Adults may require speech therapy for a number of reasons, including: strokes, traumatic brain injuries (TBI), fluency, Parkinson’s, voice changes, and more.
Traumatic Brain Injury (TBI)
TBIs can occur due to a blow to the head or penetration into the head by a foreign object. The cognitive effects of a TBI vary depending on the location in the brain the trauma occurs. Speech pathologists can work with a variety of symptoms following a TBI including (but not limited to) memory and attention, executive function, language, and speech production.
Aphasia
Aphasia is often caused by a stroke or TBI. There are a number of different types on aphasia based on location and type of injury to the brain, so aphasia can look different for everyone. Communications caused by aphasia can include: understanding speech, producing speech, reading, writing, gesturing, using numbers, and more. While there is no cure for aphasia, most people can improve over time with good speech therapy. The brain is capable of healing by making new connections.
Apraxia
Acquired apraxia of speech can be caused by damage to the brain from strokes, TBI, brain tumors, dementia, and other degenerating diseases. Apraxia is caused by a message from your brain to your mouth not getting through correctly. You may have difficulty moving your tongue or lips around the right way to make sounds, or may not be able to speak at all. Apraxia is considered a motor speech disorder since the motor planning part of your brain is disconnected from your muscle movements.
Dysarthria
Dysarthria indicates a group of neurologically-based speech disorders that have abnormalities of “strength, speed, range, steadiness, tone, or accuracy of movements required for breathing, phonatory, resonatory, articulatory, or prosodic aspects of speech production” (Duffy, 2013, p.4). There are 8 different types of dysarthria that are identified by individual characteristics due to originating in different areas of the brain. Therapy for dysarthria will vary depending on dysarthria type, but often includes focus on respiration, phonation, articulation, resonance, and prosody. Speech intelligibility is affected negatively by the differing types of dysarthria. Dysarthria may be present with the following diagnoses; CVA or stroke, Parkinson’s disease, TBI, Cerebral Palsy, and other neuromuscular disorders.
Dysphagia (Swallowing)
Dysphagia, or difficulty swallowing, is caused either by neuromuscular abnormalities (involving nerves or muscles) or structural abnormalities, such as when the esophagus is narrowed or compromised. When abnormalities occur, you may experience a variety of symptoms, including:
- Coughing/gagging when swallowing
- Pain while swallowing
- “gurgly” or hoarse voice after eating
- Difficulty swallowing
- Drooling
- Unexpected weight loss
- Frequent heartburn
- Sensation of food stuck in your throat or the middle of your chest (if you can’t breathe – call 911)
Dysphagia, or difficulty swallowing, may be present with the following diagnoses; CVA or stroke, Parkinson’s disease, TBI, Cerebral Palsy, Guillian Barre, or other neuromuscular disorders.
ASLHC offers swallowing evaluations one to two times per month completed by a speech-language pathologist (SLP) with special FEES certification.
FEES stands for ‘fiberoptic endoscopic evaluation of swallowing.’ FEES is performed using a thin, flexible instrument passed through the nose. The SLP can then visualize part of the throat to assess how well you may be swallowing.
Voice
Voice disorders can be caused by a number of factors including (but not limited to) phonotrauma (e.g. yelling, too much throat-clearing), vocal fatigue due to overuse, inflammation of the larynx, spasmodic dysphonia, chronic stress disorders, anxiety, and depression. SLPs will begin by identifying behaviors that contribute to the voice problem and then implement healthy vocal hygiene practices. They may use direct or indirect methods of therapy (or both) to treat voice disorders.
Some disorders of your voice may involve: difficulty sustaining sound, vocal nodules or polyps, spasms of the vocal folds, and diplophonia, having two pitches at one time. Additionally your voice may not sound like you, pitch or loudness may be impaired.
Fluency
These are characterized by interruptions in the normal flow of speech. Stuttering – an abnormal repetition or prolonging of sounds, syllables or words – is the most common fluency disorder. Cluttering is a less common fluency disorder.
Parkinson’s and LSVT
One of our SLPs is specially trained in this research-based treatment. This is also a viable treatment option for patients with moderate to severe dysarthria or another muscular dysfunction (not including ALS). To learn more about this treatment, see below:
- LSVT LOUD is the first speech treatment with level 1 evidence and established efficacy for treating voice and speech disorders in people with Parkinson disease (PD) with application to other neurological disorders.
- The LSVT Programs have been developed and scientifically researched over the past 25 years with funding from the National Institutes of Health. LSVT LOUD outcome data have been published in a series of refereed articles in speech, otolaryngology and neurology journals.
- Research on LSVT LOUD has documented improved impact on multiple levels of functioning in people with PD following treatment including:
- Increased vocal loudness
- Improved articulation and speech intelligibility
- Improved intonation
- Improvements in facial expression
- Changes in neural functioning related to voice and speech
- Research on LSVT LOUD has documented improved impact on multiple levels of functioning in people with PD following treatment including:
- LSVT LOUD is a standardized treatment protocol that is customized to the unique communication goals of each person across a range of disease severity and communication impairments.
- LSVT LOUD treatment consists of:
- 16 sessions: four consecutive days a week for four weeks
- Individual 1-hour sessions
- Daily homework practice
- Daily carryover exercises
- It is essential that LSVT LOUD treatment is only delivered by speech-language pathologists who are certified in this method.
- Over 24,000 speech therapists from 70 countries have been certified in LSVT LOUD.
Select References:
- Ramig, L. O., Halpern, A., Spielman, J., Fox, C., & Freeman, K. (2018). Speech treatment in Parkinson’s Disease: Randomized Controlled Trial (RCT). Movement Disorders, 1-15. https://doi.org/10.1002/mds.27460
- Ramig, L., et al. (2001). Intensive voice treatment (LSVT®) for individuals with Parkinson disease: A two-year follow- up. J. Neurology, Neurosurgery, and Psychiatry. 71, 493-498.
- Mahler LA, Ramig LO, Fox C. (2015). Evidence-based treatment of voice and speech disorders in Parkinson disease. Curr Opin Otolaryngol Head Neck Surg. 2015 Jun;23(3):209-15. PMID: 2594396615.
- Research has been funded, in part, by the: National Institutes of Health-National Institutes on Deafness and Other Communication Disorders (NID-NIDCD) DC00976 and DC001150; and The Office of Education-National Institute for Disability and Rehabilitative Research (OE-NIDRR) Grants H133G00079 and H133G40108.
Call Albuquerque Speech Language Hearing Center at (505) 247-4224 for more information or to schedule an appointment.