Speech-Language Pathology Services

We work one-on-one with individuals to help enable them to reach their full potential, be productive, and function as independently as possible in society.

Speech-Language Pathologists work with individuals who have difficulty with communication and related abilities.

SLP's also work with individuals who are recovering from stroke or head injuries, those with hearing loss, developmental disabilities, cerebral palsy, Down Syndrome, ADD/ADHD, autism spectrum disorders, and developmental delays.

Some of the specific areas include the following:

Articulation
Articulation is the use of the lips, tongue, teeth, larynx, jaw, etc. to produce speech sounds.
 

Language
Receptive language: Words one understands; may be spoken, written, or visual.

Expressive language: The ability to communicate using spoken, signed, or printed words.
 

Reading and Reading Comprehension
The acquisition of phonological awareness is an important factor in learning to read and spell.

Phonological Awareness will facilitate children's learning of the alphabetic principal by drawing attention to the sounds that are related to individual letters.
 

Handwriting and Written Expressing
Handwriting Without Tears and written expression.
 

Voice
Voice disorders consist of any deviation in pitch (high and low sounds) , intensity (loudness), quality (e.g., hoarse), or resonance (nasal) that interferes with communication, draws unfavorable attention, adversely affects the speaker or listener, or is inappropriate for their age or sex.
 

Fluency
Stuttering/Dysfluencies: interruptions that interfere with the smooth, easy flow of oral speech. Examples include repetitions, prolongations, interjections, and silent pauses.
 

Orofacial Myology
Structural or functional factors that relate to a communication disorder. For example, a tongue thrust that is impacting articulation and swallowing.
 

Swallowing Disorders
Dysphagia: the impaired movement of food or liquids from the mouth through the pharynx (throat) into the stomach.

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In-depth definitions of the areas listed above

Articulation

Here are some examples when a person would need articulation therapy:

• Substituting one sound for the other. For example, saying "tat" for "cat"
• Omitting sounds from a word. "ba" for "bat"
• Distorting sounds: For example, interdental or lateral lisp, or an atypical sounding /r/
• Adding sounds: "balack" for "black" or "sthoap" for "soap"
• Muscle weakness (dysarthria) or incoordination (apraxia)

Developmental Apraxia

• A disorder of articulation characterized by difficulty acquiring speech, inconsistent sound errors, and groaning or struggling behaviors during speech.

Key Benefits of Articulation Therapy

• Articulation therapy can help your child be understood better
• Increase confidence
• Decrease frustration because they are not understood
• Communicate wants and needs clearly
• Articulation errors can impact spelling; therefore, articulation therapy may improve spelling errors related to the speech sound

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Language Therapy

Here are some examples when a person might need language therapy:

• Limited or immature vocabulary
• Having trouble providing information orally
• Difficulty with grammar
• Not following or comprehending directions
• Unable to communicate thoughts clearly
• Does not ask or answer questions appropriately
• Difficulty sequencing

Developmental Norms:

• 9 Months:
  • Smile and laugh while looking at you
  • Turn to sounds they hear
  • Reach for things they want
  • Use their voice to get help and attention
     
• 12 months:
  • Respond to their name
  • Understand simple directions with gestures
  • Use gestures like giving, showing, and pointing
  • Use sounds and maybe a few words
  • Play social games like peek-a-boo
  • Let you know what they want and don't want
  • Show you things that interest them
     
• 15 months:
  • Use lots of gestures and sounds
  • Use some words to communicate like "mama", "dada", "bottle", "bye-bye" and "uh-oh"
  • Understand familiar words and phrases like, "Where's mama?" and "Get your bottle."
  • Play with a variety of toys like blocks, cars, books, stuffed animals, and dolls.
• 18 months:
  • Use at least 10 words
  • Make more than 5 different consonant sounds, like /m/, /n/, /b/, /d/ and /p/
  • Imitate words you say
  • Identify several body parts when named
  • Play by pretending to feed dolls or stuffed animals
     
• 21 months:
  • Use at least 25 words
  • Learn a few new words each week
  • Combine words together like "want bottle" and "go bye-bye"
  • Identify several objects when named
  • Put actions together during play like scooping and feeding a doll
     
• 24 months:
  • Use at least 50 words
  • Make simple sentences like, "Mommy go outside," and "What's that?"
  • Put many actions together during play like stirring, pouring, scooping and feeding a doll
  • Recognize pictures in books and listen to simple stories.

(Adapted from First Words Project, http://firstwords.fsu.edu)

For more detailed developmental information, please see the following site: http://www.kidsource.com/kidsource/content4/growth.chart/page1.html

Language difficulties can be either be delayed or disordered.

• The order in which children learn speech sounds and language forms is fairly predictable. Most children follow the same pattern of development. When a child is developing skills in this order, but is doing it more slowly, they have a speech/language delay.
   
• Sometimes a child does not have the same speech or language skills as other children their age and is not just slow in developing. They have gaps in development, that is, they may have some skills that are age-appropriate, but are missing some that should have been learned when they were younger. They may use some sounds for forms that are unusual and never used by any child at any age. This is considered a disorder.
   
• Language disorders can be caused by a variety of factors: (McCormick and Schiefelbusch, 1990)
  • Motor disorders due to brain pathology: cerebral palsy, aphasia (language loss due to stroke)
  • Sensory deficits: hearing or visual impairments
  • Central nervous system involvement: learning disabilities
  • Severe emotional-social dysfunctions: autism
  • Cognitive disorders: developmental delays
    
     
• For some activities to help your child learn about language, please refer to the following web site: http://www.kidsource.com/kidsource/content4/growth.chart/page2.html

Key Benefits of Language Therapy

• Understand what people/teachers are saying
• Produce language to express their wants and needs
• Increase vocabulary skills
• Be able to follow multi-step directions
• Find a communication system that works for you: oral speech, sign language, picture exchange, or voice output device

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Reading and Reading Comprehension

Learning to read means learning how to pronounce the sounds that correspond to the letters of the alphabet, learning how to identify words and get their meaning, and learning how to bring meaning to a text in order to get meaning from it (comprehension).

Although exposure to literature and level of intelligence are important for overall development, they are less predictive of reading success than phonological awareness.

1. Phonological Awareness includes:

• Rhyming: What rhymes with "cat"?
• Blending sounds: What word is this: /sh/ /oe/?
• Phoneme counting: How many sounds are in the word "box"?
• Phoneme segmentation: What sounds do you hear in "bus"?
• Phoneme deletion: What is left if the /t/ is taken out of "cart"

2. Sound/Symbol Awareness
    
3. Visual memory for grade level sight words

Key Benefits

• Increased sound/symbol (phonics) awareness
• Increased understanding of a written passage
• Increased knowledge of vocabulary and sentence structures
• Multi-sensory approach to learning how to read
• Increased skills in encoding and decoding
  

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Handwriting and Written Expression...

Handwriting Without Tears Preschool to 5th grade

Handwriting Without Tears (HWT) is a simple, developmentally based curriculum. HWT uses a continuous stroke for printing and vertical style. The cursive is greatly simplified and is vertical instead of slanted. HWT is a fun, multi-sensory approach to learing how to print and write in cursive. HWT is a complete handwriting curriculum that is successful for ALL children.

Please go to: www.hwtears.com for more detailed information.

Written Expression: Kindergarten to High School

Levels of activities will be determined by the student's age and present levels of performance, but will include either a review or lessons with the following:

• Parts of Speech
• Antonyms, Synonyms, Homophones
• Building Sentences
• Punctuation
• Letter writing
• Narrative writing
• Persuasive writing
• Expository writing
• Mind maps and other visual organizers (e.g., webs) for brainstorming

Key Benefits

• Increased understanding of a written passage
• Increased ability to organize thoughts and put them to paper
• Ability to express academic, personal, and creative thoughts
  

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Voice Therapy

Here are some examples when someone would need voice therapy:

• Voice quality is perceived as: hoarse, breathy, or harsh
• Your ENT has identified vocal nodules or another vocal fold pathology
• Resonance is perceived as being hypernasal (all sounds coming out of the nose) or hyponasal (continually sounds like they have a cold).
• If your child has nasal emissions (audible air coming out of the nose) when speaking
• Loudness is perceived as being too loud or too soft
• Pitch levels are too high, too low, or monotone

A medical evaluation is needed prior to voice therapy.

Key Benefits of Voice Therapy

• Identify and reduce vocally abusive behaviors
• Increased confidence in speaking situations
• Increased speaker intelligibility
• Improved social acceptability

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Fluency

Below you will find some examples of what the speech of a person with a fluency disorder might sound like:

• Repetitions
  • Part-word repetitions: "What is your n-n-n-name?"
  • Whole-word repetitions: "What-what-what time is it?"
  • Phrase repetitions: "I want to-I want to-I want to do it."
• Prolongations
  • Sound/syllable prolongations: "Lllllllllet me do it."
  • Silent prolongations: A struggling attempt to say a word when there is no sound
• Interjections
  • Sound/syllable interjections: "um, um, um, I had a problem this morning."
  • Whole-word interjections: "I had a well problem this morning."
  • Phrase interjections: "I had a you know problem this morning."
• Silent Pauses
  • A silent duration within speech that is considered abnormal: "I was going to the [pause] store."
• Broken Words
  • A silent pause within words: "It was won[pause]derful."
• Incomplete phrases
  • Grammatically incomplete utterances: "I don't know how to...Let us go, guys."
• Revisions
  • Changed words, ideas: "I thought I will write a letter, card."

(M.N Hedge and D. Davis, Clinical Methods and Practicum in Speech-Language Pathology, 1995)

• Secondary Behaviors
  • Visible displays of tension during the dysfluent speech--eye blinking, wrinkling the forehead, sudden exhaustive exhaling, frowning, distorting the mouth, moving the head, and/or quivering the nostrils. Sometimes they include movements of body parts that are not normally associated with speech, such as moving the arms, hands, legs, feet, or torso (Bloodstein, 1987). Shipley and

McAfee, Assessment in Speech-Language Pathology: A Resource Manual, 1998.

• Developmental Dysfluencies
  • Young children (ages 3-5 years) may sometimes demonstrate normal dysfluencies as they are acquiring language. Do not call attention to the dysfluencies. A speech pathologist will be able to assess if the stuttering is developmental (within normal limits for their age), or if direct speech intervention is needed.

Key Benefits for Fluency Therapy

• Increased confidence in speaking situations
• Decrease the avoidance/fear of speaking
• Improved self image

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Orofacial Myology

An orofacial myofunctional disorder (OMD) is any anatomical or physiological characteristics of the lips, teeth, tongue, jaw, cheeks, and palate, that is noticeably different and that interferes with normal dentofacial, speech, physical, or psychosocial development. This includes the lips and tongue at rest, during the swallow, and speech differences (Hale, Kellum & Gross, 1991).

Here are some examples when a person might need orofacial myology intervention:

• Pedodontist/Orthodontist or Dentist has identified a tongue thrust
• Interdental distortions (lisp) of the following sounds: s, z, sh, ch, and dz
• Swallowing or feeding concerns

Key Benefits

• Reduce the risk of dental problems
• Orthodontist will usually not place braces until tongue thrust is fixed
• Increase speech/articulation skills

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Swallowing

A medical evaluation is needed prior to dysphagia/swallowing therapy.

Swallowing difficulties can be a result of a stroke, head injury, dementia, or Parkinson's Disease.

Aspiration (when food or liquid falls into the airway and into the lungs) can lead to pneumonia

A speech language pathologist is part of an interdisciplinary team that can make recommendations for appropriate diet consistencies, compensation techniques and rehabilitation procedures.

Warning Signs of Swallowing Problems:

• Unable to hold liquid or food in the mouth
• Can't chew food
• Delay in swallowing
• Complaints of food being stuck in the throat
• Coughing or choking any time before, during, or after the swallow
• Gurgling sounds when talking during a meal or afterwards
• Any change in vocal quality--especially breathiness or harshness
• Food left in the mouth after the swallow--pocketing or residue left
• Rapid intake (may indicate impulsivity)
• Slow rate of intake and/or multiple swallows per spoonful
• Poor intake. Not eating enough
• Ongoing weight loss
• Head or neck posturing while swallowing (forward, left/right, extended)
• Any complaints of pain during the swallow
• Pneumonia
• Not tolerating current diet
• Heartburn/Indigestion

Signs of Aspiration:

• All of the above plus a temperature, chronic cough, and congestion

Adapted from Hardy & Robinson Swallowing Disorders (1993).

Key Benefits of Swallowing Therapy

• Increase safety in swallowing food and liquids
• May be able to increase the variety of foods eaten
• Increase ability to eat /drink orally to maintain adequate nutrition and hydration

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Please feel free to contact us at 281-379-4373 or e-mail us for more detailed information or to schedule a free consultation.