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This may be a result of an impairment in physical structure, like vocal nodules, paralysis of the vocal cords, cancer of the head, neck or throat or simply age related changes to the vocal structures. However, sometimes voice disorders may be a result of ineffective or improper use of the vocal mechanism. This may mean putting too much strain on our vocal cords, improper breathing and voice coordination, unresolved psychological conflict etc. These are some common complaints:
My voice sounds different.
Why can’t people hear me?
Why am I running out of breath while speaking?
People make fun of my voice.
My throat hurts when I speak!
I sound nasal or high-pitched.
I’m losing my voice!
Learn strategies to improve your vocal health, avoid strain and maximize the quality of your voice. A voice disorder can cause an individual to feel embarrassed, avoid social interaction and negatively affect our quality of voice. Urvi Solanki is also trained in the Lee Silverman Voice Treatment (LSVT-LOUD) specifically designed for individuals adapting to life with Parkinson’s disease. Schedule a consultation to learn more.
Dysphagia refers to difficulty or pain while swallowing, may or may not be a cause of an underlying condition. Often includes difficulty with chewing, food getting “stuck”, coughing while eating or drinking or transmitting the food from your mouth to esophagus and finally to the stomach. Common complaints include:
It hurts to swallow.
I’m scared of choking
I cough when I eat or drink
Recurrent Gastro esophageal Reflux Disease (GERD)
Food is getting “stuck” in my throat
I am constantly belching
It’s taking me too long to chew
Recurrent Aspiration Pneumonia
Excessive Saliva or drooling while swallowing
Urvi Solanki has worked extensively with swallowing disorders over the course of her career. An assessment normally entails a detailed oral mechanism examination to test the strength and integrity of the swallowing system (tongue, jaw, throat etc.) followed by assessment of performance with different textures of food and drink. Swallowing treatment is normally a combination of strategies that help optimize the transport of food from your mouth to stomach in an efficient and pain free manner and exercises that improve the strength of muscles of swallowing. Swallowing disorders are very treatable and the presence of a disorder can greatly impact the ability to enjoy food, socialize and the general quality of life.
Articulation or phonological disorders, also known as speech sound disorders refers to the presence of some difficulty saying sounds the right way, mostly prevalent in children. For adults see: motor speech disorders.
The cause of these difficulties may be organic in nature, i.e resulting from a structural abnormality like a tongue tie, cleft of the lip or palate or something of neurological nature as seen in children with a history of seizures, head injury etc. In my experience, the presence of speech sound disorders in children has been more a result of improper learning and general linguistic errors during development. Living in a diverse community, I have sometimes seen that dialect also plays an enormous role with speech sound production and as a result some children may struggle with producing certain sounds due to lack of exposure during their language development period. Here is what I commonly hear:
“My child can’t say K, R etc.”
“My child has a lisp”
“My child mixes up sounds”
“People can’t understand what my child is saying”
“My child isn’t speaking clearly”
Speech sound disorders are very treatable and a qualified speech therapist is trained to complete a detailed assessment of each speech sound produced and can provide treatment strategies for appropriate placement and accurate production of the sound. Schedule a consultation to learn more.
These most commonly refer to what is known as Dysarthria and Apraxia of Speech.
Dysarthria refers to poor control and weakness within speech musculature while apraxia refers to impaired sequencing of movements involved in speech production.
A large number of neurological conditions can cause these conditions, in my experience as a speech therapist the most common conditions are Parkinson’s disease, Stroke, Multiple Sclerosis, Amytrophic Lateral Sclerosis (ALS) etc. Dealing with a condition like a stroke or other neurogenic condition is difficult as is, but the effects are exacerbated with the frustration of unintelligible speech, slurred nature of speech, difficulty saying the right sounds, altered speech or voice quality etc.
A speech therapist is trained to assess different aspects of speech production that include but are not limited to voice quality, speech and breathing coordination, resonance, intelligibility of speech overall as well as articulation of specific sounds, rate of speech etc. Here are some common complaints:
“I can’t get the words out”
“People can’t understand what I’m saying”
“I’m slurring”
“I’ve lost my voice”
“The words are stuck”
Dysarthria and apraxia are both treatable by trained speech therapists with the use of strategies to improve strength and coordination of speech musculature. Schedule a consultation to learn more.
Stuttering or stammering refers to a breakdown in the fluency of our speech. This fluency disorder may be due to an underlying disease or other factors that mainly include family history, psychological or emotional or just generally when a child is learning how to speak. Sometimes children will gradually overcome their stutter with age while in some cases it may persist. Stuttering can create havoc on self-esteem, confidence, the ability to socialize and impede us from living our personal and professional lives to the fullest.
Stuttering normally manifests itself in the following ways:
Trouble with initiating or starting a word or sentence
Repeating certain sounds, syllables or words
Stretching out or prolonging parts of a word or the whole word
Adding interjections like “us” or “um” excessively
Stopping or pausing between or within a word, resulting in unnatural silences
Sometime stuttering may be accompanied by:
Being excessively nervous or anxious about talking
Avoiding talking
Clenching fists or jaws
Involuntary tics or tremors in face or jaw
Head jerks while speaking
Here is what I’ve heard some of my patient’s say:
“I hate going out”
“Nobody even bothers asking me things anymore”
“I ask my mom to say things for me”
“I don’t know how to speak”
“I have a disease”
“Nobody takes me seriously”
“People just can’t stop laughing at me”
“I’m not normal”
Stuttering is very treatable if one is motivated to put in the time and work that treatment entails. There isn’t a single standard program to fix an individual’s stutter, but normally involves a combination of recognizing and altering negative thought and anxious feelings, boosting self-confidence and learning strategies to help us recognize and correct fluency breakdowns.
Often a result of brain injury or age related cognitive decline. Very commonly seen with dementia, specifically Alzheimer’s, Lewy body dementia and Mild Cognitive Impairment. Attention, memory, problem solving, processing information, speed of processing information, reasoning, interpreting language etc. are commonly affected thus affecting communication as well as activities of daily living like managing medications, finances, appointments etc. These are things I’ll often hear my patients say:
I can’t remember where I put things.
I’m forgetting names, dates and places.
I can’t get the words out!
I’m losing my mind!
I can’t seem to organize my thoughts.
I forget to be safe/ have frequent falls.
Treatment may involve administering a standardized cognitive assessment which includes testing short term memory, attention, language components, visuospatial skills, reasoning, executive functioning abilities etc. Evidence over the years have demonstrated the effectiveness of various programs for treatment of cognitive linguistic disorders. These include the use of spaced retrieval training, reminiscence therapy etc.
Aphasia refers to an impaired ability to understand or produce speech as a result of damage to the brain, normally a stroke or traumatic brain injury. The severity of aphasia can range from a mild form, with some occasional trouble getting a word out occasionally or may be quite severe, with no verbal expression and difficulty following even simple one step commands.
SPARC Health focuses on providing expert care for rehabilitation of speech and language to individuals adapting to life with aphasia. The type of aphasia is normally determined by the area of brain that has been damaged. Broadly speaking, aphasia can be categorized as fluent or non-fluent aphasia. There are several other subtypes under these broad categories.
The presence of aphasia causes a deep impact not just on the individual suffering from aphasia but caregivers as well. A Speech therapist assessment and a speech therapy plan of treatment is imperative for an individual with aphasia. A detailed speech therapy assessment entails assessing several aspects of language comprehension and production. These include naming skills, repetition skills, auditory comprehension abilities, fluency of speech etc. Common complaints or thoughts include:
“Nothing I say makes sense”
“I can’t get the right words out”
“I can’t understand what people are saying”
“I’m stuttering”
“I am so frustrated”
“I need to rely on someone to communicate”
“I can’t ask for the things I need”
“Nobody understand me”
Aphasia is treatable and years of research have equipped speech pathologists with several approaches to treat many different types of aphasia. Depending on the type of aphasia, the speech therapist may opt for Melodic Intonation Therapy, the Verb Network Strengthening Treatment for Aphasia, Constraint Induced Language Therapy, Semantic Feature Analysis for word retrieval etc.
It is also exciting to note that in this day and age we have so many technological support systems in the form of Augmentative & Alternative Communication devices and applications for smartphones and tablets that help support communication for the individual with a stroke as well as for carryover and generalization of learned speech and language therapy skills.
Each individual speaks and communicates in their own unique way. We live in a world where it is more probable than not that our friends, neighbors, neighborhood grocers etc. all sound different and say things differently. Accents may differ depending upon the region where a speaker comes from or may be a result of learning a different language later in life.
The presence of a strong accent can sometimes make personal and professional growth difficult. Some of my clients have felt that their thick accents made it difficult for others to understand them and as a result they felt like they were poor communicators. As a result some felt like they were not receiving promotions or professional growth opportunities compared to some others. This is especially true for those that are required to speak publicly or interact with clientele as part of their job requirements.
Here are some common complaints:
“What did you say?”
“Can you repeat that?”
“I can’t understand what you’re saying”
“Can you write it down instead?”
“Can you ask someone else to repeat that?”
A speech therapist can help you learn how to modify an accent to communicate with different types of listeners may be very beneficial and help us to integrate easily in different communication settings. Sometimes all it takes is learning how to alter just a few sounds to make a large difference.
It is important to note that speech therapy to modify an accent is not considered to be a disorder of speech or language or a medically necessary service. Most insurance companies will not cover this service.
Social communication refers to following or abiding by a set of rules that are used to interact with others in social settings. While it can sometimes be a result of a co-existing impairment like a traumatic brain injury, a voice problem, a stutter, mental health or intellectual disabilities etc.
The presence of “social anxiety” is a term I’ll often hear my patients use while describing their thoughts prior to engaging in social activities, especially with teenagers and young adults. Social anxiety may occur in isolation but the effects are compounded further with the presence of an associated condition like voice problems, speech problems or accents that the listener may struggle to comprehend.
Social communication disorders may affect children, youth and adults and can wreak havoc on an individual’s ability to make meaningful connections and grow both personally and professionally.
Social communication does not incorporate speech or language production alone. It encompasses a combination of listening or auditory comprehension skills, learning to identify and respond to non-verbal social cues and behavioral and cognitive components. A combination of these factors is what helps shape our responses efficiently and appropriately for different contexts. Here are some things I’ll commonly hear:
“My child says the most inappropriate things”
“I don’t know how to start a conversation”
“I’m embarrassed to speak in public”
“I’m just shy”
“I never know what to say”
“I’m so awkward”
“I get really nervous while talking”
“I can’t seem to organize my language”
“What I say doesn’t make sense”
Social communication disorders are very treatable. Therapy normally involves developing an honest relationships with your speech therapist followed by an in depth analysis and assessment of social skills. In addition to interaction with the speech therapist, assistance and input from caregivers, friends and family is imperative. After your speech therapist completes your evaluation, treatment involves identifying strengths to build on or weaknesses that we can alter with the use of strategies, practicing in social situations and sometimes during group therapy sessions.
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