Speech Language Dysphagia

Speech language pathology is a field that deals with the assessment, diagnosis and treatment of various communication disorders, voice disorders and swallowing disorders. A speech language pathologist is a specialist who deals with infants, children, adults and seniors having any speech, language, voice or swallowing difficulties.

Articulation Disorder/ Phonological Disorder:

When speech sounds are made incorrectly due to incorrect placement or movement of the lips, tongue, velum, and/or pharynx. Sounds can be substituted, left off, added or changed. These errors may make it hard for people to understand what is said.

For instance, many children make the “t” sound for a “k” sound, e.g., “tup” for “cup”) or they may leave sounds out of words, such as “nana” for “banana.”

Fluency Disorder (Stuttering/Stammering and Cluttering):

In stuttering the flow of speech is disrupted. Stuttered speech often includes repetitions of words or parts of words, as well as prolongations of speech sounds and silent blocks.

Eg. W-W-W Where are you going? , Mom Mom Mom Mom come here. , I …….. want the ball. Cluttering is characterized primarily by a rapid rate of speech, which makes speech difficult to understand.

Dysarthria:

In dysarthria speech intelligibility, audibility and naturalness are affected because of weakness or paralysis or a lack of coordination of the motor-speech system. Symptoms of dysarthria include:

  • Slurred speech (sounding as if drunk)
  • Speaking softly or barely able to whisper
  • Slow rate of speech
  • Limited tongue, lip, and jaw movement
  • Breathiness
  • Drooling or poor control of saliva
    Dysarthria is often caused by strokes, Parkinson's disease, ALS, head or neck injuries (surgical /accident) or cerebral palsy.

    Apraxia:

    Apraxia of speech (AOS) is a neurogenic communication disorder affecting the motor programming system for speech production. Individuals with AOS demonstrate difficulty in speech production, specifically with sequencing and forming sounds.
    Delayed / Deficient Language in children
    The first few years of a child’s life are very important for language development. Conditions such as Autism, Mental Retardation, ADHD, Cerebral Palsy, Hearing loss interfere with normal speech and language development. Such children often show a gap between their chronological age and language age (expressive language and receptive language). A speech language pathologist plays a key role in bridging this gap and enabling these children to participate in the world around them.
    Acquired Language Disorders in adults

    Acquired language and communication difficulties/disorders in adults occur due to brain damage caused by trauma to the brain. Trauma to the brain can be caused by conditions like:

    • Intra cranial surgery for tumour removal.
    • Cerebrovascular disruption such as a stroke
    • Traumatic Brain Injury (TBI) following a motor vehicle incident or fall
    • Infectious diseases such as encephalitis or meningitis
    • Other neurological disorders such as Multiple Sclerosis (MS), Parkinson’s Disease (PD), Amyotrophic Lateral Sclerosis (ALS), Huntington’s Disease (HD).

    The communication disorder is manifested by significant decline in cognitive functioning. There are changes in neuropsychological functions such as language, memory, attention, executive functions, etc. There also is, deterioration in personality, impulse control and judgment.

    The most common acquired neurological communication disorders are aphasia and dementia.
    Aphasia is a communication disorder resulting from brain damage usually following a stroke. In aphasia a person losses the ability to either comprehend or express thoughts using language (spoken or written). These language impairments involve difficulties in the recall of words, difficulty formulating sentences to express oneself and difficulty in comprehension of speech or printed word or even sign language.

    Dementia is characterized by a progressive decline in cognitive functions (such as orientation to time, place and persons, memory, attention, executive functions, visual-spatial skills and reasoning), linguistic functions and behavioral functions.
    A voice disorder occurs when the vocal folds do not vibrate effectively. Vocal folds are affected by excessive voice use, voice abuse or misuse (yelling), excessive throat clearing and gastro-esophageal reflux (excessive stomach acid backing into the larynx). The above conditions cause vocal pathologies like muscle tension dysphonia, vocal fold nodules, vocal fold polyps, contact ulcers, Reinke’s edema and vocal fold cysts.
    Other vocal pathologies include vocal fold paralysis, spasmodic dysphonia, puberphonia and aphonia.
    A voice disorder manifest itself as hoarseness of voice, breathiness in voice, harshness of voice, pitch fluctuations, monotone, feeble voice, vocal fatigue.

    Voice therapy focuses on improving voice quality and helping the patient regain his/her original voice through vocal strengthening exercises and reduction of vocally abusive behaviors.
    Dysphagia is the medical term for the symptom of difficulty in swallowing.
    Signs and symptoms of dysphagia include difficulty controlling food in the mouth, delayed swallow reflex, gurgly or wet voice after swallowing and coughing after swallowing. Dysphagia may involve any or all the three stages of swallowing ie oral-preparatory phase, pharyngeal phase or esophageal phase. Conditions causing dysphagia are:
    • Surgery for oral and pharyngeal cancers
    • Stroke
    • Traumatic Brain Injuries
    • Degenerative conditions like Parkinson’s Disease, ALS, PSP, Alziemher’s Disease
    Dysphagia treatment involves working on strengthening the oro- pharyngeal structures involved in swallowing to enable the patient to have safe swallows and keep down the risk of aspiration pneumonia. These structures in real have a dual responsibility of speech and deglutition. Thus dysphagia therapy is a done by speech language pathologists because, who better than them would understand the anatomy and physiology of the oro-pharyngeal structures and could treat disorders involving these structures.