Speech Therapy

Speech Therapy is intended to restore speech, communication and reduce frustration following an injury or surgery so patients can improve their situation and recover as fully as possible.  Our Speech staff is trained to evaluate and determine the scope and severity of speech and cognitive challenges resulting from concussion, stroke, head injury or dementia.

 

Aphasia

What are some signs or symptoms of aphasia?

Some people with aphasia have trouble using words and sentences (expressive aphasia). Some have problems understanding others (receptive aphasia). Others with aphasia struggle with both using words and understanding (global aphasia).

Aphasia can cause problems with spoken language (talking and understanding) and written language (reading and writing). Typically, reading and writing are more impaired than talking or understanding.

Aphasia may be mild or severe. The severity of communication difficulties depends on the amount and location of the damage to the brain.

A Person With Mild Aphasia

• May be able to carry on normal conversations in many settings
• May have trouble understanding language when it is long and/or complex
• May have trouble finding the words (called anomia) to express an idea or explain himself/herself-this is like having a word “on the tip of your tongue”

A Person With Severe Aphasia

• May not understand anything that is said to him/her
• May say little or nothing at all
• May make approximations of common phrases, such as “yes,” “no,” “hi,” and “thanks”
• Characteristics of Expressive Aphasia
• Speaks only in single words (e.g., names of objects)
• Speaks in short, fragmented phrases
• Omits smaller words like “the,” “of,” and “and” (so message sounds like a telegram)
• Puts words in wrong order
• Switches sounds and/or words (e.g., bed is called table or dishwasher a “wish dasher”)
• Makes up words (e.g., jargon)
• Strings together nonsense words and real words fluently but makes no sense
• Characteristics of Receptive Aphasia
• Requires extra time to understand spoken messages (e.g., like translating a foreign language)
• Finds if very hard to follow fast speech (e.g., radio or television news)
• Misinterprets subtleties of language-takes the literal meaning of figurative speech (e.g., “it’s raining cats and dogs”)
• Is frustrating for the person with aphasia and for the listener—can lead to communication breakdown
• Very often, a person with aphasia has both expressive and receptive difficulties to varying degrees.

How is aphasia diagnosed?

The SLP evaluates the individual and determines the type and severity of aphasia. The evaluation is done by assessing the following areas of communication:

• Speech
• Fluency, vocal quality, and loudness
• How clearly the person speaks
• Strength and coordination of the speech muscles (tongue, lips)
• Understanding
• Understanding and use of vocabulary (semantics) and grammar (syntax)
• Understanding and answering both yes-no (e.g., Is your name Bob?) and Wh-questions (e.g., What do you do with a hammer?)
• Understanding extended speech-the person listens to a short story or factual passage and answers fact-based (the answers are in the passage) and inferential (the patient must arrive at a conclusion based on information gathered from the reading) questions about the material
• Ability to follow directions that increase in both length and complexity
• Ability to tell an extended story (language sample) both verbally and in written form
• Expressing
• Can the person tell the steps needed to complete a task or can he or she tell a story, centering on a topic and chaining a sequence of events together?
• Can he or she describe the “plot” in an action picture?
• Is his or her narrative coherent or is it difficult to follow?
• Can the person recall the words he or she needs to express ideas?
• Is the person expressing himself or herself in complete sentences, telegraphic sentences or phrases, or single words?
• Social Communication
• Social communication skills (pragmatic language)
• Ability to interpret or explain jokes, sarcastic comments, absurdities in stories or pictures (e.g., What is strange about a person using an umbrella on a sunny day?)
• Ability to initiate conversation, take turns during a discussion, and express thoughts clearly using a variety of words and sentences
• Ability to clarify or restate when his or her conversational partner does not understand
• Reading and Writing
• Reading and writing of letters, words, phrases, sentences, and paragraphs
• Other
• Swallowing (as needed)
• Ability to use an augmentative or alternative communication aid (as needed)

This information is gathered through both structured observations and formal tests, administered by a speech language pathologist.

Voice Disorders

A voice disorder occurs when pitch, loudness, or quality calls attention to itself rather than to what the speaker is saying. It is also a problem if the speaker experiences pain or discomfort when speaking or singing. Vocal cord nodules, polyps or nodes are different types of growths on the vocal folds. These cause changes in voice quality, such as hoarseness or breathiness and can create discomfort. Paradoxical vocal fold movement (PVCM) and spasmodic dysphonia are a few other conditions that can result in voice problems.

Why be concerned?

• Inappropriate pitch (too high or low)
• Harsh, hoarse, breathy, or nasal-sounding voice
• Inappropriate volume (too loud or too soft)
• Limited pitch and loudness variations

Causes

• Prolonged misuse of voice by screaming, cheering, and yelling
• Using pitch that is too high or too low
• Excessive drinking ands smoking
• Upper respiratory infections and neurological conditions (i.e., Parkinson disease, stroke, Lou Gehrig disease)
• Tumor and cancer of the larynx
• Gastro esophageal reflux disease (GERD)

Treatment

The SLP can help retrain use of voice and teach strategies to avoid voice misuse, as well as assist people with achieving appropriate pitch, loudness, and quality.