Alternative or Augmentative Communication:
Those with more severe language disorders may benefit from the use of an alternative or augmentative communication (AAC) system.
AAC systems may be low-tech like communication books or pictures, or high tech like speech generating devices or applications on tablets/iPads.
A Speech-language pathologist can help you find an appropriate method for you or your loved one and help you learn how to use the system in the most effective way for your individual needs.
AAC has been proven to enhance and expand language, and never to reduce or suppress language. While some families may have hesitations regarding AAC, it is a wonderful tool to help develop foundation language skills and communicate wants and needs (even if they speak verbally)!
Apraxia can be acquired later in life through incidents involving the brain. While similar to childhood apraxia of speech (the entire speech system is interrupted, you may see inconsistent errors and groping), treatment is specific to each individual and may vary depending on severity.
Articulation refers to what you may think of when you hear ‘speech.’ If your child has difficulty producing a few sounds, they may need assistance with their articulation skills.
Common articulation difficulties are with the ‘s’ sound (may produce with tongue in between their teeth), ‘r’ (‘rabbit’ produced as ‘wabbit’), and ‘l’ (‘look’ produced as ‘yook’).
Children continue to develop sounds throughout childhood and an SLP will tell you if your child’s articulation errors are typical and likely to improve over time or if they require speech therapy services.
Childhood Apraxia of Speech:
Childhood Apraxia of Speech (CAS) impacts the entire sound system. This disorder occurs when the message being sent from your brain to your muscles is in error.
Perhaps your child means to say ‘hat’ but they said ‘cat’ instead. These errors are often inconsistent from one moment to the next.
Children with apraxia also often have ‘groping’ where you can see their mouths and tongues attempting to reach a certain position, but having much difficulty doing so. They may benefit from a variety of techniques that an speech-language pathologist can provide.
This disorder should not be diagnosed before the age of 3 and is often misdiagnosed by other professionals. If you suspect your child has apraxia, attending an evaluation with an speech-language pathologist can determine how to best help your child.
At Speech and Hearing Associates, speech-language pathologists work with individuals from infancy to geriatrics who have a range of disorders, including cognitive-communication disorders.
Individuals who have noticed difficulty with their cognitive function (such as attention, memory, reasoning, problem solving) may benefit from skilled treatment by a speech-language pathologist.
Difficulties or changes in function may be related to:
- Brain injury
- Parkinson’s disease
- Any other disorder impacting the brain
A speech-language pathologist will complete a full evaluation to determine areas of weakness and tailor a specific treatment program depending on the needs of each individual.
Treatment for cognitive-communication often includes techniques to improve function as well as education on compensatory strategies to use to improve ability to succeed at work, school, and in the home.
Speech-language pathologists also work with speech in adults who have been affected by stroke, brain injury, or progressive diseases. Individuals with dysarthria (slurred speech) may benefit from education and training in compensatory strategies and exercises to improve muscle strength and movement.
Speech and Hearing Associates offers a support group for people with Dysarthria. The group is appropriate for people who experience limited tongue, lip and jaw movement, slurred speech, slow rate of speech or rapid rate of speech, changes in vocal quality, hoarseness or breathiness.
At Speech and Hearing Associates, speech-language pathologists work with individuals from infancy to geriatrics who have a range of disorders, including fluency disorders (stuttering and cluttering).
Stuttering in early childhood may be developmental and no cause for concern. Often children will use repetitions and pauses in their speech as their language is expanding and developing at a quick pace.
For children under 4 years old, seek a fluency evaluation if the stuttering has been occurring for more than 6 months, if you have a family history of stuttering, or if your child is aware or frustrated about their disfluencies.
For older children and adults who are stuttering, a full evaluation is recommended to determine severity and most appropriate treatment plan.
People who stutter require individualized treatment plans to achieve the best outcomes. Stuttering therapy often includes exploration of emotions and feelings surrounding fluency in addition to techniques and treatments.
Cluttering is a fluency disorder that may present similarly to stuttering with repetitions and ‘getting stuck’ when talking. There are, however, some differences in the manifestation and treatment of cluttering. Individuals who clutter also often have difficulty organizing their thoughts for writing and story-telling.
The Lidcombe Program is a treatment protocol for children age 6 and younger who stutter. Our SLPs will educate, train, and work with parents to help their children achieve improved fluency. This program initially gives support to parents weekly to give them the tools to help their child in the home/daily environment.
LSVT-LOUD (Lee Silverman Voice Treatment) is a structured treatment program for individuals with Parkinson ’s disease who have reduced volume, a monotone voice, a breathy quality of voice, or mumbled speech. In order to be trained, our SLPs attended a 2-day hands-on learning course. For this program to be successful, the individual must be motivated to complete carry over exercises in the home in addition to attending therapy with one of our LSVT-LOUD trained SLPs.
PECS (Picture Exchange Communication System) is a type of low-tech AAC (alternative/augmentative communication system) that has been used to help individuals of all ages increase their functional communication. This program is appropriate for a wide range of disorders/diagnoses, including (but not limited to): apraxia, autism spectrum disorder, cerebral palsy, cognitive impairment, and traumatic brain injury. This program has six distinct phases which help the child go from learning to communicate simple requests for items/activities all the way to answering questions and commenting with full sentences. Research suggests that AAC does NOT hinder speech development, but in fact helps facilitate the development of verbal communication.
Phonology refers to patterns of speech production. If your child is very difficult to understand and has trouble producing a wide variety of sounds, they may need assistance with their phonology skills.
Some examples include:
- if your child drops the last sound in all their words (‘ball’ à ‘ba-‘ ; ‘orange’ à ‘oran’)
- if your child produces ‘front’ sounds (t, d) in the back (dog à gog, toe à goe).
Errors like these suggest that the entire system of sounds requires therapy to improve patterns.
Pragmatic language encompasses the social aspects of language, and it is important for children of all ages.
This includes using language for different social purposes such as:
- Requesting information
- Acknowledging answers
- Having a conversation
- Staying on topic
- Talking turns
- Using and interpreting body language and facial expressions.
Speech and Hearing Associates offers social communication groups that target individual treatment goals within a group setting and focuses specifically on social thinking, emotions, conversational skills, and social interactions. For more information contact our Group Therapy coordinator, Elizabeth Bornstein at 800-742-7551 ext:286.
PROMPT (Prompts for Restructuring Oral Muscular Phonetic Targets) is a specific therapy technique to aid individuals with motor planning difficulties. In order to be trained, our SLPs attended a 3-day intensive and hands on learning course. PROMPT therapy involves using tactile cues on the articulators (touching the lips, cheeks, throat) to encourage accurate speech production. This technique may be beneficial for children and adults with a variety of disorders including: apraxia, aphasia, dysarthria, autism spectrum disorder, Down Syndrome, traumatic brain injury, stroke, and cerebral palsy.
At Speech and Hearing Associates, speech-language pathologists work with individuals from infancy to geriatrics who have a range of disorders, including swallowing disorders.
Individuals who have suffered an injury to the brain, neck, or mouth may notice an increase in difficulty swallowing (dysphagia). Others who may have dysphagia are those who have anomalies of the swallow structure or musculature. Some signs of dysphagia include: difficulty chewing, inability to clear your mouth of food, choking, or coughing. In most cases, individuals who have difficulty swallowing should first be assessed through an objective swallow study. Objective swallow studies include videofluoroscopic swallow study (VFSS, aka modified barium swallow/MBS) and fiberoptic endoscopic evaluation of swallowing (FEES). These objective swallowing studies determine any muscle weakness or dysfunction that is contributing to the dysphagia symptoms. Once cause is determined, therapy using swallow strengthening exercises and/or compensatory strategies can be initiated.
Speech-language pathologists also help individuals who have behavioral and/or sensory feeding difficulties. These may be children diagnosed with autism spectrum disorder, sensory processing disorders, or children who are described as ‘very picky eaters.’ Speech-language pathologists will use behavioral strategies to assist with feeding disorders.
There are a wide variety of voice disorders that SLPs are qualified to treat.
Individuals may benefit from behavioral treatment from a speech-language pathologist in lieu of, in preparation for, or following surgery if they have:
- Vocal nodules
- Vocal polyps
- Other vocal fold pathology on the vocal folds
Individuals who use their voice often, do not have good vocal hygiene, and children who scream or use ‘cartoon’ voices often may be at risk for damaging their vocal folds.
If you suspect that you may have damaged your vocal folds due to changes in vocal quality (hoarseness, breathiness) or pain in your throat, it is imperative that you see an ENT first to determine what is causing these changes. SLPs can help treat the symptoms, but first need to know the cause in order to provide appropriate and effective treatment.
Individuals who have been diagnosed with chronic cough and/or paradoxical vocal fold movement (PVFM, aka vocal fold dysfunction/VFD) may benefit from skilled services provided by a speech-language pathologist. Speech-language pathologists can help make behavioral changes to alleviate symptoms and improve quality of life for individuals with these disorders.
Individuals with low vocal intensity/loudness (such as those diagnosed with Parkinson’s disease) will benefit from skilled therapy provided by an speech-language pathologist. Speech-language pathologists will tailor a specific treatment plan depending on individual needs to increase breath support, improve muscle strength and function, and use compensatory strategies to improve voice.
This article was written by SHA Speech-Language Pathologist, Ann Martino,
MA, CCC-SLP. Ann sees patients in SHA’s Cliffside Park office.