Online Therapy Guide
What is Speech Therapy?
Speech Language Pathology Therapy is a health care profession focused on evaluation and treatment of children and adults with speech, language, cognition, and swallowing disorders. Speech-Language Therapists are professionals who are specially qualified to work with people who have speech, language, hearing and / or swallowing disorders. Thus their work in real life encompasses wider aspects of human communication.
What does a Speech-Language Therapist do?
Speech Therapists work with adults and children who have speech, language and / or swallowing problems. They focus on:
- Improving communication (speaking and understanding language)
- Teaching compensatory strategies for effective communication
- Rehabilitating swallow function
- Restoring vocal quality, pitch and projection of voice
- Fostering cognitive skills (memory, reasoning, etc) for daily tasks
Communication and the related disorders can lead to a change in one’s life style, loss of independence, frustration, adverse reactions from others and many a times difficulty with relationships. Hence Speech Therapists during the course of therapy which is often a journey, need to look all possible contributing factors and come up with wide ranging intervention plans to help the individuals overcome and cope with the communication and / or swallowing disorders.
What do the terms Speech, Language and Communication mean?
Speech is a large part of the languages (Mandarin, Malay, Tamil, English, French etc) that we use on a day-to-day basis. It is the physical production of speech sounds. Sounds are coined together based on the rules of the language to form words and eventually sentences.
Language on the other hand is much more that speech alone. It is the way we combine words to convey a meaningful message.
Communication is an everyday experience and it includes not only words, but also nonverbal messages, written words, facial expressions and gestures.
What are the various kinds of speech and language disorders?
There are different kinds of speech, language and communication disorders affecting individuals across different age groups.
In children
- Developmental speech and language delays and disorders
- Articulation problems in children
- Childhood stuttering
- Voice problems in children due to misuse
- Acquired speech and language problems following injury to the brain
- Communication disorders associated with developmental conditions such as Cerebral palsy, Down syndrome, Autism spectrum disorders.
In adults
- Fluency disorders (stuttering)
- Voice disorders (hoarseness , loss of voice after prolonged use etc)
- Speech disorders (slurred speech, difficulty pronouncing sounds) following injury to the brain ( eg, Strokes, Tumours, Head and Neck Cancers, post surgery, Degenerative conditions such as Parkinsons disease etc).
- Language disorders (Dysphasia) wherein a person can have difficulty understanding, speaking, reading or writing.
- Cognitive disorders ( memory problems, difficulty problem solving as a part of day-to-day activities )
What is Dysphasia?
Dysphasia also called as Aphasia affects a person’s ability to communicate. These two terms mean the same and are often used interchangeably. Aphasia means a total loss of language and Dysphasia refers to a partial loss. When a person is dysphasic he/ she loses the ability to understand, speak, read and write either totally or partially. This often results due to a stroke, tumour in the brain or injury to the brain. The severity and type of dysphasia will depend on the area of the brain affected as different sections of our brain serve specific functions. In simple terms the person will find it difficult to talk, understand what others say, read, write or even use numbers and calculate…functions that we all often take for granted! A dysphasic person can often think clearly but has difficulty getting spoken and or written messages in and out. Also we often see caregivers talking loudly to their dysphasic family members-one needs to remember that dysphasic persons are NOT deaf, they have difficulties making sense of what they hear & / express their needs and thoughts via speech.
What is Dysarthria?
Dysarthria is the technical term for slurred speech. It is a speech disorder due to weakness or in coordination of the muscles used in the production of speech sounds. Hence speech may be slurred, jerky or strained and unintelligible to varying degrees. In adults this can be caused by stroke, degenerative diseases of the brain such as Parkinsons disease, Multiple sclerosis etc, infections, brain tumours or excessive intake of medications or drugs. A dysarthric person can have difficulties with various aspects of speech production. The person may have difficulty maintaining the breath support needed to speak. The vocal cords may not move adequately and voice may sound harsh or breathy. Weakness of the lips, tongue and cheeks may make it difficult to pronounce words clearly and speech may sound slurred. The person may also have difficulty controlling the rhythm and rate of speech and may speak too quickly or too slowly. Speech Therapy will involves exercises and strategies to help with any or all of these aspects of speech production.
What is Dysphagia?
The term Dysphagia means ‘swallowing difficulty’. We all take eating, drinking and swallowing for granted. But there are many around us who have difficulties chewing food, swallowing food and tolerating fluids. Swallowing disorders (dysphagia) can be caused by neurologic insult such as stroke or traumatic brain injury, head and neck cancers, developmental abnormalities, surgical excisions, progressive degenerative diseases (Parkinsons, Alzheimers), the aging process, and many other medical conditions.
For people who have difficulty swallowing, the simple act of eating can not only be difficult but life threatening as well. Providing the correct treatment for a swallowing problem can save a person's life by decreasing the risk of choking. In order to provide the correct treatment, an accurate evaluation of the specific structures involved in swallowing and how they are working - or not working - is critical.
What is Videofluoroscopy?
Videofluoroscopy is an x-ray of swallowing recorded onto videotape in ‘real time’.
It enables a detailed objective examination of swallowing on a range of food and fluid consistencies. Videofluoroscopy is performed to determine safety for oral feeding and also determine the effects of various strategies on swallowing function. This test is used to develop a suitable management plan for the patient and also as a baseline to measure progress with treatments such as Vitalstim therapy. Hence patients may need to go through this procedure before and after therapy. Videofluoroscopy is also a useful education tool for patients, families and caregivers.
What is FEES?
Fiberoptic Endocsopic Evaluation of Swallowing (FEES) is another objective tool for examining the swallowing mechanism. It involves passing a thin tube called the endoscope through the nose into the pharynx to observe the act of swallowing as well as the integrity of the structures involved in swallowing. During the procedure the Therapist will ask the patient to swallow different consistencies of food colored with blue or green food coloring to observe swallowing safety. The procedure also allows the therapist to examine the effectiveness of some strategies for safe swallowing.
What is VITALSTIM therapy?
VitalStim Therapy is the only FDA approved neuromuscular electrical stimulation therapy for treatment of swallowing disorders ( Dysphagia).
How does VitalStim work?
VitalStim Therapy uses small electrical currents to stimulate the muscles responsible for swallowing. During treatment, small electrodes are placed externally on the patient’s neck and connected to the VitalStim unit continuously for an hour. The current provides a painless electrical stimulation, which facilitates pharyngeal muscle contraction helping to “re-teach” functional muscle-use patterns. Patients feel varied sensations along with contraction such as tingling, crawling or a grab sensation during therapy. Literature has indicated that 10-15 sessions may be required to achieve the desired outcomes in swallowing function ( Freed et al 1998). Evidence on the efficacy of this treatment method is building with twenty over research projects being undertaken at various centres. A recent study at the Wake Forest University (Christiaanse et al 2005) on 30 paediatric clients revealed improvement in swallow function in 57% of the clients.
How does one get referred for this therapy?
Referrals can be made by any medical specialist. Patients may also request for this service. 'Following a clinical evaluation of swallow function, a Videofluoroscopic assessment of swallowing will be recommended by the Speech Therapist to decide on candidacy for VitalStim Therapy. This test is repeated at the end of the therapy program to evaluate change in swallow status and plan for subsequent management
For more details on VitalStim Therapy visit the website: www.vitalstimtherapy.com or ask your Speech-Language Therapist.
What are the various treatment options for a person with dysphagia/swallowing difficulties?
There are several treatment options available for swallowing disorders. The choice of the management plan will depend on various factors such as nature and severity of the problem, underlying cause, patiet’s motivational level, cognive abilities, caregiver support and so on.
In general, patient may need any one of a combination of the following treatment options:
Diet modification – such a pureed foods, chopped side dishes, thickened fluids etc
Compensatory strategies to reduce the risk of food entering the airway-such as holding the breath while swallowing ( supraglottic swallow), tilting the head or tucking the chin while eating.
Exercise and facilitation techniques
- Exercise to increase muscle tone and range of movement and thus augment the swallow
- Biofeedback ( using EMG, visual feedback during FEES or VFS) to reeducate the muscles which have been affected. The feedback techniques are often used to educate the patient on the use of various compensatory techniques during swallowing.
- Endoscopic and surgical interventions done by the surgeons- such as dilatation of the upper part of the oesophagus called the upper oesophageal sphincter, removal of very obvious obstructions such as cervical osteophytes etc.
- Medical interventions such as Botox injections may also be recommended in some cases.
- Non-oral feeding via different tubes such as the Naso-gastric tube (NG tube) which is a thin tube inserted via the nose into the stomach or via Percutaneous endoscopic gastrostomy (PEG) where a tube is inserted directly into the stomach to aid in feeding.
At Integrated Speech & Swallow Work Pte Ltd (ISSW) we provide comprehensive solutions for communication and swallowing problems.
We believe in ENABLING SKILLS AND EMPOWERING LIVES!
