There is no such thing a perfectly fluent speech! Everyone may repeat some words, sounds, or pause to think of what they want to say. However, stuttering is more intense. It is a developmental speech disorder that may not resolve in the childhood. The child will grow with it and the adult will start to avoid dyslfuency by avoiding some words, some social events, talking to phone, etc.
There are multiple methods of treating stuttering in adulthood:
1- Stuttering Modification: which is known as "easy stutter". The Speech-Language Pathologist will work with the person who stutters on the negative attitudes toward stuttering. The person who stutters will learn techniques of catching the moment of stuttering and make their stuttering easier.
2- Fluency Shaping Techniques: The person who stutters will learn strategies to increase moments of fluency by learning certain techniques. e.g. Slow speed rate, pausing, etc.
3- Mixed Techniques: The person who stutters may be able to use stuttering modification and fluency shaping techniques together.
4- Camperdown Program: A new program that teach the person who stutters to speak in monotone voice and very slow speed rate speech, then fade the technique gradually until the person achieves the natural and fluent speech together.
Sound production is a complex process that requires multiple systems to complete it: Respiratory System (The lungs), Phonatory System (Voice box), and Articulatory system (Oral structure and function). Some adults may mispronounce some sounds like R or S for different reasons. The Speech-Language Pathologist helps the client corrects the sound production by completing an assessment and then providing a hierarchy of trainings:
1- Auditory training of the accurate sound production.
2- Increased awareness of the place and manner of the sound production.
3- Producing the sound in isolation, syllables, word (Initials/Medials/Finals), phrases and sentences, and finally at the conversation level.
The therapy continue to ensure the client is pronouncing the sound accurately in his/her spontaneous speech.
Everyone has his/her own unique voice. However, sometimes our voice quality changes due to various reasons:
Medical (infection, cancer, etc.), neurological (nerve damage), functional (misuse the voice by adding tension on our vocal folds while speaking), environmental (smoking, etc).
The Speech Pathologist will do an Auditory- Perceptual Evaluation of Voice and may use special instruments to assess your voice quality. Additionally, the S-LP may ask the patient to fill a questionnaire to describe their voice and the effects of their voice on their lives. The S-LP may request a referral to the Ear Nose Throat to complete a Fiberoptic Laryngoscopy for more investigation about the status and the movement of the vocal folds. After the assessment and the imaging are done, the S-LP will provide the best technique/exercises (e.g. vocal function exercises) and treatment for the patient. The patient may also need medical intervention (medicines and/or surgeries).
Some adults may suffer from a brain injury (bleeding, clots, trauma, etc) due to accident, or stroke that damage parts of the language and motor speech areas in the brain. This injury may lead the patient to either lose their ability to speak (e.g. Aphasia, Apraxia, Dysarthria) or may lead to a swallowing disorder (Dysphagia).
Some of stroke survivors lose their communication abilities because of a damage that happened to a specific area in the brain which controls language expression and comprehension. This will lead to a language disorder known as Aphasia (a disorder that affects the ability to understand, express, read, and write). Other people lose their language abilities gradually due to dementia and this is known as Primary Progressive Aphasia.
Aphasia has several types:
Broca's Aphasia (expressive)
Wernicke's Aphasia (receptive)
Anomic Aphasia: (word-finding difficulty)
Global Aphasia: (receptive and expressive).
If you have Aphasia, the Speech-Language Pathologist will test your language skills: How you understand words, questions, directions, how you produce words, sentences, and will test your reading and writing abilities.
After the assessment, the S-LP will set the goals to help you find the best method of communication and improve your language abilities. additionally, the S-LP will educate your family/ communication partners on how they can make it easier to understand you and talk to you.
Eating and tasting a variety of food, desserts, and drinks is leisure and fun. It could be one of the most important social activities in our life! We eat with family, friends, beloved ones, groups, colleagues, etc. We all have few difficult moments in our life eating something hard to chew or we are hurried drinking and choke with water. However, some people have these difficult moments frequently in their daily living! When swallowing affects our daily living and quality of life it could be threatening! it is called Dysphagia.
Swallowing is a mechanical process starting from chewing food or sucking liquids (Oral Phase) to swallowing by pushing food down the throat (Pharyngeal Phase) then entering the esophagus (the tube down to stomach) to reach finally your stomach (Esophageal Phase) .
Dysphagia may occur at any phase. Signs of dysphagia are, but not limited to:
1- Increased chewing time or extra effort to chew.
2- Food/Liquid coming out of mouth.
3- Holding or keeping liquid/food in mouth.
4- Coughing or choking.
5- Wet-gurgly sounds in the voice when talking.
6- Painful swallow.
7- Hard to swallow.
8- Food/liquid coming back from nose.
9- Food stuck in throat/chest.
11- Difficulty breathing.
Dysphagia can cause severe conditions if untreated such as choking, dehydration, poor nutrition, weight loss, and pneumonia (lung infections) and may cause death.
There are many reasons for Dysphagia in Adults. It could be a damage in the brain like a stroke or Alzheimer’s, or in the head and neck like cancer or injury.
We can evaluate swallowing and make recommendations according to the condition in collaboration with other professionals. We may request for imaging swallow studies: VFSS in a hospital or FEES in an ENT clinic.
Treatment of dysphagia depends on the type and severity of dysphagia in addition to the cognitive abilities of the client.
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