States, there are some dedicated schools for children with special needs but most children attend their local public school and receive special education services as part of an IEP, or individualized education plan. A federal law known as IDEA (the Individuals with Disabilities Education Act) mandates that all children receive a “free and appropriate education (FAPE) in the least restrictive environment (LRE).” This means that when possible, children with special needs are educated along side their peers and are encouraged to function at the highest level possible while still being successful in their academic and social endeavors. In Mexico, children with special needs of many different varieties attend a school called a CAM, or Centro de Atención Multiple. This “center for multiple attention” serves children with a variety of special needs. Some are specialized and serve only children who, for example, are deaf or who are blind and some serve children with many different types of disabilities.
CAM Hellen Keller serves children who are deaf, visually impaired, have intellectual disabilities, and other impairments. We first met Directora Garfias, director of the school who sent us into classrooms in pairs to observe. Several of the classes we observed were classes of deaf students that were taught in Mexican Sign Language. This school uses a bilingual approach to deaf education, and students learn Spanish as a second language. A great deal of emphasis is put on literacy (reading, writing, handwriting skills, vocabulary). The strong focus on written literacy skills in Spanish will support students when interacting with the hearing community and enable them to communicate effectively even when others don’t use Mexican Sign Language.
Classes were comprised of a verity of ages and mixed ability levels. For example, one class that we were able to observe was for deaf students, and a small portion of the students had also been diagnosed with an intellectual disability. The students in this particular class ranged in age from 14 to 16 years of age. We were informed that the curriculum for this age group consists of Spanish, math, science, art, PE, history, and civics.
Through the class we learned so much from both Maestra Dalia and her students. They taught us to sign “thank you” and “Washington” in Lengua de Señas Mexicana, (LSM), or Mexican Sign Language, and honored us by assigning us a name sign. In Deaf culture, you sign your name with the manual alphabet until someone Deaf gives you a name sign. We enjoyed observing the students learn new information in the context of a rigorous, collaborative, and supportive classroom environment. As we thought about special education, and even general education in America, it was interesting to compare the two systems. In other classes that we observed, there were some differences in both content and how the teacher interacted with the students when compared to the United States that was eye-opening.
After our site visits we came to campus and had a delicious lunch at the cafeteria that consisted of enchiladas and agua fresca. Satisfied, we then walked across campus to our classroom and attended Spanish class. The advanced class had a discussion about out site visits, as well as children and adults with intellectual disability and what we as speech-language pathologists can do to help them reach their communicative potential. We also talked about swallowing disorders and learned related vocabulary. In the beginning class we learned adjectives related to frequency (todos los dias means every day), practiced generating simple sentences, verb conjugation, reviewed basic syntax, and learned that when a speaker raised his or her intonation at the end of an utterance it transforms a statement into a question. This is consistent across English and Spanish. We also learned functional phrases that we can use to introduce ourselves to parents and describe the profession of speech language pathology. The intermediate class discussed the past tense and how to talk about things that have happened.
After class, our wonderful teachers got on the bus with us and we all went to Parilla Leonesa, where we ate many delicious tacos, drank delicious horchata (a rice water drink with cinnamon and sugar) and jamaica (hibiscus juice) and had great conversation. It was so fun to spend time with our maestras outside of class and we were glad to be able to thank them for all of the hard work that they have put into preparing this curriculum for us.
Now we are back at our hotel and a group of us is going to do a city center tour where we will learn about the local “leyendas” or legends. The rest of us will do the leyendas tour tomorrow night after our final group dinner.
Whitney and Leah