Allied Rehab: Speech Therapy

Articulation Disorders
Cleft Palate
Fluency
Language
Articulation Disorders
Voice Disorders
Reading Disorders

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

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.

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.

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.

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

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

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.

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

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

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.



	“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)	Articulation Disorders Cleft Palate Fluency Language Articulation Disorders Voice Disorders Reading Disorders 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 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. 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. 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. 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 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 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. 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 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 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.

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