Briona Daugherty’s (MS-SLP ’22) speech-language pathology (SLP) path began on board a cruise ship. Daugherty graduated from San Diego State University with a bachelor’s degree in theatrical performance. She studied opera and musical theater, originally wanting to be a touring singer for Broadway-style shows. After spending time as a professional singer in Las Vegas and New York City, she began a career performing on cruise ships, including five years in China, Japan, Korea and Thailand. The longer she worked on cruise ships, the more she aided other vocalists in adjusting to life onboard. This included helping entertainment employees maintain their voices for more than two hours a night in a 2,000-seat theater. After witnessing Read more
“To share your unique thoughts, ideas, and feelings is a human right,” says Deann O’Lenick, PhD, CCC-SLP, MBA. Dr. O’Lenick is an expert in working with nonverbal clients through augmentative and alternative communication (AAC). She joined the core faculty of USAHS’ Master of Science in Speech-Language Pathology (MS-SLP) program in September 2021 and is based on our Dallas, Texas, campus.
A clinician, professor, and entrepreneur, Dr. O’Lenick has extensive experience teaching SLP students best practices for working with clients who use AAC devices. AAC comprises all the ways that people communicate outside of standard verbal communication, “from eye gaze to iPads,” Dr. O’Lenick says. This includes picture communication systems and computer-based speech-generating devices.
AAC is used with children who have not yet developed language, as well as with people across the lifespan who are not able to produce voice due to conditions such as cerebral palsy (CP), amyotrophic lateral sclerosis (ALS), autism, strokes, or damage to the structures that produce respiration, articulation, or phonation.
“Whether it’s about the development of language or the loss of language—it’s about the power of language,” says Dr. O’Lenick.
Discovering Her Passion
As an undergrad in communication sciences, O’Lenick was assigned a client who used a speech output device. “He was a young boy with CP who had so many thoughts, ideas, and feelings,” she says. “People were just guessing” what he wanted to communicate. “I got a taste of what it meant for him to share what was really on his mind and heart.”
Later in her undergraduate career, O’Lenick interned at the “Anne Carlsen Crippled Children’s School” in North Dakota. One nonverbal teenager communicated using a speech device that he programmed using alphabetical and numerical codes. After he clashed with a teacher and called her the “B” word, the principal asked O’Lenick to go into his device and erase any curse words he had programmed. “Absolutely not,” she said. “He has the right to say those things, and he has the right to get in trouble for them.” It turned out that the teen had conspired with a classmate who was intellectually disabled, but who had more manual dexterity, to program the codes for those curse words. “I would have loved to have seen that collaboration,” says Dr. O’Lenick.
“I was hooked—for the human rights component and the tech potential.”
She refers to the Communication Bill of Rights, drafted by the National Joint Committee for the Communication Needs of Persons with Severe Disabilities, which lists 15 rights related to communication. “It’s a human right to be able to communicate for ourselves,” she says. “Speech-language pathologists need to provide alternative communication methods so that people can exercise this right.”
“Symbol Speaking” Through Speech-Generating Devices
Dr. O’Lenick calls AAC users “symbol speakers,” given that most speech-generating devices are centered around symbols that the user selects through a keyboard or a touchscreen. USAHS students gain experience working with both single-meaning picture systems and systems that semantically compact meaning.
Students also practice using both dedicated and multi-use speech-generating devices. Dedicated machines focus solely on AAC, with hardware and software designed to work together. On some such devices, the symbol speaker can make selections using an eye gaze bar, a reflective dot on their forehead, a touchscreen with customizable variables, or a stylus. The device then speaks the message out loud. The speaker might use “and” and “but” to signal that they haven’t finished a thought.
Although dedicated machines can have five-figure price tags, they typically qualify for public funding. However, they are inaccessible to schools. By contrast, multi-use speech-generating devices include tablets, laptops, and smartphone apps. Dr. O’Lenick explains that while these are much less expensive than dedicated machines, they are typically not covered by insurance because the patient could use them outside of a purely AAC application.
She speaks about her friend Chris Klein, a preacher with CP who composes sermons on his personal speech-generating device, touching the screen with his big toe. Composing these “Lessons from the Big Toe” takes an extraordinary amount of effort (up to 20 hours of work for one sermon). His sermons are then spoken to his congregation through the device. With the help of his device, he is able to fulfill his vocation—and communicate with his wife, his friends, and those who help him with daily tasks. “I have been using AAC for over 30 years now,” Klein says in a video, “and it has given me a life. It has given me the opportunity to build relationships, and those relationships have developed into a great community. The community I have built has given me the freedom to live on my own.”
The Challenges of Symbol Speaking
According to Dr. O’Lenick, a person who is proficient with an AAC device communicates at about 9 to 15 words per minute (wpm). Even the rare few who can symbol-speak at 45 wpm communicate much more slowly than the typical speaking rate of 120–150 and typing rate of 60–90 wpm. “But that doesn’t mean that the symbol speaker’s thought processes are different,” she notes. “And what does the listener do? If they start finishing the person’s sentences, this disrupts the purpose of communication.”
Frustrations with the pace of communication can have serious consequences. “More than eighty percent of the time,” she says, “the person, family, or educational system abandons the device. This high failure rate means we need to change how we educate our SLPs and how they educate their clients. I teach them that the goal is language, not device use.”
Dr. O’Lenick taught in the SLP program of Texas Christian University (TCU) for 18 years before joining USAHS. She is leading a shift in our MS-SLP curriculum such that students will begin learning about the various AAC devices in their first term, then get hands-on experience working with them during their residencies on the Austin or Dallas campus. She plans to invite guest symbol speakers for synchronous class sessions. She dispels “myth-understandings” about AAC and teaches students to “identify how the features of a given system align with the person’s wants, needs, and likes.”
The speech-language pathologist may work in an interprofessional team alongside a physical therapist, occupational therapist, educators, and family members to assess the client and provide them with a few speech-generating device options that match the features needed. Together, they conduct device trials, then make a collaborative decision with the client and family. However, Dr. O’Lenick cautions that “to decide on a device is the beginning of the person’s language development or rehabilitation—not the end.”
The SLP trains teachers and family members how to use the speech-generating device so they can model that use for the symbol speaker. The SLP may also teach them how to listen with greater patience, engagement, and respect.
Filling Gaps in Products and Services
Besides her work in the clinic and the classroom, Dr. O’Lenick is an innovator. She founded the company SymbolSpeak, which is developing an app that turns any iOS device into a speech-to-symbol translator using the leading AAC symbol systems. Designed for the communication partner, Symbol-It™ translates verbal speech to picture symbols at the speed of conversation. It’s the foundational technology of the nonprofit Halakah, which helps people share the Gospel with those who have or need augmentative communication. Dr. O’Lenick is an advisor to Halakah, and Chris Klein is on the board. She is also a founding board member of Hear MY Voice: Language Through AAC, a nonprofit that trains caregivers and educators to immerse in language using AAC.
“When the goal is self-expression, I apply that lens to developing the tools and technology for new methods to support augmentative communication,” says Dr. O’Lenick. “It’s in those moments that innovations are born.”
The University of St. Augustine for Health Sciences (USAHS) offers a Master of Science in Speech-Language Pathology (MS-SLP) program. Designed for working students, the MS-SLP is an online program with four required on-campus residencies on either the USAHS Austin or Dallas campus. The program offers two intakes per year, in January and September. Join a collaborative cohort of peers who learn under the mentorship of expert faculty-practitioners. Prepare to make a difference in the lives of clients across the lifespan with a meaningful career in speech therapy!
For students with a bachelor’s degree in a field other than communication sciences and disorders (CSD) or SLP and for students with a CSD or SLP degree whose undergraduate program did not include the required leveling coursework, we offer SLP leveling courses for completing the necessary prerequisites to enter the graduate program.