Cleft Palate and Speech Therapy
One of the most common birth defects, Cleft Palette occurs in about 1 or 2 of every 1,000 babies born in the United States each year. As early as the 3 first months of pregnancy, a cleft palette may appear as a small notch in the edge of the lip or extend into the nose. Surgery, such as the Phalangeal Flap, can aid in repairing these defects. Through this treatment, performance in children or adults with a cleft palate who have velopharyngeal insufficiency can be improved. In this week’s session, we worked on a student who recently recovered from this cleft palette surgery through which his upper palette was reconstructed. Currently, R.J. is relearning air distribution to better clarify his speech with the assistance of a Cleft Palette team. As part of R.J’s targeted speech goals, we are currently working on including the production of the “S” sound without the use of dentalization. In facilitating activities, such as matching words, R.J is able to show improvement in his articulation of words containing the phoneme /S/ and appropriating times for correct saliva management. This activity of word match also provides a visual for R.J in regard to proper letter formation, spacing, and sizing. By visually seeing how words appear and in which contexts each is used, R.J will gain a better understanding of the word and apply these visual cues to his speech.
My best kept secret would have to be my handy dandy I-pad. It is a fun and effective way that noticeably elicits a sense of eagerness from almost all of the children I work with—specifically Cleft Palette cases. One of my major concerns with R.J is getting the positioning of his tongue to be just right so that he can vocalize his R’s properly. By providing him with an anatomical side by side visual, R.J is able to compare and contrast while interacting with the demo. Since the start of his treatment (post-surgery), R.J has shown vast improvement in appropriating times for correct saliva management. Through activities such as Word Match and asking WH- questions, R.J. works on his swallowing and effectively applies this to his use of /R/. I am pleased to see he is continuing to reach many milestones children of his age have difficulty achieving post-surgery.
Through The Years Speech Therapy is trying to decide on a new logo. Which one do you prefer? Feedback encouraged and welcome! Help us choose (please excuse the bad quality of this Jpeg).
Brain Tumors:The Role of The Speech-Language Pathologist
Brain Cancer- an inexorable reality. Despite our medical and scientific advances, we err on the side of caution when it comes to our body’s temperamental motherboard- an organ so exactly wired that one small deviation in its composition can change a life drastically…….So, a tumor is often left untouched by the scalpel- it’s course left up to potent medication and chance.
Not all brain tumors are inoperable but those that are can mean a drastic life-change for the inflicted person. Depending on where the tumor is located, the person will experience different symptoms that are related to the region of the brain and its locative function. Also, swelling and pressing of healthy portions of the cortex may occur as a result of the tumor and/or the medication (specifically steroids).
A person with a malignant brain tumor will be introduced to many specialists over their course of treatment but a Speech Therapist? What does a Speech Therapist know about treating brain cancer? Well, as an SLP, I can tell you not all that much…but… we do have a decent understanding of the cerebral cortex, sub-cortical areas, and brain stem. We know even more about the symptoms that might occur relating to damage of an area that helps a person function linguistically. Considering that language is how a person connects with the world; it is understandable that it is one of the first changes to be observed. Perhaps, the patient him/herself notices that they cannot express their thoughts coherently or they cannot remember their own sister’s name. Or maybe it is a family member or doctor that is having trouble understanding when the patient speaks. This is where the speech pathologist may be of assistance.
In such cases Speech Therapists are treating symptoms. We are “communication specialists” and if we can’t treat the symptoms from the etiology then like any progressive-degenerative disorder, we will find compensation techniques so that our patients may communicate effectively.
Case study:
Patient A.R. was diagnosed with an inoperable brain tumor that extended from his frontal lobe to his occipital lobe on the left hemisphere. He is currently taking steroids and cycles of chemotherapy and radiation. As expected from damage to any area in the left hemisphere, he is experiencing speech-language changes. Word retrieval problems proved to be the most troublesome for him. He claimed that it interferes with meaningful communication with his family and doctors. The treatment for this symptom is for A.R.to become an expert describer. I created a simple hierarchy of “describers” or ways to describe a word be it noun, verb, or adjective. With a lot of practice and a word log (commonly forgotten words) he is able to automatically go into description mode when he cannot retrieve the word, making it easy for his listener to predict the missing word, help him fill in the utterance, and complete the thought.
Reading is also difficult for A.R. now. He can recognize letters and their sounds but has lost the ability to instantaneously recognize words as most adult readers do. Our technique is to return to a bottom-up approach to reading. A.R. is beginning to sound out words phonetically (we reviewed the diphthongs, blends, and other tricky sound combinations) and then allows the initial phonemic cues to spark recall of the written word. So far it has been working.
A.R.’s path is unpredictable as his tumor changes and manifests for better or for worse. He may experience swelling or, as a cancer patient knows, the enormous relief of a shrinking tumor. As his brain responds to the changes, I will be there responding to his speech-language symptoms.
Visit this link for a list of brain tumor support groups across the nation:
http://www.braintumor.org/patients-family-friends/find-support/support-groups/support-groups.html?state=NY
Or go to our website for more information about the SLP’s role in brain cancer:
http://www.ttyspeechtherapy.com/
Through The Years Speech Therapy is so happy to ring in the new school year at Conerstone Healing, the most therapeutic place in Carroll Gardens, Brooklyn!
476 Court Street
Brooklyn, NY 11231
Augmentative Devices: Easy to Obtain, Easy to Use!
After exhausting all strategies to assist one of my stroke patients overcome their non-verbal Broca’s Aphasia, I decided to go a different route and test her electronic manipulation skills. It turned out that she was a natural, navigating her way around the computer and Ipad with only minimal assistance. She even proved to be able to type a few practiced sentences. I knew right a way that an Alternative Augmentative Device was the solution to her communication problems.
I immediately called Dynavox, creator of all types of speech generating devices (type/touch to speak) designed to fit all different people’s needs. I was given the name of my local Dynavox representative and made an appointment with him. He came right to my clinic with all different devices. Then, we met my patient and her husband to demonstrate the devices. They were both moved to tears. After that one session, they knew that their communication troubles were over. We chose the Maestro, a sleek, tablet-like device that allows the user to navigate around seamlessly choosing pictures, photographs (it has a built-in camera), or typing to speak. I wrote up an evaluation, got a prescription from her primary care physician, sent it to Dynavox, and they did the rest. Now my patient will be able to use her own device in a matter of 3 weeks time! It feels great knowing that she will finally have a voice.
Some things you should know when considering an SGD:
- Medicaid covers 100% of the cost, provided the rationale is there. A trial period with a “loaner device” is necessary before the actual order. The trial could be anywhere from 1 day to 2 weeks.
- Medicare covers 80% of the cost of the device.
-Dual coverage patients (medicaid and medicare) may receive full coverage of the cost with no trial period.
- The devices alone cost between 4 and 8 thousand dollars (Speech Generating).
If you want to know more, check out our website:
TTYSpeechTherapy.com
Speech Therapy- A Family Affair
Speech Therapy is an effective service for re-mediating disorders related to
speech, language, feeding, and swallowing. It can drastically improve an adult or child’s quality of communication, eating, and life….
but it is less effective when therapy
only takes place during therapy. Is that confusing? Let me elaborate- a
good speech-language pathologist is one who includes the entire
family (or caretakers) in therapy. It is not necessary that mom and dad are present during every session or that the home health aid sits in throughout the entirety of therapy
but they should be aware of all the techniques used in therapy. A good
SLP will make additional time for
Family Training or a whole session devoted to teaching family and caretakers how to carryover therapy techniques throughout the child’s or adult’s day for increased efficacy. For example, /s/ reinforcement can be done while mom is giving Johnny a bath (“get the sssssoap”) and swallowing techniques should be prompted to be used by a well-trained aid during Mrs. Johnson’s dinner time. By incorporating speech therapy into daily activities, the skills being taught are more likely to become as habitual as the routines themselves.
Through The Years Speech Therapy always includes the family and caretakers!
http://www.ttyspeechtherapy.com/
Tactile Cues For Accuracy In Speaking And Swallowing
Many fortunate people don’t have to think about what their mouth is doing when they speak or swallow food and liquids. During speech, these fortunate people conjure their ideas then their brain sends a signal to all of the body parts involved in getting the message out accurately. There is little or no thought about the actual process of transforming a “thought” into “speech”, it just sort of happens. Swallowing is similar. It is an automatic reaction that is triggered when food reaches a certain part of our mouth. Unless we are eating something inordinately large or foul tasting, we don’t think much about the actual process of swallowing.
Not all people are so fortunate. Speaking and swallowing involves fine coordination of several muscle movements. Individuals who have a neurological disorder or an articulation disorder with a non-neurological etiology may have difficulty commanding all of their muscles to work together to create speech sounds or to swallow a bolus. During speech therapy there are many different types of cues and prompts that can be used in order to elicit accurate muscle movement. One type of prompting that has proven to be successful is tactile, or prompts involving the sensation of touch. If a person can feel where their articulators should go, they will have an easier time matching the location. For example, words that have the K sound involve elevation of the tongue base to reach the roof of the mouth near the velum. A quick touch with a gloved finger, Q-tip, or lollypop can help direct the tongue to the right location. A patient who is having difficulty swallowing may benefit from a mini massage around the area of the Cricoid Cartilage or a tap with a mirror around the area of the anterior faucial pillars. When it comes to speech therapy, “hands on” is the way to be!
http://www.ttyspeechtherapy.com/
Pediatric Speech-Language Evaluations
Maybe it was your child’s school who suggested a speech-language evaluation, maybe it was your own concern about your baby’s language development, or perhaps it was a pediatrician who recommended an evaluation by a Speech-Language Pathologist. Regardless of the source, a thorough speech-language evaluation should always consist of a few things.
Pediatric Evaluations:
- Intake form by a parent or guardian regarding the child’s medical and communicative history as well as that of their genetic/immediate family.
- An Oral-Peripheral examination in which the Speech Therapist examines the child’s mouth and peripheral mechanisms with a pen light in search of a structural cause of the speech-language deficit (i.e. cleft palate).
- An articulation test to determine any sound errors, if they are consistent, and whether they are developmental or deviant.
- A language evaluation assessing both receptive and expressive language as well as play skills. This usually consists of a standardized test and a language sample.
- A feeding & swallowing assessment if it applies.
Throughout the examination voice, fluency, eye-contact, and other speech-language-related behaviors will be assessed to determine the diagnosis, prognosis, need for therapy, and appropriate goals.
For more information contact the professionals at http://www.ttyspeechtherapy.com/
