Speech Education

Pediatric Population/Parent Focused

 

EARLY INTERVENTION

 

Why is my child delayed?
There are many different variables that may have contributed to your child's speech and language delay including if your child was born with a medical condition associated with language delay (ie, Down syndrome, prematurity, cerebral palsy, etc) or has experienced significant medical difficulties after birth (ie, otitis media, seizures, hearing loss, head trauma). However, some children require more language stimulation (ie, repetition of skills) in order to learn.

 

What speech sounds should my child have at his/her age?
Your Speech Language Pathologist (SLP) can provide you with written information regarding what speech sounds develop by certain ages. It is important that you enunciate your words clearly and emphasize sounds that your child is either leaving out or substituting with other sounds. For example, if your child says, "I wa ba." You can respond with, "You want a ball." Emphasize the last sound that the child is leaving out. Your SLP will help you determine what speech sounds are appropriate to address.

 

How can I help my child with communication during daily routines?
It is very helpful to talk to your child using simple language during your daily routines (ie, meal times, bath time). Label and comment on what you are doing, what your child is doing, and what he or she will do next. Have your child follow directions first (ie, get your shirt please) and then have him or her name it (ie, what are you wearing?). Your child will learn the vocabulary and concepts much quicker if you incorporate them into his or her everyday activities.

 

Should I be using sign language with my child?
Sign language is a way of helping your child communicate when they are not yet verbalizing. It teaches your child that they need to "do something to get something" rather than just pointing, grunting, or whining. It also helps others understand your child when they do not yet pronounce words clear enough for others to understand. Basic sign language that is helpful during daily routines: want, drink, eat, all done.

 

Will sign language prevent my child from talking verbally?
No. Sign language should always be accompanied by the spoken word. Once your child is using the sign for a word consistently with little to no prompts, start emphasizing the first sound in the word as you model the sign. For example, if your child is signing "eat," you can imitate the sign with your child but emphasize the vowel "ea" to encourage your child to say the first part of the word. It is also important to encourage any vocalizations accompanied with your child's sign language.

 

SCHOOL AGE

What are some things I can do to help my child who stutters?
Slow things down. Remind your child to slow down (his/her speech rate), have him/her think about what they want to say before they say it, and breathe slowly. You should also slow down your speech rate as you talk to your child. Give your child plenty of time to finish talking, don’t interrupt him/her. Limit corrections. Don’t correct every stutter your child makes. You do not need to point out the stuttering if you understand what your child is saying. Help your child feel accepted. Family members should learn to take turns talking and listening. You want to limit interrupting. Show your child that you understand his/her communication through the use of your body language (such as eye contact, head nodding, etc). Make sure to educate your child’s other communication partners (teachers, babysitters, coaches, etc) about stuttering. 

 

My child was diagnosed with pragmatic deficits (difficulty with social language skills).  What are things I can do to help my child learn to use language socially?
Ask questions or make suggestions to use language for different purposes or with different communication partners. Instead of correcting your child’s grammar or pronunciation, respond to your child’s intended message. However, make sure to provide an appropriate model if needed. For example, if your child says, “What you want to do this weekend?” Respond by saying, “What do I want to do this weekend?” and then answer the question. Practice social language in everyday situations such as greetings in the morning or ask what the child wants to do that day. You can role play by pretending to talk to different people in everyday situations such as teaching how to play a game. You can also work on conversational and storytelling skills by introducing the topic and providing comments to help your child stay on topic. In addition, you can use pictures or visual cues to help with sequencing a story as well as staying on topic. 

How can I help my child make friends? He/she only plays by him/herself at home and at school.
Set up a play date with a peer from school or a neighbor. Encourage interaction and have activities to do that promote social interaction such as a board game. Find out what activities interest your child. Consider enrolling your child in a sport, music, art, or other community activity that would encourage your child to interact with same-age peers. 

 

My eight-year-old son is having difficulty following directions. He always says “What?” or “huh” when I speak to him and he is having difficulty keeping up with school work. When I read a story aloud he doesn’t remember what I have read. The school psychologist suggested I have him tested for Auditory Processing Disorder? What is that and who can assess this disorder?
Auditory processing disorder (APD) is a disorder in which an individual has difficulty differentiating, recognizing, and/or understanding sounds while both his/her hearing and intelligence are normal. APD is assessed and diagnosed by an audiologist. First, a child’s hearing is tested to rule out a possible hearing loss or physical issue with hearing. Then, a specific battery of tests are given, usually over 2 or more days, to assess an individual’s ability to differentiate, recognize, and understand sounds/spoken language. An individual must be seven years old or older in order to be assessed for APD.

 

My child has recently been diagnosed with vocal nodules. He has always had a hoarse voice and tends to yell. What should I do? Vocal cord nodules are growths on an individual’s vocal cords that are a result of vocal abuse. Abuse of the vocal cords over time causes hard callous-like growths called nodules to form. These nodules typically become larger and stiffer as the vocal abuse continues. Signs and symptoms of vocal nodules may include: hoarseness, breathiness, a rough voice, a scratchy voice, harshness, decreased pitch range, vocal fatigue, and pain in neck/throat area. Vocal nodules are diagnosed by a physician. A speech language pathologist provides voice treatment and teaches a vocal hygiene program to improve your child’s voice and to prevent reoccurrence of nodules.

 

Adult Population

 

STROKE

 

When will I get my speech back?
Recovery from a stroke is not something that happens in a week or even several weeks. Most of the time, it is a process which takes several months, and smaller improvements may even go on for years. Improvements happen gradually, and may be hard for you to notice on a short-term basis. It’s also important to realize that your speech may not return to “100% normal”; there may be residual of the stroke which stays with you. Be patient with yourself, and don’t isolate. Dedicate yourself to the therapy process, and put yourself in situations where you can practice your speech. 

 

I have been feeling depressed and isolated since my stroke because I have trouble communicating. My friends don’t call me very much anymore. How can I deal with this?
In the life of a human being, a relationship is primary and essential. The ability to communicate is highly prized in our society, and those who suffer communicative disabilities often feel marginalized and devalued. In your journey toward healing, seek out communication practice groups and stroke support groups through hospitals, outpatient treatment clinics, and universities. Also, encourage family and friends to participate in organizations and educational opportunities about stroke. Your speech pathologist can help you locate resources in your community. Fear and lack of understanding create isolation; knowledge dispels fear, and compassion creates connections.

 

I can’t remember people’s names and it’s embarrassing. What can I do?
There is a difference between retaining and recalling. Though you may instantly recognize the name of a family member or friend when you hear/see it, you may not be able to say the name in the moment of face-to-face meeting. This is a common occurrence with aphasia. There is no shame in admitting the problem, light-heartedly and unapologetically, when you are greeting people. Ask the individual to say their name so you can repeat it, then use their name a few more times in the course of the conversation. Most people will be touched that you care enough about them to practice their name. Making a collection of digital photos of those close to you, labeled with their names, may also provide a way to practice recall. Your speech pathologist can help you with these and other strategies.

 

What should I do if the right word just won’t come to me, or when I say a word I didn’t mean to say?
Those people with whom you communicate most can help you with this by “double checking” with you to make sure they understood your intended response. This may involve a question such as, “This is what I heard you say; is that what you meant?” If you are having trouble finding the exact right word, think of what the word means and see if you can find a word with similar meaning (a synonym), or describe the meaning of the word. If you can communicate the word in another way, such as a gesture or a quick drawing, that sometimes works, too. Family and friends with good intentions may try to “fill in the blank” for you (often incorrectly), which may interrupt your thought process. Ask them to give you a minute before they jump in, and then ask for help if you want it.  

I lost my driving privilege after my stroke. When can I start driving again?
Driving is a complex skill requiring many simultaneous actions. Quick reaction time, full range of vision, reading comprehension for signs and directions, depth perception, alertness and attentiveness, patience, and good judgment are all essential components of safe driving. If any of these abilities were compromised by your stroke/injury, it could affect your driving skill. Your rehab therapists will assess these skills and design treatment programs to address problem areas. It is important to have your driving ability professionally evaluated before you get back behind the wheel. Be patient as you go through the process of being cleared for driving; it is for your safety as well as the safety of others on the road with you.

 

ACQUIRED BRAIN INJURY/TRAUMATIC BRAIN INJURY

 

Everybody thinks I’m fine because I have recovered from my visible injuries, but I know I’m not OK. How do I get people to understand?
The deep personal knowledge that something has changed and that “I am not the same as I was before” is a common experience, especially among those with mild brain injury. Subtle differences in coping ability, mood, memory, and other cognitive abilities may affect relationships and job performance and may be misunderstood by those around you. An assessment by a neuropsychologist may be helpful in objectively documenting problem areas which can then be addressed in cognitive therapy and in counseling with a qualified psychologist who is knowledgeable in the area of brain injury. Brain injury support organizations, your rehab therapists, and social workers/case managers can help you locate resources.

I used to be able to accomplish several tasks in my day, but since my injury I have trouble finishing even one or two. Will I ever be able to “multi-task” again?
After a brain injury, a person may commonly experience difficulty sustaining and dividing or alternating attention/concentration, may be more distractible, and may have difficulty with initiating tasks or finishing them once they’ve started. It’s important to set realistic goals for yourself in a day and to realize that you may not be able to jump in and resume your customary busy schedule right away. Start out by setting up your environment to be as quiet and free of distractions as possible; identify those things that distract you and minimize them as best you can. Choose two tasks you know you can accomplish (one at a time) in a reasonable period of time so that you experience success. Organize/gather the materials you need to accomplish the task before you begin. If there are more things you must accomplish in a day, make a list and post it in an easily seen place. Keep a daily written schedule in a daytimer, and check off items as you finish them. Your speech pathologist can suggest other strategies which may work best for you in your particular situation.

 

What can I do to help my memory?
Your speech pathologist will help you find ways to help your memory. Some of those ways may involve strategies for arranging your schedule and your environment, or external devices like daytimers to help you organize your days and make your schedule more manageable and predictable. You can help yourself by using those devices faithfully, and helping your speech pathologist know which ones seem to work best for you.

 

What effect could brain injury have on my ability to do my job?
Brain injury often affects a person’s ability to pay attention and concentrate for extended periods of time, which can then have further effects on ability to organize and remember information. You may find yourself more easily frustrated, and you may fatigue more quickly. It is important that your return to work be gradual. Returning to work full time without a gradual transition may be overwhelming and discouraging, leading to unnecessary failures and misunderstandings with superiors. Talk with your physician and your speech pathologist about how to schedule your return to work, and about what aspects of your work may be most challenging for you as a result of your injury.

 

After his/her brain injury, my loved one is more irritable and quick to anger, and sometimes it scares me. How do I handle this?
Brain injuries often affect a person’s ability to inhibit their emotional responses, giving rise to a “short fuse” and a low threshold of frustration. They may not have the immediate ability to manage this without help. When an outburst occurs, try to stay calm and redirect them away from whatever stimulated the anger. If it started with an argument, don’t keep reiterating your point; change the subject and move on. As much as possible, avoid known “trigger” situations, and try to keep the household environment calm and the routine predictable. Try to get agreement that when a situation escalates, you both will take a time out. For both of you, learning and practicing relaxation techniques may be helpful. Medication to help even out mood may also be helpful if appropriate, and should be discussed with a physician well versed in psychiatric medications.

 

 

DYSPHAGIA

 

Will I ever be able to swallow normally again?
Because dysphagia occurs for so many different reasons and along such a long continuum of severity, it is difficult to make a definitive statement about a complete return to normal swallowing. Many people who have had strokes return to a normal diet in a matter of days to weeks, and many continue to require modified diets because of ongoing problems. Alterations to a person’s anatomy related to surgery, or changes in swallowing ability related to radiation therapy can create ongoing challenges to swallowing which may require permanent diet modifications or even a need for alternative means of nutrition. For a discussion of your individual prognosis, talk with your physician and your speech pathologist.

 

What is the difference between a clinical swallow evaluation and an instrumental swallow evaluation?
A clinical swallow study (within the outpatient setting) is frequently referred to as a bedside swallow study when conducted within the hospital setting. This is an evaluation wherein the speech pathologist will review medical history in relation to the current condition, assess the strength, range of motion and overall function of the swallow musculature in addition to assessing the ability to swallow on a variety of different food and liquid consistencies. Recommendations will be made as to the consistencies that the patient is able to safely consume and recommendations will be made in regard to treatment options. Instrumental swallow evaluations are typically conducted within the hospital setting, either on an in-patient or out-patient basis. The two most common types of instrumental swallow evaluations are the Modified Barium Swallow Study (MBS) and the Fiberoptic Endoscopic Evaluation of the Swallow (FEES). 

What is the difference between an MBS and FEES?
An MBS is a Modified Barium Swallow Study. This is a fluoroscopic procedure designed to rule-out whether food or liquid is entering a person’s lungs (also known as aspiration) and to assess swallow function. It is conducted by a licensed speech pathologist in cooperation with the radiology team. It offers a visual image of the swallow and assists in confirming whether there is a risk of penetration or aspiration upon intake of food or liquids. FEES (Fiberoptic Endoscopic Evaluation of the Swallow) is a procedure wherein a speech pathologist, specifically trained in the FEES procedure, will evaluate the swallow by passing a flexible scope (called a fiberoptic laryngoscope) through your nose and down into the back of the throat in order to visualize the swallow via a small camera attached to the laryngoscope.  

 

What are the most common treatment options for swallowing?
There are many different options for treating a swallow disorder. The recommendation would be made after a complete evaluation by a trained, licensed speech pathologist. In most cases, a directed home exercise program will be established, targeting the specific musculature in need of remediation. Diet modification or safe swallow techniques may be implemented. Other treatment options frequently used, in conjunction with exercise and diet modifications, would include neuromuscular electrical stimulation (NMES), thermal tactile stimulation (TTS), or deep pharyngeal neuromuscular stimulation (DPNS). TTS and DPNS are similar in that they both use frozen swabs applied to structures within the oral cavity and pharynx in order to improve sensory response, strength of swallow, and coordination and timing of the swallow. DPNS requires specified training and certification in that is it a more intensive form of thermal tactile stimulation. 

What is electrical stimulation and how is it used in helping someone to swallow?
Electrical stimulation, or NMES, involves the use of electrical currents to stimulate the nerves or nerve endings that innervate the muscles beneath the skin.  From a rehabilitative standpoint, electrical stimulation has been used for many conditions such as spinal cord injuries, muscle atrophy, etc. The anticipated outcome, in regard to its application in dysphagia treatment, would be increased range of motion, improved strength, improved patterns of muscle contraction, and improved timing in regard to triggering the swallow.

 

VOICE DISORDERS

 

Why am I being referred to a speech pathologist when I am having difficulty with my voice?
Many people are confused when they are referred to a speech pathologist when they are experiencing a voice problem. Rest assured that the speech pathologist is the designated expert when it comes to remediating a problem with the voice. The speech pathologist is trained in identifying the underlying vocal dysfunction and will be able to customize a treatment plan designed to reestablish a healthy balance of proper vocal mechanics in addition to proper vocal hygiene.

 

Why do I need to see an ENT before I begin my voice therapy?
Obtaining a medical clearance, or referral, from an ENT (Ear, Nose, and Throat Specialist) is imperative when it comes to initiating any voice therapy program.  The initial symptoms associated with most voice problems are essentially the same whether the underlying problem is simple laryngitis from overuse, a benign vocal cord lesion or even something more severe such a laryngeal cancer. It is critical that the vocal cords be viewed in order to identify whether a medical condition exists that needs to be addressed in addition to any condition that may be related to misuse or abuse of the vocal mechanism.

 

What can I do to make my voice sound better and prevent hoarseness?
Adequate hydration is very important in preventing dryness and keeping tissue moist in the mouth and throat. Water is the best fluid to drink for this purpose. Short periods of vocal rest are beneficial after long periods of vocal use such as giving a business presentation, yelling at a sports event, or teaching all day. It is important to keep the chest, neck, and throat muscles relaxed during vocal use to prevent muscle strain. You should consult your physician anytime vocal hoarseness persists longer than a few days. A speech pathologist can be helpful in providing education on vocal hygiene and teaching you better ways to use your voice.

 

Is it possible to ever have a normal voice if I have a paralyzed vocal cord?
Unfortunately there is never a guarantee of voice return after a diagnosis of vocal cord paresis or paralysis, although individual results vary greatly depending upon the etiology. Vocal cord paralysis occurs for many different reasons. It may be due to nerve damage after trauma or surgery, or it could be associated with a neurological event such as a stroke, or even result from a virus. In some cases, the voice may return on its own but with the assistance of a trained speech pathologist, the chance of voice recovery post paresis or paralysis is very good. In most cases, only one vocal fold will be affected, making it possible to still attain adequate vocal cord closure in order to regain the use of the voice. Surgical interventions to medialize the vocal fold or procedures involving injection or implants are also available if necessary. In most cases, a referral to a speech pathologist who specializes in voice is the first step in recovery of the voice post vocal cord paralysis. An evaluation from a physician specializing in voice and swallow issues would be the first step in making a decision as to the best course for treatment.

 

Is voice therapy beneficial for individuals with Parkinson’s?
Parkinson’s disease can impact one’s vocal quality due to reduced muscle strength, coordination, and motor control. Individuals with Parkinson’s may have a soft, breathy vocal quality and therefore can have reduced speech intelligibility. Some people may also have essential tremors which impact pitch and loudness of the voice. LSVT LOUD is a voice program designed specifically for Parkinson’s patients to improve vocal quality and loudness. A speech language pathologist can make a recommendation for this specialized treatment program.