(Lightly edited for readability)
Speakers: Shoba S. Meera, Subhra Priyadarshini
00:01 Sponsor announcement: This episode is produced with support from DBT Wellcome Trust India Alliance.
00:29 Subhra Priyadarshini: If you've spent any time around a baby, chances are that you've heard or mumbled things like this with the baby. Though baby talk may sound simple, it accomplishes a lot, according to clinician researchers and speech language pathologists.
The science of speech is the study of sound production, transmission hand perception of speech. This is an interdisciplinary field, and includes the study of linguistics, psychology, anatomy, physiology, neurology, and of course, acoustics.
I'm your host Subhra Priyadarshini and in this episode of the series “I am a scientist and this is where I work”, we are going to chat with Shoba S. Meera, a speech language pathologist who works with individuals who have communication difficulties across their lifespan. She's a faculty in the Division of Neurosciences in the Department of Speech Pathology and Audiology at the National Institute of Mental Health and Neurosciences in Bengaluru.
01:38 Shoba S. Meera: I work broadly in the area of communication. One forms of communication is to use speech, but in the research lab, we are looking at communication and conversations between parents and tiny humans or little babies. I am a clinician and researcher. As a speech language pathologist, I work with individuals who have speech, language and communication difficulties. Most specifically, I closely work with autistic children and their families. One of the things I do is I help families understand existing speech and communication difficulties their child has. My team and I suggest methods and demonstrate methods through which they can communicate better with their children and vice versa.
02:26 Subhra Priyadarshini: So communication is a two-way process and most often we use speech to communicate. We can communicate using our eyes, signs, or even sending a WhatsApp message. What a speech language pathologist like Mira wants is for communication to flow smoothly for individuals that may find it hard to communicate. For example, autistic children, or children with other neurodevelopmental disorders like attention deficit hyperactivity disorder (ADHD) or with cerebral palsy. Meera, help us understand your research and the work that it involves.
03:09 Shoba S. Meera: So one of the things that we are doing, which I believe is the first time in India, is that we are recording day-long audio, we are recording the natural environment of a baby. We use a tiny recorder called the LENA, which is really the size of a credit card, to record what the baby hears every day and how the baby and parents talk to each other. This is also called conversational turns. Although babies so young (less than a year old) may not say words like kodu, amma, etc. but they do produce a lot of sounds like bubb bubb bubb bubb, dudd dudd dudd dudd and so on -- baby babble. I work with this technology the LENA technology as a Fulbright postdoctoral fellow in neurosciences at the University of North Carolina Chapel Hill, with Joe Piven and I very quickly realized the potential of this technology in India and decided to research in this area upon my return to India. The amount of parent talk and conversational turns have a positive impact on a child's limited abilities, to understand, to speak, to read, to make decisions. And, in fact, what we know from neuroimaging research, that is results from brain scans, is that there is preliminary evidence that this to and fro exchange between the parent and the infant are related to early brain development.
04:36 Subhra Priyadarshini: Wonderful! While giving others the tools they need to effectively communicate is amazing in itself, what really prompted you to choose this area of research?
04:49 Shoba S. Meera: I was introduced to the field of speech language and communication sciences, definitely a much less known field in India, by my mom who has always said, "Do whatever makes you happy". My dad has always said, "Choose your path, make sure you give your 100% to it". I've loved being around children. I understand very deeply how much Indian classical dance as a medium of communication has made an impact on me. So I decided to pursue a career that would give me an opportunity to work with children who struggle with communication due to problems and brain development.
05:28 Subhra Priyadarshini: So, a busy clinician researcher who logs an average of 15,000 steps a day, walking from one examination room to another, and from one hospital ward to another. Let's walk through your day at work, literally, and see all the things that you pack into one day at work.
05:48 Shoba S. Meera: I start my day with my team, with a quick discussion on Slack. Every day is different for us. And scheduling is everything in our line of work because we are working with families with children, their nap time, their food time. Entering my lab today, the first thing is we are greeted is with is several different kinds of families who are sitting outside in the OPD in a busy day. We then discuss the different kinds of problems that people have. And we distribute our case, patient load, and we start seeing these patients. It's a clinical job, yes, but I very, very firmly believe that these interactions with our patients are the ones that allowed me to ask so many questions. And then I go to the lab in the afternoon, for example, even 11 o'clock or post 11 o'clock. And we start by deciding on which family to reach out to today. Where do we go, how we are recording a baby's day-long environment. So we pack our research kits, we drive through Bangalore traffic, go to the houses, drop the packets, explain to them what this research involves, make sure we build trust with the families because after all, they're giving us precious data about their babies. This is followed by some very interesting conversations over coffee, tea, some snacks -- families are very hospitable. We go from one house to another house. And if I'm in the clinic, I go from one examination room to another. Several days are spent in the wards where we see families who are admitted.
07:14 Subhra Priyadarshini: That's a truly crowded day. So one of your workplaces is your lab where a lot of assessments take place. And these labs are distinctly different, let's say, from a regular science labs. They have toys, rhymes playing, you have cartoons painted on the walls. So describe to us what does a speech language pathology lab look like? And what all do you aim to find through your research questions.
07:45 Shoba S. Meera: Our labs are really very beautiful. They have nice, very, very nice space to use, very interesting cartoons painted, it's very vibrant. Somebody just walks in, they will find toys, anything that you think of the child can play with. But actually there is so much science there. Every time there is actually a tool through which we evaluate a child's abilities to understand, the child's ability to manipulate, the child's ability to build on it. A common person will call it a toy, but we know that that toy has a reason why it is there. The second thing we do is record the child's natural environment, the entire 16 hours of the baby. Wherever the baby goes, whatever the baby hears, whatever the baby does. So once the recorder is returned to us, we then connect it to the computer, which has a specialized programme and it's called the LENA device and the LENA software. The programme gives us automatic counts of how many words the child has heard, how many words the parents talk, how many things that the child says. If it's a child younger than a year, they may not speak words, but they may vocalise, they may make sounds of all kinds. And finally, how many times the parents spoke and the child returned a response. So that it also gives us a count of how many times the stolen through activity happened. And that's called conversational turns. So we don't have large MRI equipments or test tubes. But we surely have these very tiny recorders for our tiny humans, but it's very powerful and gives us so much insight.
09:15 Subhra Priyadarshini: Interesting! Now, I'm curious about these research kits that you mentioned earlier, what do they contain?
09:22 Shoba S. Meera: Good question. The research kit is like a parcel into which we have a small recorder, very clear instructions of how to use it and information that parents usually ask us, about safety of the device, what does it collect, what is it, what do you do with it, and a consent form. So we need them to sign off and trust us that we will use this data in a meaningful way. In addition to the recorder, the dress that the baby has to wear. It has a question and answer sheet like an FAQ sheet.
09:50 Subhra Priyadarshini: Right. So what does the data collected through these research kits then interpret?
09:57 Shoba S. Meera: When we analyze data that we get from these recorders, the first thing we see are numbers. How many number of adult words are spoken to the baby? How many times did the baby vocalize, that is saying sounds like bubb bubb bubb bubb, dudd dudd dudd dudd, jujj jujj jujj jujj , how many times the parent and the baby exchange of conversation. There are a variety of things we can do with this data? In addition to understanding how much the parents stopped the baby, we can also analyze the quality of the interaction. What are the variety of things the parent tells a child? Do they use a singsong form of speaking when they speak to their child? Do they tell their children stories? How do they describe stories and so on? So a lot of rich, rich information. There are times when we know from the data that not enough parent talk has happened, there is not enough exchange between the parent and the baby. What we usually do is we contact the family and try to understand the setting. Was it a one off event or something that happens on a daily basis? We try to systematically understand if the baby is not being exposed to enough. And probably then some of the babies may require a detailed evaluation. If we are in doubt, we err on the side of investigating further.
11:27 Subhra Priyadarshini: These little recorders do they work for any language at all, or specifically for English?
11:35 Shoba S. Meera: Good question. The numbers that we get from these tiny recorders about parent talk and child vocalizations are based on automatic speech recognition models that have been developed based on data from babies and families in North America, and who primarily speak English. In order to use these models in India, which is home to 22 official languages and 1000 plus dialects, it has to be validated here, with data from babies and families from India. This is another related line of research we are pursuing in our lab. And this is in close collaboration with computer science engineers. It has been a difficult learning process, learning curve for us, but we are making good progress.
12:24 Subhra Priyadarshini: Very intense work days spent with the families, the babies. I'm sure you have some very intense stories to tell us, things that give you a sense of achievement.
12:36 Shoba S. Meera: One success story in the clinic that I would like to share with the listeners is this child who has a diagnosis of cerebral palsy. my PhD student and I have worked with this family for many years now. Initially, we had to start by telling the family that your child may take much longer to learn to speak. But there are many other ways the child can communicate and that we would like for the child to start to use eye tracking, a high technology device that helps children communicate using their eyes. We started by helping the child make a choice of yes and no through her eyes. And today, she's able to negotiate with her parent for her favorite TV show. She's able to crack a joke using her eyes and eye tracker, she's able to discuss elaborate things using her the eye tracking device. And I don't think we should take credit for this. We sure are happy. But I think it's the family and the child that have really worked hard, believed in the system of alternate augmentative communication that is something that's alternate to speech, and have been so consistent in using this and this is a great example of patient clinician rapport.
14:07 Subhra Priyadarshini: Truly gratifying Have there been any moments of distress Meera during this clinical research experience?
14:16 Shoba S. Meera: Working with children and their families is no doubt a very nice process. But you know, when we work with families, we do hear a 'no' from some families. They say that they don't want their child to be subjected to research they don't want their child to be subjected to any form of tests. And when they say 'no' we feel bad. After all the explanation we have given they say 'no', but we are and we do understand that there are reasons for them to say no we are getting better at accepting or 'no' gracefully. We will get there.
14:52 Subhra Priyadarshini: Pretty much understandable. As a speech language pathologist still deal with little babies anxious fine. Families and obviously there are emotions involved.
15:04 Shoba S. Meera: Yeah, when a family comes back and tells us, "My child did not say amma give me, but pointed to what the child wanted" and that for the parent it is such a big deal because a child has communicated. That for me brings such happiness when the parents are, one, able to see the change, and two, able to recognize small changes. If you're asking me particularly about research, just working, holding these little babies in our arms, and talking to them and seeing that smile, the partial smile, and then the full smile, and then a range of emotions -- I think that's like, that's just the point where many people will decide, okay, this is what I want to do going forward. My day, almost every day, ends with another medium of communication, dance, Indian classical dance Bharatanatyam. I have learned that for over close to three decades now. I also teach children and interacting with children in the evening through dance gives me a whole new perspective about communication, about children. Dancing, I would say has been a very steady companion.
16:12 Subhra Priyadarshini: Juggling between research and clinical work arduous and immensely satisfying moments, scientists such as Meera interpret and respond to the world around us, bringing hope and smiles to millions of such babies and their families.
If you liked what you heard, be sure to share this episode of the Nature India podcast with friends and colleagues and check out our archives for more in both English and Hindi. Thanks for tuning in. I'm your host Subhra Priyadarshini and this is the Nature India podcast, your go to podcast for all things science in India.
17:09 Sponsor announement: This episode was produced with support from DBT Wellcome Trust India Alliance.