FAQS

Speech therapy can vary from a short duration for something like an isolated tongue thrust or reverse swallow to a lengthy period of time for people that are deaf or have Down syndrome, autism, or cerebral palsy. Each case needs to be looked at individually and discussed with the professionals and family members within the context of the remediation process.

Speech-Language Pathologists specialize in treating a variety of speech-language, cognitive, voice, and feeding-swallowing problems.

Working with the full range of human communication and its disorders, speech-language pathologists:

• Evaluate and diagnose speech, language, cognitive-communication and swallowing disorders.
• Treat speech, language, cognitive-communication and swallowing disorders in individuals of all ages, from infants to the elderly.

The main components of speech production include: phonation, the process of sound production; resonance; intonation, the variation of pitch; and voice, including aeromechanical components of respiration.

The main components of language include:

• Phonology, the manipulation of sound according to the rules of the language
• Morphology, the understanding and use of the minimal units of meaning
• Syntax, the grammar rules for constructing sentences in language
• Semantics, the interpretation of meaning from the signs or symbols of communication
• Pragmatics, the social aspects of communication.

Receptive language includes the skills involved in understanding language. Receptive language disorders are difficulties in the ability to attend to, process, comprehend, and/or retain spoken language.

Receptive language disorder means the child has difficulties with understanding what is said to them. The symptoms vary between individuals but, generally, problems with language comprehension usually begin before the age of four years.

Other names for receptive language disorder include central auditory processing disorder and comprehension deficit. In most cases the child also has an expressive language disorder, which means they have trouble using spoken language.

Expressive language includes the skills involved in communicating one’s thoughts and feelings to others. An expressive language disorder concerns difficultly with verbal expression.

Expressive language disorder affects work and schooling in many ways. It is usually treated by specific speech therapy, and usually cannot be expected to go away on its own.

Children with social pragmatic language disorder demonstrate deficits in social cognitive functioning.

Individuals with SLD have particular trouble understanding the meaning of what others are saying, and they are challenged in using language appropriately to get their needs met and interact with others. Children with the disorder often exhibit:

• delayed language development
• difficulty understanding questions
• difficulty understanding choices and making decisions
• difficulty following conversations or stories. Conversations are “off topic” or “one sided”
• difficulty extracting the key points from a conversation or story; they tend to get lost in the details
• Stuttering or cluttering speech
• Repeating words or phrases
• difficulty with verb tenses
• difficulty with pronouns
• difficulty explaining or describing an event
• tendency to be concrete or prefer facts to stories
• have difficulty understanding satire or jokes
• have difficulty understanding contextual cues
• difficulty in reading comprehension
• difficulty with reading body language and reading/using nonverbal communication
• Problems with nonverbal cues such as personal space between others
• Difficulty with writing
• difficulty in making and maintaining friendships and relationships because of delayed language development
• difficulty in distinguishing offensive remarks
• difficulty with organizational skills
• difficuly telling left from right

Articulation is the production of speech sounds. An articulation disorder is when a child does not make speech sounds correctly due to incorrect placement or movement of the lips, tongue, velum, and/or pharynx.

An articulation disorder involves problems making sounds. Sounds can be substituted, left off, added or changed. These errors may make it hard for people to understand you.

Young children often make speech errors. For instance, many young children sound like they are making a “w” sound for an “r” sound (e.g., “wabbit” for “rabbit”) or may leave sounds out of words, such as “nana” for “banana.” The child may have an articulation disorder if these errors continue past the expected age.

It is important to recognize that there are differences in the age at which children produce specific speech sounds in all words and phrases. Mastering specific speech sounds may take place over several years.

Phonology refers to the speech sound system of language. A phonological disorder is when a child is not using speech sound patterns appropriately. A child whose sound structures are different from the speech typical for their stage of development, or who produce unusual simplifications of sound combinations may be demonstrating a phonological disorder.

Commonly, children with this disorder have:

• Problems with words that begin with two consonants. “Friend” becomes “fiend” and “spoon” becomes “soon.”
• Problems with words that have a certain sound, such as words with “k,” “g,” or “r.” The child may either leave out these sounds, not pronounce them clearly, or use a different sound in their place. (Examples include: “boo” for “book,” “wabbit” for “rabbit,” “nana” for “banana,” “wed” for “red,” and making the “s” sound with a whistle.)

Milder forms of this disorder may disappear on their own by around age 6.

Speech therapy may be helpful for more severe symptoms or speech problems that do not get better. Therapy may help the child create the sound, for example by showing where to place the tongue or how to form the lips when making a sound.

Prior to the speech evaluation

Parents complete a questionnaire regarding their concerns and the child’s medical, developmental, and educational history.

We will request medical information from the child’s pediatrician, and may also request information from other medical or educational professionals who have evaluated the child.

During the speech evaluation

Your child’s medical, developmental, and educational history is carefully reviewed. Parents are interviewed regarding their concerns and the child’s history. This information helps the Speech-Language Pathologist identify areas to evaluate more closely.

A variety of methods, including formal and informal tests, observation, parent/caregiver interview, and play-based activities will be used to evaluate your child’s speech, language, cognition, and voice. Selection of testing methods is based on your child’s individual needs. Parents are encouraged to observe during the evaluation.

Following the speech evaluation

Initial results of the evaluation and recommendations are reviewed with you (and your child if age appropriate). A written report detailing evaluation results will be mailed to your home and to your child’s physician (if requested).

A speech therapy treatment plan is an individualized plan created by the Speech-Language Pathologist to address your child’s speech, language, cognitive, and/or voice needs.

The plan may include:

• Recommendations for therapy or re-screening/re-evaluation at a later time
• Initial goals to address during therapy
• Referrals to other professionals (i.e., audiologist, medical specialist, occupational/physical therapist, etc…)
• Referral to other community services, such as an early intervention program
• Suggestions for parents/caregivers and educators

Motor speech disorders can make it very difficult for individuals to clearly and effectively express themselves, which can be very frustrating. People with motor speech disorders know what they want to say, but cannot get it out. The two types of motor speech disorders are:

• Dysarthria:  This is when the muscles of the mouth, face, and respiratory system may become weak, move slowly, or not move at all. Sometimes people refer to dysarthric speech as “slurred” speech.
• Apraxia:  People with apraxia of speech have trouble sequencing the sounds in syllables and words. Sometimes a person cannot say a word, and then later they can say the same word without any difficulty. People with apraxia have problems imitating words but often can produce “automatic speech” without any problem (for example, saying “hello”, “I’m fine”, “OK”, etc.)

Aphasia

Aphasia is a language disorder, usually caused by damage to the left side of the brain. There are different types of aphasia that affect people in various ways. Aphasia can make it difficult for a person to understand spoken or written information. It can also affect a person’s ability to speak or write. Sometimes an individual can have impairments in all of these areas to some degree. The different types of aphasia are known as global, Broca’s, transcortical motor, conduction, anomic, transcortical sensory and Wernicke’s aphasia.

Evaluation

The Speech-language pathologist will obtain medical history, perform an oral motor examination, and have the patient perform various speech tasks. The Speech-language pathologist may ask the patient to follow commands, respond to questions, name objects, repeat words and sentences, or perform reading and writing tasks. All of the information obtained during the evaluation will be used to establish a treatment plan to meet the patient’s individual needs.

Treatment

Treatment and therapy varies greatly depending on the specific disorder. For example, if someone has problems speaking clearly because of weak muscles, they may perform oral exercises and be taught speech strategies to speak more clearly. If a patient has a type of aphasia that causes them to have difficulty understanding what others are saying; therapy may target comprehension activities. The Speech-language pathologist will establish what the patient’s individual needs are and will develop a specific treatment plan that will be most beneficial for the patient.

Dysarthria is a condition where muscle weakness in the jaw and mouth area cause problems with speaking. Dysarthria is often the result of a disease like cerebral palsey, multiple sclerosis, Lou Gehrig’s Disease or a stroke or accident causing damage to the brain.

One way to improve the muscle movements is an activity that uses oral motor therapy. The instructor asks the patient to pretend he is a mirror. The patient is to mimic the movements the instructor makes. These movements include making silly faces, smiling and frowning, blowing kisses and using the tongue to lick all the way around the lips. This is a fun activity that exercises necessary mouth muscles to improve speech function.

One common speech problem that adults can have is apraxia or motor speech disorder. This condition is caused by damage to the speech-related areas of the brain.

Patients with apraxia have difficulty putting the sounds of syllables together to make words. Therapists engage patients in an activity that slows down the pace of speech and practices sounds over and over. The patient reads a list of simple sentences while a metronome taps out a slow pattern of speech. The patient repeats the first sentence over and over to the beat of the metronome. When the first sentence is mastered, he moves on the next sentence.

Stuttering affects the fluency of speech. It begins during childhood and, in some cases, lasts throughout life. The disorder is characterized by disruptions in the production of speech sounds, also called “disfluencies.” Most people produce brief disfluencies from time to time. For instance, some words are repeated and others are preceded by “um” or “uh.” Disfluencies are not necessarily a problem; however, they can impede communication when a person produces too many of them.

In most cases, stuttering has an impact on at least some daily activities. The specific activities that a person finds challenging to perform vary across individuals. For some people, communication difficulties only happen during specific activities, for example, talking on the telephone or talking before large groups. For most others, however, communication difficulties occur across a number of activities at home, school, or work.

Some people may limit their participation in certain activities. Such “participation restrictions” often occur because the person is concerned about how others might react to disfluent speech. Other people may try to hide their disfluent speech from others by rearranging the words in their sentence (circumlocution), pretending to forget what they wanted to say, or declining to speak. Other people may find that they are excluded from participating in certain activities because of stuttering. Clearly, the impact of stuttering on daily life can be affected by how the person and others react to the disorder.

Signs and Symptoms of Stuttering

Stuttered speech often includes repetitions of words or parts of words, as well as prolongations of speech sounds. These disfluencies occur more often in persons who stutter than they do in the general population. Some people who stutter appear very tense or “out of breath” when talking. Speech may become completely stopped or blocked. Blocked is when the mouth is positioned to say a sound, sometimes for several seconds, with little or no sound forthcoming. After some effort, the person may complete the word. Interjections such as “um” or “like” can occur, as well, particularly when they contain repeated (“u- um- um”) or prolonged (“uuuum”) speech sounds or when they are used intentionally to delay the initiation of a word the speaker expects to “get stuck on.”

Some examples of stuttering include:

• “W- W- W- Where are you going?” (Part-word repetition: The person is having difficulty moving from the “w” in “where” to the remaining sounds in the word. On the fourth attempt, he successfully completes the word.)
• “SSSS ave me a seat.” (Sound prolongation: The person is having difficulty moving from the “s” in “save” to the remaining sounds in the word. He continues to say the “s” sound until he is able to complete the word.)
• “I’ll meet you – um um you know like – around six o’clock.” (A series of interjections: The person expects to have difficulty smoothly joining the word “you” with the word “around.” In response to the anticipated difficulty, he produces several interjections until he is able to say the word “around” smoothly.)

Voice is the sound produced by vibration of the vocal cords (vocal folds) in the larynx (voice box). A voice disorder occurs when the vocal folds do not vibrate effectively to produce a clear sound.

Common Causes

Causes of voice disorders can include abuse or misuse of the voice, such as yelling, excessive throat clearing, or speaking too loudly. These types of behaviors result in excessive hard closure of the vocal folds causing blister-like bruises that can harden into callous-like lesions called vocal fold nodules. Other causes of voice disorders can include Laryngo-Pharyngeal Reflux (excessive stomach acid backing into the larynx), vocal fold polyps, vocal fold paralysis, vocal fold cysts, etc.

Symptoms of Voice Disorders

• Voice quality disturbance: breathiness, raspiness, harshness
• Voice pitch disturbance: pitch too high for age and gender, pitch too low for age and gender, pitch fluctuates excessively, pitch is monotone
• Voice volume is too low or too loud
• Vocal fatigue (decreased stamina, increased hoarseness following speaking)
• Effortful voice use (having to use too much effort to speak)

Evaluation of Voice Disorders

Voice evaluations are conducted by Speech-language pathologists who are experts in the area of voice. Evaluations include non-instrumental assessment and instrumental assessment. These assessments allow the Speech-language pathologist to measure the voice objectively, determine patterns that suggest how the larynx is functioning physically, and determine whether there is a hyper functional or hypo functional component present. Voice disorders are complex and this type of evaluation helps determine whether behavioral voice therapy, surgery or a combination of approaches would best serve the patient.

Treatment Options

Types of voice treatment may include:

• Vocal strengthening- exercises that can improve voice quality and stamina and can also reduce symptoms of vocal effort and fatigue. Examples of exercises are repetitions of high speech sounds, pitch glides, or glottal closure. These exercises are often used with singers.
• Reduction of vocally abusive behaviors- During the evaluation and interview, vocally abusive behaviors are often identified. Some examples include:  talking in competition with background noise, yelling, throat clearing, loud cell phone use, not using a microphone, etc. In the treatment session, goals can be made to improve or eliminate these behaviors and provide strategies for care of the voice.
•  Improvement in vocal technique- improving respiratory support for proper voice use, reducing hard glottal attack, and improving vocal resonance. Goals are created during voice therapy sessions and home exercises are provided for continued practice. Carryover of these techniques into everyday situations is also expected.
•  Pre and Post surgical treatment- Counseling of proper voice care before and/or after vocal fold surgery can significantly improve surgical outcomes and assist patients in healthy return to voice use following surgery. Patients can expect gradual return to voice use following surgery.

Dysphagia is the medical term for the symptom of difficulty in swallowing. Dysphagia can occur at different stages:

• Oral Phase – sucking, chewing, and moving food or liquid into the throat
• Pharyngeal Phase – starting the swallowing reflex, squeezing food down the throat, and closing off the airwayto prevent choking
• Esophageal phase – squeezing food through the esophagus into the stomach

Some patients have limited awareness of their dysphagia, so lack of the symptom does not exclude an underlying disease. When dysphagia goes undiagnosed or untreated, patients are at a high risk of pulmonary aspiration and subsequent aspiration pneumonia secondary to food or liquids going the wrong way into the lungs. Some people present with “silent aspiration” and do not cough or show outward signs of aspiration. Undiagnosed dysphagia can also result in dehydration, malnutrition, and renal failure.

Some signs and symptoms of oropharyngeal dysphagia include difficulty controlling food in the mouth, inability to control food or saliva in the mouth, difficulty initiating a swallow, coughing, choking, frequent pneumonia, unexplained weight loss, gurgly or wet voice after swallowing, nasal regurgitation, and dysphagia (patient complaint of swallowing difficulty). When asked where the food is getting stuck, patients will often point to the cervical (neck) region as the site of the obstruction. The actual site of obstruction is always at or below the level at which the level of obstruction is perceived.

The most common symptom of esophageal dysphagia is the inability to swallow solid food, which the patient will describe as ‘becoming stuck’ or ‘held up’ before it either passes into the stomach or is regurgitated.

M.A. is an abbreviation for master of arts. M.S. is an abbreviation for master of sciences. Both graduate degrees have been used for students of Communication Disorders depending on the university attended and the year.

C.C.C. is an abbreviation for Certificate of Clinical Competence. Speech pathologists that have passed a national exam and did a clinical fellowship year with proper accreditation from the American Speech Language and Hearing Association will have those letters after their name.

S.L.P is an abbreviation for Speech-Language Pathologist, a certification awarded by the Americah Speech-Language-Hearing Association (ASHA)

Health insurance may sometimes cover speech and language therapy. There are variations in coverage based on carriers, individual’s policy and diagnosis. Be aware of  restrictions, deductibles and co-payments.