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| FEATURE STORY | 05/15/2006 |
| Author: Julia Elliott | |
| Bilingual SLP Makes Dramatic Difference in Community |
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| Vivian H. Topp, MEd, CCC-SLP, Director of Ambi-lingual Associates, Inc., knew way back in high school that she was going to be a SLP, due to the influence of a neighbor who was involved in the profession. Topp, born in Havana, Cuba brings a unique service to an area that contains a large Spanish speaking population. "My parents immigrated to Florida and moved to North Carolina and Long Beach, New York. In 1968 we came to Miami, and I finished high school here," recalls Topp. She went on to earn her bachelor's degree in 1974 from the University of Georgia, and then, in 1976, she earned her master's from the University of Miami. During the time she was choosing a college, Topp read up on the SLP profession after coming across it in a college catalogue in the library, and was fortunate enough to go observe her neighbor when she could. "In fact, I came back and did an internship with her at the end of my four-year course at the University of Georgia. I requested to do my internship with my neighbor because she was a wonderful person, a dedicated public school clinician and an inspiration and a mentor to many people besides my sister and I." Topp, who, along with her sister Victoria Topp, has practiced for almost 28 years in Hialeah, Florida, remembers how interestingly the neighbor presented her work. The neighbor allowed Topp to enjoy the challenges and the rewards of speech-language pathology through observation, and this is where Topp caught the fever. After college, Topp landed her first job by mistake. When she went to apply for a SLP positon at the local public school system, a director told her that she did not have any jobs. "Just then, a little girl came running in crying because she missed the bus," recalls Topp. "The bus area was near the special education center where we were, and I heard them say they could not understand the little girl who was speaking Spanish and that they had to find an interpreter. I told them that I understood what the little girl was saying. When the director found out that I spoke Spanish, my fate with the school systems was sealed. The director said she did not know where she was going to get the money, but she said, ‘You have the job. Come here on Monday and I will show you where to go.'" Although Topp was not trained to be a bi-lingual clinician because there were no bi-lingual courses back then, she got a lot of on-the-job training and lot of guidance from her professors in the last leg of her master's program. It was at that time that Topp was encouraged to open a private practice due to the great need of a bi-lingual service. "Before I knew it, I was ASHA certified, got my license, and opened my practice in 1978," she says. There was, and still is, a huge need for the bi-lingual service in Hialeah, which is the reason that Topp and her sister opened another office in Boca Raton, and yet another one in Miami Beach. Offering the bi-lingual service to the community comes easy for Topp because her first language was Spanish. "I grew up speaking Spanish. When our parents didn't want us children to know what they were saying, they would speak English," says Topp. However, the two sisters caught up very quickly when they entered a bi-lingual school and learned the English language. Many people are surprised when they find that Topp speaks Spanish as a first language. "When you look at me, I don't look Spanish nor do I have an accent. If you learn a second language before puberty, you usually do not carry along the accent of the first language," she explains. "We can always learn a second language, even into our 60s, but will always carry the accent of the native tongue if it happens after puberty. It has to do with the maturation process of the language and speech centers in our brain." Topp and her sister Victoria, who is also bi-lingual, use their unique abilities at Ambi-lingual Associates, where they provide services in the areas of articulation, language, voice, stuttering, auditory processing, literacy and swallowing. Additionally, the occupational therapists employed at the facility use special techniques to help children function to their maximum potential in the environment. Topp first opened her practice with a partner, and the two worked out of the trunks of their cars for a short time. That changed after they treated the Mayor of Havana, who was one of their very first clients. "He was a lovely man who was Mayor for two terms in a row and was secretary of state under Batista in Cuba," recalls Topp. "He was my first stroke patient and when he heard about us traveling and treating out of the trunks of our cars, he graciously offered to have his bank assist us with financial planning and, with each of us putting in $50, we started our first bank account. We were on his admiralty client list, and even though we were not eligible for a whole lot of loans, were put on a very good financial plan by his staff and when he was able to return to work, he helped us out. After three mergers with three other banks, his initials are still on our bank account and we still get very, very good treatment because of that beginning." About four years afterward, Topp's partner moved to Massachusetts and Topp bought her out, operating solo until 12 years ago when her sister joined the practice. Currently, Topp's practice consists of a large pediatric population, and includes patients with language and articulation disorders including Autism, pervasive developmental disorders, stuttering and voice disorders, while her sister treats stuttering and child language. "We have eight therapists—four full-time and four part-time—and a clerical staff of four," explains Topp. "Our occupational therapist is also qualified to work on sensory integration issues, helping children to focus and attend to task and improve coordination. Our group of highly qualified and dedicated professionals carefully evaluate, plan and implement an individualized treatment program designed to meet the specific needs of the children and adults with whom we work." For 15 years, Topp and her practice managed the Speech Pathology program at Mercy Hospital in Coconut Grove, Florida, where they developed a very successful dysphagia service. Two years ago, when Topp and her colleagues realized that they needed more time to devote to their own practice and programs, they moved on from Mercy Hospital after helping the hospital staff a new speech department. The latest program that Topp has developed is for the SpeechEasy device, which has been proven to improve fluency. The fitting of the device is handled only by state-licensed and ASHA-certified SLPs who have also completed an additional SpeechEasy certification program, which both Topp and her sister have. "We were always interested in stuttering and we were approached by the people at Janus, who distribute the SpeechEasy altered auditory feedback device, and were asked to be dispensers of the device," explains Topp. "However, at the time I was serving on the Board of the Florida Speech Language Hearing Association and [was] VP for Professional Services in Speech Pathology and wanted to complete that term before I started dispensing. After talking to people who wore the device and doing a lot of research, I became very interested, and my sister and I both went to Greenville, North Carolina to become certified." The SpeechEasy altered auditory feedback device is one of the best tools to reassure and rebuild self-confidence in those that have stuttering issues because it helps to reduce stuttering, regardless of rate of speech. Topp appreciates the device because it has made some very dramatic changes in the lives of the patients that she has treated. The fact that it is not readily visible is a plus to many people who are already self-conscious about their stuttering. "It can be programmed for delayed auditory feedback and altered feedback, worn over the ear or in the ear, simulating a choral speech situation," explains Topp. "When stutterers speak in unison with someone else, they do not stutter, or stutter significantly less. It is a different mechanism than singing, but research shows a relation to part of the central nervous system. This device helps the stutterer's ability suppress the central nervous system spasm that takes place at the level of the vocal chords and works only when it is worn. The resurgence of altered auditory feedback has sparked a lot of research projects funded by the National Institute of Health. We need to know why patients react differently to Delayed Auditory Feedback." One of the co-inventors of this device, Dr. Joe Kalinowski, a profound stutterer, has devoted most of his life to developing a portable device like this to be worn discretely. Dr. Kalinowski and the device were featured on a Good Morning America health segment, where he actually took the device off to demonstrate the dramatic difference it made. "Before he removed his device, he repeated his name three times, ‘My name is Stanley Joseph Kalinowski,' effortlessly," explains Topp. "When he removed the device, he could not get past the word ‘My.' It was a very dramatic example of how it works only if it is worn, and how quickly the stuttering can resume when removed." She continues, "The most noticeable benefit [of the SpeechEasy device] is the remarkable reduction or elimination of stuttering in a short period of time. Once the individualized prescriptive settings are determined, usually within 20 to 90 minutes, the fluency effects may be instantaneous. Other benefits include improved levels of confidence when using the device, as well as cosmetic appeal. The device has no cumbersome equipment, and is virtually unnoticeable when worn in the ear canal." Topp admits that although the FDA registered device is effective, it is not a miracle cure and ongoing checking and tweaking must take place. "The human brain is really smart and, after awhile, it figures out that the auditory feedback sound is really the person's own voice and will allow the stuttering to resume," explains Topp. "This is why they added a feature called ‘frequency altered feedback,' which changes the tone of the voice so that as the person hears it, the brain does not recognize it, preventing the brain from adapting to the device." After 28 years, Topp still loves what she does and is proud to pass this on by lighting the fire of passion for this profession in aspiring students. "People cry when they hear themselves read or say their name without stuttering," says Topp. "One 10-year-old boy would not even look me in the eye before his grandparents bought him the device, much less speak to me or anyone before he came for treatment. He was recently featured in our local newspaper and did a whole on-camera interview with a local TV station reporter. When someone is a candidate for the device and the delay works for them, it is a dramatic life-altering experience." Vivian H. Topp, M Ed, CCC-SLP, Director of Ambi-lingual Associates, Inc., earned her BS in Speech and Hearing Science at the University of Georgia in 1974 and her master's degree from the University of Miami in 1976. She is acting clinical supervisor of Speech Pathology services at Mercy Hospital in Miami, has served as Vice President and President of the Miami Association of Communication Specialists (MACS) in 1980, 1998 and 2000 and was Vice President for Clinical Practices in Speech Pathology of the Florida Speech-Language Hearing Association (FLASHA) from 2000-2003. She was the recipient of the MACS Honors of the Association in 1989. Julia Elliott is a freelance writer based in New York. She is on the editorial staff of NEWS-Line for Speech-Language Pathologists and Audiologists. |
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