Voice therapy encompasses a variety of techniques and may involve correcting abnormal pitch, loudness, resonance and/or quality of voice that interferes with communication. These techniques may seek to eliminate potentially harmful vocal behaviors, alter the manner of voice production, and/or enhance vocal fold tissue healing following injury. Emerging data suggests that voice therapy is an effective and appropriate method of therapy either in itself or as a compliment to other treatment modalities (e.g., surgery, medications).
Speech Therapy
What is Pediatric Speech Therapy?
Pediatric Speech Therapy is the treatment of communication and feeding/swallowing disorders in children. Speech – Language Pathologists (SLP) and Speech-Language Pathologist Assistants (SLP-A) treat patients who exhibit difficulties with comprehending or expressing spoken and/or written language as well as weaknesses with articulation, voice and fluency disorders. SLP’s can also assist in the development of rehabilitation of the oral and pharyngeal stages of swallowing.
Components of language include phonology, the manipulation of sound according to the rules of the language; morphology, the understanding and use of the minimal units of meaning; syntax, the grammar or principles and rules for constructing sentences in language; semantics, the interpretation of meaning from the signs or symbols of communication; and pragmatics, the social aspects of communication. Components of speech production include: phonation, the process of sound production; resonance, opening and closing of the vocal folds; intonation, the variation of pitch; and voice, including aeromechanical components of respiration.
SPEECH THERAPY TREATMENTS AND TOOL RESOURCES USED IN THE EVERYDAY ST SETTING
Auditory Verbal therapy is a highly specialist early intervention programme which equips parents with the skills to maximise their deaf child’s speech and language development. The Auditory Verbal approach stimulates auditory brain development and enables deaf children with hearing aids and cochlear implants to make sense of the sound relayed by their devices. As a result, children with hearing loss are better able to develop listening and spoken language skills, with the aim of giving them the same opportunities and an equal start in life as hearing children.
Auditory Verbal techniques and strategies – to develop their child’s listening and spoken language. Auditory Verbal therapy enables parents to help their child to make the best possible use of his or her hearing technology and equips parents to check and troubleshoot it in collaboration with their audiology team. This will maximise a child’s access to sound so that listening and spoken language skills can be developed to the fullest extent possible.
the child develops a listening attitude so that paying attention to the sound around him or her becomes automatic. Hearing and listening become an integral part of communication, play, education and eventually work. All learning from the sessions carries over into daily life. This means that at home, parents can make everyday activities such as setting the table or reading a story into a fun listening and learning opportunity.
Treatment involves correcting inappropriate productions of standard speech sounds due to incorrect placement of the lips, tongue, teeth, velum and pharynx during speech. Correct speech becomes easier as a child’s tongue and motor skills mature and gain experience. Sometimes a child holds onto these “baby” or an “immature” pattern of speech simply because they are not aware that they are saying sounds wrong. If a child continues to use these phonological processes, the result is a developmental phonological disorder.
An augmentative and alternative communication (AAC) device is a form of communication (other than oral speech) that is used to express thoughts, needs, wants and ideas. It includes things such as facial expressions, gestures, symbols, pictures or writing. It may be a low-tech or high-tech device that provides nonverbal means of communication. These range from picture cards to electronic devices that emit spoken words and sentences. AAC is used by those with a wide range of speech and language impairments, including congenital impairments such as cerebral palsy, intellectual impairments and autism, and acquired conditions such as amyotrophic lateral sclerosis and Parkinson’s disease.
You may feel as though providing your child with an AAC device is the equivalent of giving up on speech therapy, but in actuality, studies have shown that children who use AAC devices are encouraged to increase their nonverbal and verbal communication. These children are also less likely to be socially isolated or to become frustrated because they cannot express themselves. AAC devices are intended to complement speech therapy, not replace it. Consider AAC devices to be another tool in your arsenal of speech therapy treatments, much like using Speech Buddies to encourage correct pronunciation.
Children with speech/language impairments may also have cognitive deficits. Cognitive impairments may present areas of weakness in memory, perception, reasoning/judgment, attention, visio-spatial skills, executive function, social interaction and problem solving. Speech-language pathologists work with children to improve their overall “thinking” skills.
Play is a vital part of a child’s learning. If milestones are not met, it can signal to medical professionals and parents a more serious problem, or the need for further investigation to identify the underlying cause of the delay. Often times, the first signals of motor skill, sensory or cognitive delays present themselves as delayed milestones. It is important to address these delays as soon as they are identified to prevent secondary impairments or compensatory movements that may lead to further motor, sensory, behavioral or cognitive delays. Speech Therapists address these delays during treatment utilizing play activities where the child may not realize they are working on skill development. As speech therapists, our goal in all treatments is to find meaningful and purposeful activities that motivate the child to reach their full potential.
Language development is one of the most remarkable pieces of your child’s development. In some children, typical development does not occur in the way that it should. Researchers have found that language development begins before a child is even born. Children may have difficulties comprehending and/or using spoken and written communication. Deficits may be identified in the form, content and function of language. A functional language approach focuses on improving the child’s ability to communicate basic wants and needs. Improving the overall use of spontaneous communication, social skills, vocabulary, syntax and grammar are also commonly treated in speech therapy.
Due to medical complications, many of our patients do not develop oral skills required to coordinate sucking and oral exploration during early development. A lack of oral skills development often leads to difficulties in oral feeding. We work with feeding on all levels from enteral to oral feeds. Some children are not born with feeding issues, but develop feeding problems as a result of NICU hospitalizations, sensory impairments, sensory-motor impairments or failure to thrive. These children may have oral aversion, limited food choices, poor appetite, poor intake or weight gain. After an extensive evaluation, the best-individualized treatment approach is chosen and implemented.
Stuttering affects the fluency of speech. Stuttered speech often includes repetitions of words or parts of words, as well as prolongations of speech sounds. These disfluencies occur more often in persons who stutter than they do in the general population.
During an evaluation, an SLP will note the number and types of speech disfluencies a person produces in various situations. The SLP will also assess the ways in which the person reacts to and copes with disfluencies. The SLP may also gather information about factors such as teasing that may make the problem worse. A variety of other assessments (e.g., speech rate, language skills) may be completed as well, depending upon the person’s age and history. For younger children (ages 1-5), it is important to predict whether the stuttering is likely to continue. Factors that are noted by many specialists include a family history of stuttering, stuttering that has continued for 6 months or longer, presence of other speech or language disorders, and/or strong fears or concerns about stuttering on the part of the child or family. It is typical for children between the ages of 1 and 5 to have some speech disfluencies or stuttering. Pediatric clients who are determined to be appropriate for therapy based on the assessment criteria listed above are taught to use fluency enhancing techniques to reduce or eliminate the occurrences of stuttering during spontaneous speech.
For older children and adults, the question of whether stuttering is likely to continue is somewhat less important, because the stuttering has continued at least long enough for it to become a problem in the person’s daily life. For these individuals, an evaluation consists of tests, observations and interviews that are designed to assess the overall severity of the disorder. In addition, the impact the disorder has on the person’s ability to communicate and participate appropriately in daily activities is evaluated. Information from the evaluation is then used to develop a specific treatment program, one that is designed to help the individual speak more fluently, communicate more effectively and participate in more fully in life activities.
Interactive Metronome (IM) is a brain-based rehabilitation assessment and training program. The purpose of IM is to improve processing abilities that affect attention, motor planning and sequencing. Focusing on these areas strengthens motor skills, mobility and gross motor function, and cognitive abilities such as planning, organizing and language skills. Go to www.interactivemetronome.
Kinesio Taping® involves the use of a special elastic therapeutic tape that is applied to the skin over a specific muscle or joint. This taping method is very different than traditional taping methods that often involve rigid tape. It is Kinesiotapes elastic properties that encourage use of weakened muscle groups and improve circulation. In the pediatric population, Kinesiotape can be used for a variety of purposes, but its most common use is to encourage the use of proper muscles to perform specific movements over a period of time. Increased use of a weakened muscle improves strength and the quality of movement improves. Other therapeutic uses for Kinesiotape include pain management, edema (swelling) management and joint/tendon stabilization. Go to www.kinesiotaping.com for more information or watch this video.
NDT is the primary treatment technique for individuals with central nervous system impairment such as children with cerebral palsy or traumatic brain injury. NDT trained therapists believe that due to the central nervous system impairment, atypical posture and movement patterns are used by the child for function. Unfortunately, it is the use of these patterns that lead to secondary impairments and dysfunction. NDT trained therapists use clinical thinking to evaluate a person’s movement in order to determine the focus of each physical, occupational or speech therapy session. Therapeutic handling is used to assist in the facilitation of typical movement to gain function.
Reach Therapy is an NDTA Center of Excellence(NDTCOE). As an NDTCOE, Reach partners with NDTA in education dedicated to training as many therapists as possible in the Neuro-Developmental Treatment Approach. In addition to our trained staff, Reach has hosted many NDTA courses including the 8-week pediatric certification course. Because of our dedication and commitment to this treatment philosophy, we have been named one of the first facilities designated as an NDTA “Center of Excellence”.
Oral-motor patterns must be directly observed. The individual presents many different patterns at once with varying degrees of severity and skill, making identification of baseline oral motor skills challenging for the therapist. Different patterns may be observed with different food types and in response to different types of stimuli. At Reach Therapy, many of our SLPs and OTs are trained in oral motor treatment and assessment. Over the years, we have hosted oral motor experts such as Debra Beckman CCC-SLP and Gay-Lloyd Pinder, PhD, CCC-SLP, C/NDT. Many of our staff have taken these training courses, adding to our expertise in the area of feeding and oral motor therapy techniques.
Children may use picture cards to express their wants and needs. Each card has an image that depicts a word. For example, a child might hold up a picture of a sandwich to indicate that he is hungry. He might hold up a picture of a bed to indicate that he is sleepy. Picture cards are a simplistic type of AAC device that children with a limited vocabulary can understand and easily use. However, the drawback is that it can be cumbersome to carry around lots of picture cards. Some picture card AAC devices are available in flipbooks. Your child’s speech therapist may also introduce him to a board that displays numerous images. The child can point to the appropriate image.
The VitalStim® Therapy System is a non-invasive, external electrical stimulation therapy cleared to market by the Food and Drug Administration in 2002 for the treatment of dysphagia with application on the anterior neck. The VitalStim® Therapy System is designed as an adjunct modality, meaning a clinician will apply VitalStim® while simultaneously working with the patient on swallowing exercise. The goals of VitalStim® are to increase spontaneous swallow so that the child can manage oral secretions (saliva), begin feeding trials, advance diet texture, increase efficiency of swallow/oral intake, decrease incidences of aspiration and decrease reliance on tube feeding. Patients with the following diagnoses may benefit: anoxia, or acquired brain injury, cerebral palsy, recurrent aspiration pneumonia, chronic pulmonary problems, tube-feeding dependent, and other diagnoses deemed appropriate by your therapist and physician. Go to www.vitalstim.com for more information.