speech therapists

Speech Matters June 2011

Taking Care of Your Voice

Speech Matters

by Cheryl D. Lindsay M.S., S-LP

Have you ever felt like you had “a frog in your throat?” The belief behind this old story was that if you drank pond water, containing frog eggs, a frog would grow in your throat, obstructing your airway, and the result would be a “croaky” sounding voice.  A “croaky” sounding voice is not a normal voice.

In order to understand how to take care of your voice, it helps to understand, in simple terms, how your “normal” voice is produced.  As you breathe out, air flows over your vocal folds, (also called voice box or larynx), causing them to vibrate. The air then flows through the resonance chamber, (mouth, and sometimes nose) and then out. To “feel” your voice, put your hand on your throat and say /v/. Then try /f/ and you should not be able to feel the vibrations.

The size and shape of your mouth and the size and condition of your vocal folds, changes the way sounds are produced and gives each of us our unique sounding voice.  The larynx, located at the top of your windpipe, is made up of muscles covered in a mucous lining. If your larynx is damaged in any way, by a growth or disease, (pathology), then your voice will be affected.

There are professionals that help train your voice for singing, but that voice training is not usually in the scope of practice of a speech-language pathologist, (SLP).  An SLP can help to retrain your voice after vocal fold damage.

Normal changes in your voice occur throughout your life. The most notable changes in children occur between a very young age, (higher pitched), and early teen years, (lower pitched, especially in boys when they reach puberty). Your voice also changes with your emotions. There are further changes in older adults when their voice typically becomes weaker.

The other characteristics of voice besides loudness and pitch are nasality, i.e. the amount of air flowing through the nasal cavity, and quality, i.e. breathiness, hoarseness, strain, pitch breaks, tremors, or arrests.

The most common voice problem in children is vocal nodules, which form on the vocal folds as a result of vocal misuse or abuse. There may also be more serious problems such as vocal polyps, laryngeal cancer, contact ulcers, vocal fold paralysis, or infections, which can cause laryngitis.

Another common voice problem is linked to gastroesophageal reflux, (GERD), a burning sensation in the throat. It is caused by stomach acid backing up into the throat and damaging the vocal folds.

Other voice disorders can be related to psychological problems.

An Ear, Nose and Throat specialist, (ENT), can use endoscopy, which is a photo or video of your larynx, to identify the problem. Sometimes surgery is recommended.

An SLP can help you take care of your voice by recommending voice therapy and proper vocal hygiene.

The following tips will help you keep a healthy voice.

– Stay hydrated by drinking plenty of water.

– Get plenty of rest, including vocal rest.

– Practice good posture and relaxation exercises.

– Use a humidifier in dry winter months.

– Avoid caffeine, alcohol, certain lozenges, (peppermint and menthol), and smoking.

– Don’t strain your voice i.e. no loud talking, yelling, screaming or making loud, non-speech noises.

– Practice a softer voice, but not whispering, as it can dry your vocal folds.

– Avoid excessive throat clearing.

(Next Month: How Speech Language Pathologists can help individuals with autism)

Speech Matters May 2011

Speak Well, Hear Well, Live Well”:  May is Speech and Hearing Month

 

Speech Matters

by Cheryl D. Lindsay M.S. S-LP

The month of May has been designated by the Canadian Association of Speech-Language Pathologists and Audiologists, (CASLPA), as Speech and Hearing Awareness Month.

“One out of ten Canadians lives with a serious communication disorder.” (Source: www.caslpa.ca )

The goal for speech-language pathologists and audiologists is to enhance one’s quality of life by improving communication skills.

It is important that speech and hearing problems be identified as early as possible. In the past few years, and again this year, free speech and hearing screenings are being offered at the Early Years Centre, in Hanover, (ph. 519-376-8088).

A speech-language pathologist, (S-LP), is able to help assess, diagnose and treat many aspects of disordered communication. These include:

  • Voice:  clarity, volume, pitch, hoarseness
  • Articulation, or, how sounds are produced
  • Receptive language, or, understanding
  • Expressive language, or speaking
  • Swallowing
  • Dysfluency or stuttering
  • Respiration
  • Apraxia or motor planning
  • Phonological processing

An SLP, as part of a health care team, is also able to help people who have communication challenges as part of, or, in conjunction with, other diagnoses such as:  

  • Autism Spectrum Disorder, (ASD)
  • Attention Deficit Hyperactive Disorder (ADHD)
  •  Down syndrome
  •  Pierre-Robin Syndrome
  • Acquired Brain Injury, (ABI)
  • Central Auditory Processing Disorder
  • Cleft palate
  • Cerebral Palsy

Communication delays or disorders that affect children in infancy to preschool years, may have consequences that affect success in school, both socially and academically. Early identification and treatment can be critical to a child’s success.

If you are concerned about any aspect of your, or a family member’s communication, speech language pathologists and audiologists are here to help. To find a qualified professional in your area, visit www.caslpa.ca.

(Next Month: Taking care of your voice)

Speech Matters April 2011

Fluency Disorders – Not Just The King’s Speech

Speech Matters

By Cheryl D. Lindsay M.S., S-LP

Fluency disorders are more commonly referred to as stuttering. In England, during the time of King George VI, stuttering was, and is still called, stammering.

Fluent speech is the smooth, rhythmic flow of sounds syllables and words. It occurs “automatically” and without effort. Around the age of two years, when children begin to put words together, they may go through a period of normal dysfluency. These periods of dysfluency may last until school entry. At times, adults may also speak less fluently, especially under conditions of stress.  When periods of dysfluency persist, a speech-language pathologist, (SLP) can help to determine whether the child is truly stuttering.

Dysfluent speech is diagnosed by an SLP who measures the following characteristics:

  • Repetitions of sounds, syllables, phrases or words  i.e. “c-c-c-c-cat”, “ban-ban-ban-bandaid”, “I want – I want – I want”, “I I I I want to go”.
  • Restarts/Revisions i.e. “ I want, I mean can we … ?”
  • Prolongations i.e. “sssssssand”
  • Interjections, or fillers, such as “um” and “er”
  • Hesitations, or long pauses before speaking
  • Blocks or “silent struggles” described as words getting “stuck” or the words “won’t come out”
  • Secondary characteristics or avoidance behaviours such as eye blinking, tension or shoulder shrugs

True stuttering is a rare disorder affecting only 0.5 – 1 % of the general population. It tends to run in families, is more common in males than females, and is less common in preschool aged children. There is no known cause or cure but there is help in the form of therapy.

Before the age of school entry, normal dysfluency, or developmental dysfluency, may present with word or phrase repetitions. The child is usually unaware, there is no tension in his speech and the episodes of dysfluent speech may start and stop over a long period of time.

People, who are aware that they stutter, often experience feelings of frustration, anxiety, and fear of certain speaking situations.  It is important to note that these feelings are not the cause of stuttering but rather reactions to the speech disorder.

By being good listeners, there are things we can all do to help a person who stutters;

  • Do not interrupt or try to finish sentences.
  • Do not suggest they slow down or start over.
  • Try to create a relaxed atmosphere and model a clear, concise, slower rate of speech.
  •  Encourage turn taking which reduces competition for speaking time.
  •  Maintain eye contact.

The old school of thought regarding dysfluency said that, if you drew attention to the stuttering, it would get worse. As Caroline Bowen suggests, this thinking leaves the child “confused and wondering why her struggle to speak fluently is an unmentionable subject.” The more current view says that ignoring the issue does not necessarily best serve your child.

Bowen, C. (2001). Stuttering:  What can be done about it? Retrieved on Apr. 13, 2011 from www.speech-language-therapy.com/stuttering.htm

www.caslpa.ca  (Stuttering Factsheet)

 www.istar.ualberta.ca/content/pdf/info_4_parents.pdf

www.stutteringhelp.org  

(Next Month:  May is Speech and Hearing Month! )

Speech Matters November 2010

What is a Late Talker? – Speech Matters – November 2010

By Cheryl D. Lindsay MS., S-LP

 ‘Late talker’ is “a term used to describe children 18 to 20 months old, who have fewer than 10 words or those 21 to 30 months old, who have fewer than 50 words and no two-word combinations. Typically, these children have no other problems.” (Source:  Contemporary Pediatrics. “The ‘late talker’ – when silence isn’t golden”, by Marilyn C. Agin, MD, 2004)

 Speech and language developmental milestones have been presented here in previous columns. As speech is developing, it is important to recognize that a child will follow a certain order through the stages, but may be delayed at reaching the milestones. The stages begin with reflexive sounds; cooing, (first using vowels); babbling, (reduplicated e.g., “mama” and then variegated e.g., “baba beee-ummm gubba dum-goo-ee?”); vocal play; jargon; first words and then putting two-words together. When the order of development is not typical, or where there is regression in some areas, there may be reason for concern. A speech-language pathologist can help by assessing your child’s speech and language development.

 Although most late talkers do eventually “catch up” and speak normally, it is wise to be aware of warning signs that may indicate a disorder rather than a delay.

Sometimes talking late may be a symptom of another condition such as a hearing loss, cognitive impairment, speech disorder, (dysarthria, apraxia, phonological disorder), language disorder, autism spectrum disorder, or another syndrome. These conditions would be diagnosed by the appropriate medical professional. If late talking is not just delayed but a symptom of another condition, it will not resolve itself, therefore, early diagnosis and early intervention are necessary.

 Receptive language, which is comprehension or understanding, develops before expressive language. An example of this would be asking your child to put on their winter coat and they do so because they understand the request, but are unable to use vocalizations to express themselves. If a child’s receptive language is delayed, this would be cause for concern.

 Children can still communicate without words or nonverbally, by using eye-contact, gestures, body language, facial expression, shaking or nodding their head for yes or no, or hand leading.  Ultimately though, encouraging vocalizations with these initial nonverbal skills should lead to using true words and more verbal communication.

 Late talking may result in the experience of frustration for the child and the caregiver. It is important to stay positive and encourage good self-esteem. Think of your child as ‘learning to talk’ rather than ‘being expected to talk’ and celebrate every small step!

 (Next Month:  Phonological Processes – A child’s normal patterns for simplifying adult speech)

Speech Matters October 2010

Speech and Language School Readiness-Speech Matters – October 2010

By Cheryl D. Lindsay MS SLP

 The education system in Ontario is moving toward full day, every day, Junior and Senior Kindergarten with some schools already implementing pilot programs this year.  “Let’s Learn Clinics” are being held at all area elementary schools. These clinics are an alliance of school boards with other ministries and agencies who come together to help ease the transition from home to school in conjunction with early registration. School staff and other professionals like speech-language pathologists are in attendance to help answer questions regarding preparedness for school entry. With “Let’s Learn Clinics” upcoming or currently taking place, the question on the minds of many parents is, “What do I need to do to help my child get ready for Kindergarten?” 

 Language acquisition begins long before school entry.  Parents have probably been told that they are their child’s first teachers, as well as being the most important people in their child’s life. They provide the speech models and the enriched environment within which a child progresses through the stages of speech and language development.

 There are many checklists that describe skills to be mastered before school entry. A wide range of skills including social, gross and fine motor, as well as speech and language are included in most school readiness checklists. When reviewing these checklists, it is important to remember that young children change quickly and often, therefore, something not mastered today, may be mastered a few weeks from now.

 Under the speech and language category, the following skills are very important for school readiness:

  • ability to follow directions,
  • speaking intelligibly;
  • identifying some letters, (perhaps letters in their name), counting to ten;
  • recognizing groups of items and being able to categorize, identifying beginning sounds of words (eg. “mom” starts with the /m/ sound);
  • recognizing and producing rhymes.  

(Source: Kindergarten Readiness Checklist Family Education.com)

 The Thames Valley District School Board (TVDSB) website offers parenting tips for helping children get ready for school.  Some of these include:

  • reading aloud;
  • listening when your child talks and  ‘reads’, or imitates/pretends to read;
  • being generous with praise;
  • setting limits;
  • modeling good language;
  • setting good examples.

 In a study done by the University of Western Ontario (UWO) and TVDSB, parents learned that several factors influenced a child’s adjustment to junior kindergarten. These included:

  • activities children engaged in at home, like helping with chores;
  • being read to, including indentifying and sounding out letters and identifying numbers,
  • engaging in literacy based activities on the computer, during crafts and when colouring;
  • visiting the library. (For more information about supporting reading, visit the South Grey Bruce Youth Literacy Council website at www.sgbyouthliteracy.org

The importance of language development during play, reading and activities of daily life in the early years sets the stage for success at school.  As parents are their child’s first teachers, preparing for Kindergarten entry should be a top priority.

 (Next Month:  What can be done for “late talkers”?)

Speech Matters September 2010

Parenting Tips to Help Develop Speech and Language in Young Children – Speech Matters  – September 2010

By Cheryl D. Lindsay, M.S. SLP

In the last two columns, milestones were presented for parents who may be concerned about their child’s speech and language development.

 There are many ways in which parents, grandparents and caregivers can help encourage good communication.

 A speech-language pathologist will look at several areas of development when assessing a child. The tips shared below have therefore been divided into categories:

 Social Language:

  • Make eye contact. Communication is more effective when talking face to face.
  • Encourage turn taking by playing games.
  • Use your child’s name often.
  • Use gestures with words.

 Expressive Language:

  • Give your child time to answer questions.
  • Allow your child a chance to make a verbal request instead of anticipating what they want and giving it to them. 
  • Give choices and show interest in their choices to encourage self-confidence.
  • Let them talk to family members on the phone.
  • Describe your daily activities as you go along. For example, “I’m drying you with a big blue towel”.
  • Don’t interrupt your child when he/she is speaking.

 Receptive Language

  • Encourage your child to follow directions starting with one step directions: “Tidy-up time”, and then progressing to two or more steps.
  • Read books. Start with simple picture books. Help label items by pointing. Encourage interaction and echo reading. When your child starts to read, don’t always correct mistakes. Let them use pictures to formulate their own sentences and to anticipate what happens next. It is valuable to read the same books over and over again to help understanding. Allow invented reading. They feel like they are reading even when they have memorized the text.  Talk about first sounds and letters in words.
  • Sing songs – most include rhyming and repetition, which in turn, helps comprehension.

 Vocabulary Development

  • Label items in your house by naming them or even labeling them in print, at their level.
  • While riding in the car, sing songs, point out and name familiar objects or signs.
  • Look in a mirror together and locate and name body parts.

 Articulation

  • Talk to your child often.
  • Speak simply, slowly, clearly, and turn to face your child.
  • If words are mispronounced model back the correct pronunciation without being negative. If your child says, “Are we going in the tar?”, you may respond, “Yes, we are going in the car.” Use a calm, positive tone of voice.
  • Don’t constantly correct your child’s speech. They may become hesitant to talk.

 Overall, it is important to remember to have fun, be a good model, and show enthusiasm when communicating with your child.

(Next month:  “School Readiness:  Speech and Language are Important Components”)

Speech Matters June 2010

Will my Child Outgrow a Speech Problem? Speech Matters-June 2010

By Cheryl D. Lindsay, M.S. SLP

As a parent you may be wondering if your child’s speech is developing normally. Similar to other areas of early childhood development, there are also speech and language milestones. These act as general guidelines to help you consider whether or not your child’s speech is on the right track.

 Below is a brief outline, giving you a range of speech sound development. It is important to remember that there are always individual differences concerning which sound(s) your child will develop, and when.  The beginning of each range shows when the sound may begin to develop, and the end of the range shows when your child should be able to say the sound correctly. (Source: Helping Kids Discover and Develop Language (Angus, Cahalan, Chenette & Pinnau Emrich).

 1-3 years    /p,m,h,n,w,b/

 2-4 years   /k,g,d,f,y,ng/

 3-6 years    /r,l/

4-7 years    /ch, sh, z, j/

 5-8 years    /th, zh/

When your child is learning to speak, they may make sound errors along the way. Some errors are quite normal and expected. Common errors include saying “w” for “r” (wabbit for rabbit) and “d” for “th” (dat for that). Errors like these can become a concern when they persist as your child gets older.

 If you are concerned that your child is not saying the sounds that would be expected for his/her age, it is recommended that you first have your child’s hearing assessed. An audiologist is able to test your child’s hearing and tell you whether or not their hearing is within the normal range. The audiologist may recommend next steps for your child, if there is an issue with their hearing. As a parent, you can book an appointment with the audiologist yourself, since a referral from your family doctor is not necessary.

 After the hearing test, if you are still concerned with your child’s speech development, it is recommended that you contact a speech-language pathologist (S-LP).

 Some children will outgrow their speech sound error(s) but some will need speech therapy to help them say their sounds correctly. An S-LP assesses and decides whether or not the speech sound(s) may develop on their own, or if speech therapy is necessary.

 As a parent, there a few things you can do to help your child learn to say their speech sounds. You can model how to say the sound correctly by repeating the word or phrase back to your child, as in, “Yes, that car is red”. You can also ask your child to repeat the word or phrase by asking, “Is it lellow or yellow?” This will help your child learn how to hear the differences between the sound that they are saying and the correct sound.

Speech Matters-April 2010

By Cheryl D. Lindsay, M.S. SLP

 Enriching lives by improving communication skills is the overall goal of professionals helping those with speech, language and hearing issues. In Canada, 10% of the population has a problem with one or all of these. (Source: www.caslpa.ca)

 Speech-language pathologists, and their supportive personnel work in a variety of settings to meet the needs of their clients.  Some of these settings include private practice, schools and preschools, hospitals, health units, and research centres.

 Speech-language pathologists are an integral part of a health care team. Their work in various settings and with many unique clients, brings them together with physicians, psychologists, teachers, occupational therapists and physical therapists.  This cooperation and communication ensures that the patient’s best interests are put first when it comes to supporting development and disorders of speech.

 Communication disorders can be experienced by adults as well as children. Speech-language pathologists, also commonly referred to as “speech therapists”, can diagnose and treat articulation disorders, voice problems, disfluency, language difficulties and swallowing issues. Adults may experience some of these problems as a result of a head injury or stroke.

 An articulation disorder refers to difficulty producing sounds. Someone with an articulation disorder may substitute /t/ for /k/ and therefore, may say /tite/ but mean to say /kite/. Another common substitution is /w/ for /r/, so that the word /rat/ sounds like /wat/. Articulation disorders may include substitutions as above, or omissions or distortions of sounds.

 Voice problems may present as difficulties with hoarseness, pitch or volume and can be the result of vocal cord injury, dysfunction or disease.

 Disfluency, more commonly known as stuttering, can be identified as hesitations, syllable or word repetitions or restarts. Childhood disfluency differs from disfluency in adulthood.  Children often outgrow disfluency but it can sometimes result in long term stuttering.  Stuttering may not onset until adulthood.

 In general, language disorders can be categorized as either receptive or expressive. Receptive disorders refer to problems understanding or processing what is heard. Expressive disorders include problems putting words together in speech, in an appropriate form, so that thoughts are verbalized in a way that listeners can understand.  

 Speech-language pathologists can also assist people who have problems with swallowing and eating.  These problems can be the result of congenital or acquired diseases or disorders.

 In addition to assessments and therapy, research, public education and public awareness are also very important aspects of the professional mandate of speech-language pathologists. Over the next several months, this column will offer information on a number of different speech matters.

(Next Month: “Is it true that my child will outgrow a speech problem?”)

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