Speech Language Pathology Services

The filed of Speech and Language Pathology (SLP) encompasses assessment and treatment across three distinct fields of study. Swallowing, Speaking and Communication. Patients with swallowing disorders, speech- language disorders and cognitive-linguistic disorders can benefit from a variety of assessment and treatment techniques provided across the continuum of care.

Swallowing disorders, also called dysphagia, can occur at different stages in the swallowing process:

• Oral phase - chewing and moving food or liquid into the throat
• Pharyngeal phase - 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/symptoms of dysphagia 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

VitalStim©

VitalStim© Therapy uses small electrical currents to stimulate the muscles responsible for swallowing. At the same time, trained specialists help patients "re-educate" their muscles through rehabilitation therapy.

• Specially designed electrodes are applied to the face/neck
• A small, carefully calibrated current is delivered to the electrodes
• The current stimulates motor nerves in the throat/face
• The muscles responsible for swallowing contract
• The quality of the swallowing function improves
• With repeated therapy, muscles are re-educated

Speech and Language Disorders:

Aphasia is a disorder that results from damage to the parts of the brain that contain language. Aphasia causes problems with any or all of the following: speaking and/or writing ("expressive aphasia"), listening and reading ("receptive aphasia")

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

Dysarthria is a motor speech disorder. The muscles of the mouth, face, and respiratory system may become weak, move slowly, or not move at all after a stroke or other brain injury. The type and severity of dysarthria depend on which area of the nervous system is affected.

Signs/Symptoms of dysarthria include:

• "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
• Changes in vocal quality ("nasal" speech or sounding "stuffy")
• Hoarseness and/or breathiness

Apraxia is a general term. It can cause problems in parts of the body, such as arms and legs. Apraxia of speech is a motor speech disorder. It is caused by damage to the parts of the brain related to speaking. Other terms include apraxia of speech, acquired apraxia of speech, verbal apraxia, and dyspraxia.People with apraxia of speech have trouble sequencing the sounds in syllables and words. The severity depends on the nature of the brain damage.

Signs/symptoms of apraxia include:

• difficulty imitating speech sounds
• difficulty imitating non-speech movements (oral apraxia), such as sticking out their tongue
• groping when trying to produce 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?"

Cognitive-Linguistic Disorders

Cognitive-communication problems that can occur from damage to certain areas of the brain include difficulty with the following:

Attention: difficulty concentrating on a task and paying attention for more than a few minutes at a time. Doing more than one thing at a time may be difficult or impossible.

Left-side neglect: a form of attention deficit. Essentially, the individual no longer acknowledges the left side of his/her body or space. These individuals will not brush the left side of their hair, for example, or eat food on the left side of their plate, as they do not see them or look for them. Reading is also affected as the individual does not read the words on the left side of the page, starting only from the middle.

Memory: problems remembering information, such as street names or important dates, and learning new information easily.

Orientation: difficulty recalling the date, time, or place. The individual may also be disoriented to self, meaning that he/she cannot correctly recall personal information, such as birth date, age, or family names.

Organization: trouble telling a story in order,giving directions, or maintaining a topic during conversations.

Problem solving: difficulty responding appropriately to common events, such as a car breakdown or overflowing sink. Leaving the individual unsupervised may be dangerous in such cases, as he or she could cause injury to himself or herself, or others.

Reasoning: difficulty interpreting abstract language, such as metaphors, or responding to humor appropriately.

Social communication (pragmatics): problems understanding nonverbal cues and following the rules of communication (e.g., saying inappropriate things, not using facial expressions, talking at the wrong time).