“My children had developmental speech delays, but with the help of the speech therapists here at Allied Rehab, they are talking more clearly and normally. Now other people can understand them so much better! I have been recommending Allied Rehab to everyone.”
Laura J (mom of two preschoolers)
“My son couldn’t walk, talk, sit up or even reach for toys. He is improving so much with their help and can now talk, crawl, hold items, sit up, and is even taking steps. I consider his Allied Rehab therapists more like family. They are heaven sent. They go out of their way to help him in any way possible. They give him the confidence to succeed and never give up. I didn’t know what to expect with my son but these therapists were also moral support for me too and kept me going. I don’t know what we would do without them in our lives. I wouldn’t go anywhere else!”
Melissa W. (mother of Jason age 5)
Aphasia
Articulation Disorders
Cleft Palate
Dysphagia/Feeding
Fluency
Language
Reading Disorders
Voice DisordersAPHASIA
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 speech-language pathologist (SLP) works collaboratively with the person's family and other professionals (doctors, nurses, neuropsychologists, occupational therapists, physical therapists, social workers) to address all of the person's needs. For example, a person who has had a stroke often has physical problems, such as weakness on one side of the body, that require treatment from a physical or occupational therapist.
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.
ARTICULATION DISORDERS
Speech sound disorders include problems with articulation (making sounds) and phonological processes (sound patterns). A speech sound disorder occurs when mistakes continue past a certain age. Every sound has a different range of ages when the child should make the sound correctly. In young children learning to speak, speech sound errors are quite common. In fact, very few children develop speech without producing errors early on. By the age of 8, children should be able to produce all sounds in English correctly. Adults can also have speech sound disorders. Some adults continue to have problems from childhood, while others may develop speech problems after a stroke or head injury.
Why be concerned?
- Substituting one sound for another (wabbit for rabbit)
- Omitting sounds (winnow for window)
- Distorting sounds
Causes
Treatment 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.
- developmental disorders (e.g., autism)
- genetic syndromes (e.g., Down syndrome)
- hearing loss
- illness
- neurological disorders (e.g., cerebral palsy)
- frequent ear infections
- speaking with an accent and/or dialect is not a speech sound disorder, however an SLP an work on accent modification services if a client wishes to reduce or modify his or her accent.
CLEFT PALATE
Clefts of the lip and palate are among the most common of all birth defects. Because the lip and palate develop separately, it is possible for a child to have only a cleft lip, only a cleft palate, or both a cleft lip and cleft palate. A cleft lip can range from a slight notch in the vermilion (red portion of the lips) to a complete separation of the lip extending into and distorting the tip and side of the nose. A cleft palate is an opening in the roof of the mouth. A cleft palate does not mean that the palate is “missing” although it may sometimes look that way. It means that the two sides of the palate did not join together (fuse) as the unborn baby was developing. A sub mucous cleft palate is one type of cleft palate where the cleft is covered over by the lining (mucous membrane) of the roof of the mouth.
Why be concerned?
- Feeding/swallowing difficulties
- Ear infections
- Hypernasality- too much sound resonating in the nasal cavity during oral speech, especially on vowels and voiced oral consonants
- Audible nasal air emission- audible emission of air stream through nasal cavity during production of consonants
- Shorter Utterance Length- breath support for speech is compromised due to air leaking through nose
- Voice disorders- hoarseness, breathiness, reduced volume
Causes
- inherited factors (genes)
- certain “environmental” factors
- Clefting occurs very early in a pregnancy and represents a problem over which a pregnant woman probably has no control.
Treatment Children with clefts of the palate tend to develop speech and language a bit more slowly than other children. Many of these children will require speech therapy to achieve the best speech. The others may require further surgery, or a prosthetic speech aid in addition to speech therapy, to improve their speech. Speech therapy will help to improve articulation and improve oral pressure/airflow, reduce nasal emissions, and increase oral resonance.
DYSPHAGIA/FEEDING
What are feeding and swallowing disorders?
Feeding disorders include problems gathering food and getting ready to suck, chew, or swallow it. For example, a child who cannot pick up food and get it to her mouth or cannot completely close her lips to keep food from falling out of her mouth may have a feeding 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- starting the swallow, 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
What are some signs or symptoms of feeding and swallowing disorders in children?
Children with feeding and swallowing problems have a wide variety of symptoms. Not all signs and symptoms are present in every child. The following are signs and symptoms of feeding and swallowing problems in very young children:
- arching or stiffening of the body during feeding
- irritability or lack of alertness during feeding
- refusing food or liquid
- failure to accept different textures of food (e.g., only pureed foods or crunchy cereals)
- long feeding times (e.g., more than 30 minutes)
- difficulty chewing
- difficulty breast feeding
- coughing or gagging during meals
- excessive drooling or food/liquid coming out of the mouth or nose
- difficulty coordinating breathing with eating and drinking
- increased stuffiness during meals
- gurgly, hoarse, or breathy voice quality
- frequent spitting up or vomiting
- recurring pneumonia or respiratory infections
- less than normal weight gain or growth
As a result, children may be at risk for:
- dehydration or poor nutrition
- aspiration (food or liquid entering the airway) or penetration
- Pneumonia or repeated upper respiratory infections that can lead to chronic lung disease
- embarrassment or isolation in social situations involving eating
What are swallowing disorders?
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 -starting 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
What are some signs or symptoms of swallowing disorders?
Several diseases, conditions, or surgical interventions can result in swallowing problems.
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
FLUENCY
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. 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.
Why be concerned?
- repetitions of words or parts of words ("W- W- W- Where are you going?")
- prolongations of speech sounds ("SSSSave me a seat.")
- become tense or "out of breath" when talking
- stopped or blocked speech(no sound comes out but mouth is open).
- interjections such as "um" or "like" can occur ("I'll meet you – um um you know like – around six o'clock.")
- dysfluent speech lasting more than 12-18 months
Causes
Treatment Information from speech-language evaluation is used to develop a specific treatment program, one that is designed to help the individual speak more fluently, communicate more effectively, and participate more fully in life activities.
- a family history of stuttering
- stuttering that has continued for 6 months or longer
- presence of other speech or language disorders
- strong fears or concerns about stuttering on the part of the child or the family
LANGUAGE
Language is a code that we use in order to communicate our thoughts and understand others. This code is made up of the rules that we learn, such as how words are put together to form sentences. Language contains the elements of communication such as sounds, word formation, word order, word meaning, and actual language use. There are expected language behaviors for each age but children develop at different rates. What is most important is that the child shows continuous language growth. When a person has trouble understanding others (receptive language), or sharing thoughts, ideas, and feelings completely (expressive language), then he or she has a language disorder. Any speech or language problem is likely to have a significant effect on the child's social and academic skills and behavior. The earlier a child's speech and language problems are identified and treated, the less likely it is that problems will persist or get worse.
Why be concerned?
- By 2-3 years a child is not using 2-3 word sentences to talk about and ask for things, able to follow 2 part request and speech is not understood most of the time
- has difficulty understanding others
- has difficulty in conversations
- problems using language appropriate to the listener or to the situation
- difficulty reading and writing
Causes
- developmental disorders (e.g., autism)
- genetic syndromes (e.g., Down syndrome)
- hearing loss
- illness
- neurological disorders (e.g., cerebral palsy)
- stroke or brain injury in adults
Treatment Early language intervention can help children be more successful with reading, writing, schoolwork, and interpersonal relationships. Treatment is individualized based on patients' specific needs.
READING DISORDERS
Reading disorder is a learning disorder that involves significant impairment of reading accuracy, speed, or comprehension to the extent that the impairment interferes with academic achievement or activities of daily life. People with reading disorder perform reading tasks well below the level one would expect on the basis of their general intelligence, educational opportunities, and physical health. Reading disorder is most commonly called dyslexia. Dyslexia, however, usually includes deficits in spelling and writing as well as reading. Symptoms of reading disorder include poor comprehension, reversal of words or letters while reading, and difficulty decoding syllables or single words and associating them with specific sounds (phonics).
Why be concerned?
- slow reading speed
- poor comprehension when reading material either aloud or silently
- omission of words while reading
- reversal of words or letters while reading
- difficulty decoding syllables or single words and associating them with specific sounds (phonics)
- limited sight word vocabulary
Causes
- inherited or environmental factors
- most reading disabilities are neurodevelopmental in nature.
- most children diagnosed with learning difficulties have a primary problem with reading and related language skills.
Treatment The speech pathologist has the responsibility to assess and develop the linguistic prerequisites for reading, as well as to assist the child in developing the specific linguistic awareness required for reading.
VOICE DISORDERS
A voice disorder occurs when the pitch, loudness, or quality call 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. They 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
Treatment Many voice problems improve dramatically with the help of a speech-language pathologist (SLP). Some voice problems can be managed by a combination of medical or surgical treatment and SLP services. The SLP can help children and adults improve their voice and learn good voice habits, retrain use of voice, and teach strategies to avoid voice misuse. They can also assist people with achieving appropriate pitch, loudness, and quality.
- 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)
