A Voice of Hope: The Melisa Cano Story

One of the biggest challenges speech-language pathologist Melisa Cano says her students face has nothing to do with breath control, pitch or articulation. It's "being teased, made fun of and having people thinking they're not intelligent."

To counteract this, Melisa visits classrooms and student groups to talk about her profession. More often than not, the students will reveal that they know people in their own lives with speech difficulties.

"My uncle stutters."

"Do you love him?"

"Yeah."

"Then why would you make fun of him?"

"It's getting kids to understand," Melisa explains.

But it's more than technical knowledge and encouraging words that Melisa brings to these discussions. She offers her own extraordinary story of recovery, perseverance and accomplishment.

Rachel Torres, manager of speech-language pathology and audiology services at San Joaquin General Hospital, reflects upon the remarkable individual she saw as both patient and student.

"I recall being slightly concerned about Melisa's persistent hypernasal speech and whether patients and their families would take issue," says Torres. "The opposite occurred. Patients and their families were so inspired by Melisa's recovery and fortitude that it provided them with renewed hope."

A Tragic Accident, A Life Altered

Before one fateful morning in November 1996, Melisa Cano had been the mother of a 3-year-old daughter, Brihana, and a student at Madera Junior College considering a career in medicine. While driving on Highway 88 near Jackson, California, she attempted to slow down as a car trying to pass entered her lane. Her brakes locked, sending the car spinning into oncoming traffic. The impact instantly killed her daughter and left Melisa in a coma.

Melisa's sister, Cathleen Villarreal, remembers receiving the phone call from her mother, and receiving gentle words of caution from hospital doctors to prepare for the worst and to "make arrangements."

"But suddenly, on the third day, Melisa opened her eyes," says Cathleen. "Her doctors predicted a three- to five-month stay at the hospital, but once again, Melisa proved them wrong! She walked out of that hospital a short six weeks later."

The accident left Melisa experiencing double vision with no lateral gaze-this required retinal surgery to correct. She continued to have severe dysphagia (difficulty swallowing), which required her to have a feeding tube in her stomach, and struggled with profound dysarthria (weakness of the mouth, throat and chest muscles) and cognitive linguistic deficits.

Recovery: The Immediate Challenge

"Physical therapy, speech therapy, occupational therapy, surgeries and psychological evaluations became a way of life," Cathleen recalls.

For example, Melisa engaged in rigorous homework to recover her immediate, short-term and long-term memory. Friends and family helped her with pictures and stories that served as memory triggers.

"A lot of my childhood is gone. And I'm horrible at names." She used to be really good with remembering names, she says.

She also started numerous exercises to regain the seemingly simple functions of breath control and swallowing, such as holding her breath, opening and closing her vocal cords.

"It's so weird. Your mind says 'I know how to do this,' but you lose the triggers. I have no gag reflex. I had to learn how to breathe while eating… (It's) the little things you think you'll get back. I always thought I'd regain how to speak and how to swallow."

This involved work with a "really uncomfortable to wear" speech bulb, or obturator, and rigorous voice therapy with her professor and on her own. Some of the challenge was physical in nature, such as soft palate dysfunction that had resulted in severe nasality in her speech.

Setting the Bar High, and Surpassing It

In fall of 1997, less than a year after the accident, Melisa enrolled in courses at Madera Junior College.

According to Cathleen, "Her psychiatrist issued a 26-page report in which he discouraged this particular course of action. 'She may be setting the bar too high,' he informed us. Once again Melisa ignored the naysayers and carried on! She spent 50-plus hours a week studying, overcoming the frustrations and memory delays caused by the accident. She would spend countless hours reviewing materials until she got it."

"I didn't really know my limitations when I went back," Melisa admits. "Cognitively, I had to adapt to being not as smart as I was.

Before the accident, I could go into a classroom and just highlight notes. I never had to study. I had a crazy memory."

Melisa's still-formidable intelligence and memory skill helped her adapt after the accident.

"I began to take copious notes" writing in four different inks with a multi-ink pen: topics in black, definitions in red, examples in green, everything else in blue.

In 1999, she enrolled in the speech-language pathology graduate program at the University of the Pacific.

Regaining Her Voice

As she pursued her graduate studies, she realized it was time to focus on her speech.

"When you're in the hospital, you're caught up in learning day-to-day functions. I was really unintelligible going back to school.

I would only speak to people who knew me or one-on-one."

"By the time I was going into the master's program, I was 100 percent intelligible but had a nasal quality, similar to someone who's hearing impaired."

She would constantly monitor the quality of her voice, practicing sentences for rhythm and stops, controlling nasal sounds and constantly gauging characteristics such as cloudy vs. pristine.

"Your voice has a certain tone," Melisa explains. "My habitual pitch level, or fundamental frequency, was low for a female of my age. In sentences, I would speak at 187 to 190 cycles per second. I was speaking in my chest, not projecting my voice."

Guiding Her Own Treatment

Pivotal to refining the quality of her voice was an experimental treatment involving her palate, treatment to which she brought a unique contribution as both patient and student.

Melisa's speech-language pathologist introduced her to Dr. Granger Wong, a plastic surgeon from the University of California, Davis.

The conversation soon turned to a material he was using to treat cleft palates-and then came a sudden idea inspired by the hypernasality of Melisa's speech, which resulted from her soft palate inadequately closing off the nose from the mouth, letting air and sound escape through the nose during speech.

"I bet if I injected this into the back of your throat…" Dr. Wong speculated.

And that's exactly what he did-in a pioneering implementation of Dr. Wong's posterior pharyngeal (throat) wall implants, guided by Melisa's knowledge as a student and patient.

Rachel Torres remembers one of the experimental treatments. "The radiologist, department manager and I looked on as Dr. Wong stuck what looked like a foot-long needle into Melisa's pharyngeal wall, injecting it with implant material. The department manager and I nearly passed out. I thought, what an amazing individual to be so brave and determined to try this new procedure."

The treatment was an uncommon example of the patient being able to offer in-depth technical guidance on her own treatment. Because Melisa had no sensation in the back of her throat, she could be alert during the procedure and direct Dr. Wong's maneuvering of the six-inch needle.

"He would inject it. I would say a sentence," says Melisa. "You could immediately tell the difference. Being able to feel the contact, then my being able to guide what was going on-it was the perfect situation."

"I recorded my voice an hour after, and it sounded a million times better."

To date, Melisa has undergone the semi-permanent treatment three times. She currently is focusing on fine-tuning the muscles in her throat.

In 2003, she graduated from UOP with a master's degree in Speech-Language Pathology. She followed this with six months serving a clinical fellowship at San Joaquin General Hospital-the same hospital where she received treatment.

Teaching from Experience

Melisa's first teaching job was as a long-term substitute speech-language pathologist at Jefferson Elementary School in Tracy, California. Today she's at Ceres Unified School District in Ceres, California. Her personal experience brings rich insight-sometimes in unexpected ways-to her work helping children with communication delays and impairments.

For example, she can't yell, sing, raise her voice, or give her speech much inflection. Yet this is actually an advantage in the classroom, she says.

"It's helpful for the kids. I never raise my voice, so they know to concentrate."

She uses voice techniques with students with hearing loss. She helps students who stutter to articulate, speak in shorter utterances and slow down their speech-all techniques learned first-hand.

Her students have ranged from preschoolers to adults in continuing education. Some have speech that is less intelligible. Often, the cause is language-based; these students have missed learning a group of sounds. To compensate, they substitute other sounds, and don't realize that these are not correct. Melisa first helps them realize that other sounds are needed, then helps them develop the missing sound groups, including learning how to use them and when.

She also has worked with students with hearing loss who have just received cochlear implants, helping them learn "what to filter out and what to focus on, and how they perceive themselves speaking."

One 14-year-old student is recovering from a stroke that affected the right side of his body. With this student, she works on redeveloping immediate memory recall through word finding and using redundancy drills.

"It's scary to see a child deal with that."

A "Distinguished Consumer"-and an Inspiration

On March 31, 2006, Melisa's outstanding work with these students and others was recognized beyond the borders of her school district.

The California Speech-Language-Hearing Association recognized her with its Distinguished Consumer award for her work advocating for speech-language pathology while concurrently benefiting from it. The ceremony featured a video with Melisa's university professors, hospital colleagues and family, many of whom were in attendance.

As Michelle Hulstrom wrote in her nomination materials, "I am proud to call her my friend but more than that I am proud to call her a colleague."

"Melisa is a living example of the miracle of rehabilitation," wrote Rachel Torres. "Like her therapist that inspired her, she will go on to inspire not only her clients but also everyone who comes in contact with her."