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Greater Regional Speech Therapy 

Language is our most human characteristic. It is essential to learning, working, and enjoying family life and friendships. There are many ways to express language. Speaking, using sign language, writing, and using computerized communication devices are some of the most common ones. The professionals who are educated to assess speech and language development and to treat language and speech disorders are speech-language pathologists (sometimes informally referred to as speech therapists). Speech-language pathologists can also help people with swallowing disorders. (www.asha.org)

Services Provided

Adult Speech
Apraxia: (also referred to as apraxia of speech, verbal apraxia, or dyspraxia) is a motor speech disorder caused by damage to the parts of the nervous system related to speaking. It is characterized by problems sequencing the sounds in syllables and words and varies in severity depending on the nature of the nervous system damage. People with apraxia know what words they want to say, but their brains have difficulty coordinating the muscle movements necessary to say those words and they may say something completely different, even nonsensical. For example, a person may try to say "kitchen", but it may come out "bipem". The person will recognize the error and try again, sometimes getting it right, but sometimes saying something else entirely. This can become quite frustrating for the person. Characteristics include:

Difficulty imitating speech sounds; possible difficulty imitating non-speech movements, such as sticking out their tongue (oral apraxia); groping for sounds; in severe cases, an inability to produce sound at all; inconsistent errors; slow rate of speech; somewhat preserved ability to produce "automatic speech", such as greetings like "How are you?"; can occur in conjunction with dysarthria (muscle weakness affecting speech production) or aphasia (language difficulties related to neurological damage).

A speech-language pathologist works with people with apraxia to improve speech abilities and overall communication skills. The muscles of speech often need to be "retrained" to produce sounds correctly and sequence sounds into words. This occurs through exercises designed to allow the person to repeat sounds over and over and practice correct mouth movements for sounds. The person with apraxia may need to slow their speech rate down or work on "pacing" their speech so that they can produce all of the sounds necessary for their message. In severe cases, alternative means of communication may be necessary, such as the use of simple gestures or more sophisticated electronic equipment.
 
Dysarthria: After a stroke or other brain injury, the muscles of the mouth, face, and respiratory system may become weak, move slowly, or not move at all. The resulting speech condition is called dysarthria. The type and severity of dysarthria depends on which area of the nervous system is affected.  A person with dysarthria may experience any of the following symptoms, depending on the extent and location of damage to the nervous system: "slurred" speech; speaking softly or barely able to whisper; slow rate of speech; rapid rate of speech with a "mumbling" quality; limited tongue, lip, and jaw movement; abnormal intonation (rhythm) when speaking; changes in vocal quality ("nasal" speech or sounding "stuffy"); hoarseness; breathiness; drooling or poor control of saliva; chewing and swallowing difficulty.

Treatment depends on the cause, type, and severity of the symptoms. A speech-language pathologist (SLP) works with the individual to improve communication abilities. Goals may include slowing the rate of speech, improving breath support so the person can speak more loudly, muscle strengthening exercises, increasing mouth, tongue, and lip movement, or improving articulation so that speech is more clear. The SLP can also help the person's caregivers or family learn to adapt the environment so that they can understand the person better and can teach compensatory strategies that will enhance communication. In cases of severe dysarthria, it may be impossible for the person to speak intelligibly and an alternative means of communication may be needed. These range from using simple gestures or alphabet boards to more sophisticated electronic or computer-based equipment. If chewing and swallowing problems exist, the SLP can address these areas, as well.

Pediatric Speech
Childhood apraxia of speech (CAS):  is a motor speech disorder. Children with CAS have problems saying sounds, syllables, and words. This is not because of muscle weakness or paralysis. The brain has problems planning to move the body parts (e.g., lips, jaw, tongue) needed for speech. The child knows what he or she wants to say, but his/her brain has difficulty coordinating the muscle movements necessary to say those words.

A certified-SLP with knowledge and experience with CAS conducts an evaluation. This will assess the child's oral-motor abilities, melody of speech, and speech sound development. The SLP can diagnose CAS and rule out other speech disorders, unless only a limited speech sample can be obtained making a firm diagnosis challenging.

The focus of intervention for the child diagnosed with CAS is on improving the planning, sequencing, and coordination of muscle movements for speech. Isolated exercises designed to "strengthen" the oral muscles will not help without a combined focus on speech production. CAS is a disorder of speech coordination, not strength.

To improve speech, the child must practice speech. However, getting feedback from a number of senses, such as tactile "touch" cues and visual cues (e.g., watching him/herself in the mirror) as well as auditory feedback, is often helpful. With this multi-sensory feedback, the child can more readily repeat syllables, words, sentences and longer utterances to improve muscle coordination and sequencing for speech.
 
Speech sound disorders: SLPs provide treatment to improve articulation of individual sounds or reduce errors in production of sound patterns.   Articulation treatment may involve demonstrating how to produce the sound correctly, learning to recognize which sounds are correct and incorrect, and practicing sounds in different words. Phonological process treatment may involve teaching the rules of speech to individuals to help them say words correctly.  
 
Stuttering: Most treatment programs for people who stutter are "behavioral." They are designed to teach the person specific skills or behaviors that lead to improved oral communication. For instance, many SLPs teach people who stutter to control and/or monitor the rate at which they speak. In addition, people may learn to start saying words in a slightly slower and less physically tense manner. They may also learn to control or monitor their breathing. When learning to control speech rate, people often begin by practicing smooth, fluent speech at rates that are much slower than typical speech, using short phrases and sentences. Over time, people learn to produce smooth speech at faster rates, in longer sentences, and in more challenging situations until speech sounds both fluent and natural. "Follow-up" or "maintenance" sessions are often necessary after completion of formal intervention to prevent relapse.

Aphasia

Aphasia is a disorder that results from damage to language centers of the brain. For almost all right-handers and for about 1/2 of left-handers, damage to the left side of the brain causes aphasia. As a result, individuals who were previously able to communicate through speaking, listening, reading and writing become more limited in their ability to do so. The most common cause of aphasia is stroke, but gunshot wounds, blows to the head, other traumatic brain injury, brain tumor, and other sources of brain damage can also cause aphasia. Some people with aphasia have problems primarily with expressive language (what is said) while others have their major problems with receptive language (what is understood). In still other cases, both expressive language and receptive language are obviously impaired. Language is affected not only in its oral form of talking and understanding but also in its written form of reading and writing. Typically, reading and writing are more impaired than oral communication. The nature of the problems varies from person to person depending on many factors but most importantly on the amount and location of the damage to the brain.

The speech-language pathologist works collaboratively with other rehabilitation and medical professionals (doctors, nurses, neuropsychologists, occupational therapists, physical therapists, social workers, employers and teachers (when applicable), and families to provide a comprehensive evaluation and treatment plan for the person with aphasia.

Cognitive disorders

Damage to the right hemisphere of the brain can lead to cognitive-communication problems, such as impaired memory, attention problems and poor reasoning. In many cases, the individual with right brain damage is not aware of the cognitive difficulties or communication problems that they are experiencing. The causes of right hemisphere damage include: stroke; traumatic brain injury; surgery; infection/illness; tumor. People with right hemisphere damage experience communication problems that are more subtle in nature than those that occur from left hemisphere damage. This is due in part to the fact that, in most of the population, the language centers are in the left hemisphere, while cognitive functioning is often housed in the right hemisphere. Cognitive-communication problems that can occur from right hemisphere damage include difficulty with: attention; memory; organization; reasoning; problem-solving; orientation; left-side neglect; social judgment/pragmatics.

Attention problems include difficulty concentrating on a task amid distractions and paying attention for more than a few minutes at a time. Also, performing more than one task at once may be difficult or impossible.

A person's memory may be affected, as well. They may have difficulty recalling already learned information, such as street names or important dates, and may not be able to learn new information easily.

Organization problems include being able to correctly sequence events when telling a story or giving directions or maintaining a topic while conversing with others. Reasoning may also be impaired and the person may not be able to interpret abstract language, such as metaphors, or respond to humor appropriately.

The individual may not react appropriately when presented with a common occurrence, such as a car breakdown or overflowing sink. This is due to impaired problem-solving abilities. Leaving the individual unsupervised may be dangerous in such cases, as they could cause injury to themselves or others.

A person who has difficulty recalling the date, time, or place is said to have orientation problems. The individual may also be disoriented to self, meaning that they cannot correctly recall personal information, such as birth date, age, or family names.

Left-side neglect is a form of attention deficit that may occur from right hemisphere damage. Essentially, the individual no longer acknowledges the left side of their body or space.
 
A speech-language pathologist (SLP) is a person trained in working with people with communication disorders. When a person experiences right hemisphere brain damage with resulting cognitive-communication problems, a referral to a speech-language pathologist may be warranted. The SLP will work with the individual and develop a treatment plan designed to improve the individual's cognitive-communication abilities. What you can do: provide a consistent routine every day; use calendars, clocks, and notepads to remind the person of important information; decrease distractions when communicating; stand to the person's right side and place objects to the person's right if they are experiencing left side neglect; break down instructions to small steps and repeat directions as needed; ask questions and use reminders to keep the individual on topic; avoid sarcasm, metaphors, etc. when speaking to the individual; provide appropriate supervision to ensure the person's safety. 

Voice

We have all experienced problems with our voices, times when the voice is hoarse or when sound will not come out at all! Colds, allergies, bronchitis, exposure to irritants such as ammonia, or cheering for your favorite sports team can result in a loss of voice. Many people receive behavioral intervention, or voice therapy, from an SLP. Voice therapy involves teaching good vocal hygiene, reducing/stopping vocal abusive behaviors, and direct voice treatment to alter pitch, loudness, or breath support for good voicing. Stress reduction techniques and relaxation exercises are often taught as well.

Swallowing Disorder

Swallowing disorders , also called dysphagia (dis FAY juh), can occur at different stages in the swallowing process: oral phase-- sucking, chewing, and moving food or liquid into the throat; pharyngeal phase-- triggering the swallowing reflex, squeezing food down the throat, and closing off the airway to prevent food or liquid from entering the airway (aspiration) or to prevent choking; esophageal phase-- relaxing and tightening the openings at the top and bottom of the feeding tube in the throat (esophagus) and squeezing food through the esophagus into the stomach.

General signs may include: coughing during or right after eating or drinking; wet or gurgly sounding voice during or after eating or drinking; extra effort or time needed to chew or swallow; food or liquid leaking from the mouth or getting stuck in the mouth; recurring pneumonia or chest congestion after eating; weight loss or dehydration from not being able to eat enough. As a result, adults may have: poor nutrition or dehydration; risk of aspiration (food or liquid entering the airway) which can lead to pneumonia and chronic lung disease; less enjoyment of eating or drinking; embarrassment or isolation in social situations involving eating.

Treatment varies greatly depending on the cause, symptoms and type of swallowing problem. A speech-language pathologist may recommend: exercises, positions, or strategies to help swallow more effectively; specific food and liquid textures that are easier and safer to swallow.