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1) Oral-Prepatory: Bolus is being prepared for a safe swallow by breaking it down into smaller pieces 2) Oral: tongue pushes the bolus against the palate, moving it backwards towards the pharynx. This stage is complete when the bolus enters the pharyngeal area. 3) Oral stage: leading up to the swallow 4) Pharyngeal: epiglottis moves to protect the airway and direct the bolus towards the stomach. 5) Espohageal: lowering and backwards movement of larynx and resumption of breathing
Etiology: Medical conditions such as GERD, heart disease and respiratory conditions, structural abnormalities such as cleft lip or palate, neurological disorders such as cerebral palsy, sensory issues with the taste, smell, texture, or color of food, behavioral issues such as tantrums or resistance to mealtime, prematurity, medications that alter appetite, and autism.
Evaluation: An oral mech exam is carried out to understand muscular deficits such as the lips being unable to fully close and keep food in the mouth. SLPs will ask what sensory issues the patient has to create a treatment plan that gradually exposes them to their aversions. SLPs will work with the patient and their caregivers to obtain a complete medical history including birth complications, medical conditions, and medications.
Treatment: SLPs can work on an interdisciplinary team of gastroenterologists, psychiatrists, nutritionists, radiologists, and occupational therapists to meet the nutritional needs to grow and remain healthy in a safe way. Some alterations can include altering the position a patient is in when eating, using postural supports, adaptive feeding equipment, making the bolus thicker or thinner, and counseling families on how they can support their loved ones outside of their therapy sessions.
Treatment: Since dementia is progressive and there is no “cure”, the primary focus is retaining as much independence as possible while improving the patient’s quality of life. This can be accomplished through reminiscence therapy, using old pictures, objects, or videos with important meaning to trigger long-term memory or spaced retrieval training where the SLP presents new information and gradually increases the length of time in which the information is remembered.
Evaluation: Understanding the decline of functioning and it’s interference with one’s independence. Identify core symptoms such as attention, executive function, learning, memory, language, social cognition, and motor functions.
Etiology: Alzheimer’s disease, Huntington’s Chorea, hereditary disorders, vascular disease
Treatment: Focus on restoring the deficits revealed in the assessment. This can be accomplished through games working on memory, reasoning and problem solving.
Evaluation: Levels of Cognitive Functioning Scale monitors behavioral changes throughout TBI recovery. SLPs obtain language samples to understand deficits across cognition and communication (word finding, grammar, spelling, reading, writing, taking turns, maintaining topics, understanding facial/body expressions, sarcasm, attention span, problem solving, judgment, planning, and goal setting)
Etiology: Motor vehicle accidents, falls, blast trauma, assaults, or foreign object penetration
Treatment: The primary goal of aphasia therapy is to reduce language deficits by restoring linguistic skills and developing compensatory strategies to increase communication effectiveness. Constraint-Induced Language Therapy is a body structure and function restorative approach. Promoting Aphasiac Communicative Effectiveness and Supported Communication for Aphasia promotes communication outputs and increasing conversational abilities. Group therapy can offer a setting to practice communication skills in a non-threatening environment
Evaluation: Boston Diagnostic Aphasia Examination is a body functions and structures approach characterizing strengths and weaknesses of specific linguistic skills (naming, fluency, auditory comprehension, and repetition)
Etiology: Left hemisphere brain damage as a result of a cerebrovascular accident (stroke) or traumatic brain injury (TBI)
Treatment: Focus on phonological awareness, sight word knowledge, reading, writing or retelling stories, and social linguistic skills through play or conversation as it is age appropriate to each client.
Evaluation: Language and writing samples are used to identify deficits in expressive language and asking the child to read a passage, marking errors, gives a baseline for deficits of receptive language. The SLP can identify what area(s) their client needs the most improvement in, whether it is grammar, semantics, vocabulary, ect.
Etiology: In most cases, the disorder is idiopathic (cause is unknown) but can also occur as a result of genetics, environmental factors, brain injury, or mental illness.
Treatment: Child centered approach is where the clinician and child engage in conversation during play to increase the number and type of words a child uses. This includes self-talk, parallel talk, expansion, extension, and recast. The clinician centered model is more structured, aiming to teach a specific skill in form, function, or pragmatics. The hybrid approach is a combination of the clinician and child centered. This includes focused stimulation and vertical structure.
Evaluation: Norm-referenced tests compare a child’s skill in a given area to other children of the same chronological age. Criterion referenced tests measure a child’s performance in comparison to predetermined standards. An SLP can also conduct a language sample through play, asking the child to look at pictures and create a story around them. This is an opportunity to examine most aspects of language.
Etiology: Believed to be a result of genetic, neurological, and/or environmental factors
Carcinoma: cancer of the larynx
Treatment: A team including surgeons, speech pathologists, physicians, and otolaryngologists work together to treat cancer of the larynx. It may be possible to simply remove the cancerous tissue and proceed with chemotherapy or radiation therapy. In some cases, complete removal of the larynx may be necessary, known as a laryngectomy. Post-operative, the team counsels their patient to decide if an artificial larynx, esophageal speech, or tracheoesophageal speech is the best fit for them to improve phonation and fit with their lifestyles.
Evaluation: Videoendoscopy is when a clinician threads a long camera down the pharynx, allowing for direct visualization of the vocal folds and larynx. They may identify abnormalities with this examination. Patients will also be asked for a case history to determine any genetic links or pre dispositions such as a family history of cancer. A biopsy may also be taken to examine the tissue of the larynx under a microscope.
Etiology: Tobacco/alcohol use, older age, family history, exposure to chemicals or viruses such as human papillomavirus (HPV)
Stuttering: an unusual amount of tense, within-word disfluencies that interfere with the continuity of speech
Treatment: Stuttering modification focuses on reducing negative attitudes and reactions to speaking situations by altering the way a client stutters. Clients learn cancellation, pull-out and preparatory set techniques. Fluency shaping teaches the client a new way of talking that reduces the likelihood of stuttering. A slower rate of speech, relaxed breathing, easy initiation of sounds, and smoother transitions between words is taught with the goal of stutter-free speech.
Evaluation: Interview and case study provides information about a patient's lifestyle, environment, consistency of disfluencies, changes, and behaviors. Speech samples of 100 or more are obtained and recorded. Then, the calculations of disfluency per total words, stuttering-like disfluencies per total disfluencies, and stuttering-like disfluencies per total words are compared to mild, moderate, and severe markers. A SLP may also conduct a hearing screening, oral-mech exam, and speech and language tests to determine any comorbid conditions within the speech production system.
Etiology: Neurological and cognitive factors (such as neural structures/functions, genetics, temperament, cognition, language, information processing, and speech motor control) or external conditions (such as culture, parental expectations, childrearing beliefs, experiences, and parent/sibling/peer relationships)
Treatment: SLPs, occupational therapists, audiologists, special educators, neurologists and physical therapies work together. Surgery and drugs may work for patients where dysarthria is a symptom (such as parkinson’s). Clients may also use a postural support to be in the best position for speaking and speech therapy focusing on improving intelligibility.
Evaluation: Each subsystem of speech production is examined (respiration, phonation, velopharyngeal function, and articulation)
Etiology: Dysarthria in children is most commonly associated with cerebral palsy, a condition characterized by weak, paralyzed, or uncoordinated muscles. Acquired dysarthria occurs after speech and language development as a result of conditions such as Bulbar palsy, cerebellar damage, and Parkinson’s disease.
Treatment: Improve the motor programming of increasingly more demanding syllables, words, and phrases. Focus is on rate and rhythm control.
Evaluation: Identify core symptoms (prosodic impairment, disfluency, and speech sound errors). Diagnosis is controversial and difficult due to possible overlap with other conditions such as Broca’s area aphasia
Etiology: Stroke or traumatic brain injury
Treatment: Focus on speech motor movements (auditory, visual and tactile cueing), prosodic deficits, and phonological awareness. The use of Augmentative and Alternative Communication (AAC) is common with CAS. Development is very slow despite intensive speech therapy.
Evaluation: Identification is difficult because clinicians don’t agree on differentiating from other disorders such as a severe articulation delay. Speech and Language screenings are necessary alongside ruling out other possible conditions such as muscle weakness or phonological disorders.
Etiology: No significant sensory loss, abnormalities or emotional disorders, implying possible neurological and genetic factors as causes.
