BUSINESS SPOTLIGHT

Spotlight on… Gittel Markowitz, M.S. CCC-SLP

Name of Business: Markowitz Speech & Swallow Therapy 

Location: 1651 Coney Island Avenue

What motivated you to enter this field and open a private practice? 

I went into this field wanting to help people get better. I was fortunate enough to work for a few years in the hospital and rehab setting where I was able to help many individuals regain their ability to eat and communicate. I observed that it was difficult for patients to find outpatient speech-language pathologists specializing in adult rehab and wanted to fill that void in the community. In addition, during the pandemic, more families chose to keep their loved ones at home instead of in a facility.  I saw this as a great opportunity to help people in a new and meaningful way and decided to open a private practice. 

Who are your typical patients? 

I treat adults of all ages. The youngest person I’ve worked with was 18 and the oldest was 103! I see patients with complex medical needs in their homes immediately after discharge from the hospital, rehab, or skilled nursing facility. I also see people in the office with chronic speech or swallowing disorders. Some patients experience the onset of speech or swallowing symptoms but have not been diagnosed with an underlying condition. In such a situation, I work closely with specialists to share the findings of the evaluation. 

What causes speech and swallowing issues?

Acquired speech, cognitive, voice, and swallowing difficulties are usually present after a neurological event such as a stroke or brain injury. These symptoms can also be due to a brain tumor or neurodegenerative diseases such as Parkinson’s, multiple sclerosis, dementia, and ALS. We may also see swallowing difficulties with head and neck cancer, COVID-19, and prolonged ICU stays. 

What does a speech therapy session typically look like?

Each session is unique with our highly personalized therapy programs. A treatment session can vary from 30 to 60 minutes depending on factors such as which disorder is being treated, the modality of therapy used, and patient tolerance. All sessions start with a quick review of updates since the last session and end with a review of the home exercise program.

What are some challenges that may impact treatment outcomes? 

Change requires intensity, consistency, and commitment. Often people with speech and swallowing disorders also have coexisting cognitive impairments and require assistance to carry over treatment programs at home. This may result in a high caregiver burden which can lead to lower adherence to exercise programs and slower progress. Transportation to and from therapy and limited insurance coverage can also impact treatment opportunities. To reduce caregiver burden, we offer intensive programs that can help maintain daily gains in therapy as well as various options for access to therapy including telehealth, home visits, and office appointments. 

Are there any recent developments in the field? 

The field of speech-language pathology is always evolving. New research is completed daily which helps us have a better understanding of the effects of treatment modalities and to develop treatment plans that result in functional improvement. We use the latest evidence-based methods to treat speech, voice, cognitive, and swallowing disorders. To treat swallowing disorders, we offer neuromuscular electrical stimulation, surface electromyography, respiratory muscle strength training, and an intensive exercise-based swallow rehab program called McNeill Dysphagia Therapy Program (MDTP). To improve speech in Parkinson’s disease we use an evidence-based 4-week treatment protocol called SPEAK OUT! which emphasizes speaking with intent. 

How do you assess success in a patient?

Success can be measured in a few ways. For swallowing therapy, all patients get a baseline objective swallowing evaluation which may be a modified barium swallow study (MBSS) or a flexible endoscopic evaluation of swallowing (FEES). We will typically use a second objective swallowing evaluation during therapy to assess for progress. In addition, we look at patient-reported outcomes. This may look like a patient reporting that they are eating better, experiencing less coughing while eating and drinking, and are less reliant on a feeding tube. For Parkinson’s voice therapy, we take video and audio recordings of speech and voice before therapy and after therapy. We also take patient reports of their improved ability to speak and to be understood after completing the 4-week program.  

What’s the most important advice you give your patients?

The more you put into your home exercise plan, the better the outcomes. It is important to focus on the small gains. They are the steppingstones to your goal. 

What do you enjoy most about your work? 

Helping people regain their quality of life. Not being able to communicate or eat can be very isolating. It is invigorating when patients share how much they enjoy going out to eat with their family, socializing with their friends, and ordering their favorite coffee once they complete therapy.