Aphasia is a neurologically based language disorder (most commonly caused by stroke) that impairs the interpretation and/or the formulation of language. There are many deficits and severity levels, which can manifest due to aphasia. A comprehensive evaluation should be performed to prepare an individualized treatment plan.

A neurogenic (damage to the nervous system) speech disorder characterized by problems in positioning and sequencing muscle movements for speech sound production. Speech sounds are difficult to produce, speech is labored and the person will frequently produce unintended sounds and words.

Apraxia is a disorder caused by damage to the central nervous system. This damage makes it difficult to program the necessary motor movements to successfully complete a desired activity. There are two types of Apraxia that can occur with the oral structures. Oral Apraxia is defined as difficulty programming the oral structures for all non-verbal activities (sucking, chewing, swallowing). Verbal Apraxia is the inability to program the precise motor movements necessary to produce speech sounds. Apraxia is a complicated disorder which often requires intense speech therapy.

Articulation impairment refers to pronunciation of sounds. When a disorder is present, the person is motorically unable to produce the target sound. Articulation impairments are commonly seen with /r/ and /s/, though it can occur with any sound.

A phonological disorder refers to errors in how sounds are combined to make words. These errors are called phonological processes. While there are many phonological processes, only the most common are detailed below:

Substitutions – replacing one sound with another sound, in this case, the child is capable of producing the sound but does not use the sound in the correct place within a word (ex. “tea” for “key”).

Stopping- occurs when a sound that should have continued air flow (/s/, /f/ etc) is ‘stopped’ and produced as a short sound (ex. “to” for “shoe” or “mitt” for “miss”).

Syllable Reduction- occurs when a child drops a syllable from a multiple syllable word (ex. “nana” for “banana”).

Consonant Cluster Reduction- a sound is eliminated from a consonant cluster (ex. “top” for “stop” or “side” for “slide”).

Children with autism often have impaired language, communication, social skills, and cognitive skills. Due to the wide range of ASD, a full evaluation is recommended to identify an appropriate treatment plan and therapy strategies. Please feel free to contact us if you would like to discuss your personal needs in further detail.

A disorder in the ability to process language to obtain the meaning of the message. Children with APD often have normal hearing, however they are not able to process what was said to them at a rapid enough rate to extract the meaning. These children will often miss part of what was said to them, causing them respond to directions slowly or incorrectly. APD can lead to some learning and behavioral issues due to lack of understanding the entire message. Treatment for APD is focused on improving the time it takes to process language and teach strategies to compensate for any information that may have been missed.

Cleft Lip and/or Cleft Palate is a congenital (from birth) malformation resulting in an opening in the lip, palate or both. It usually requires surgical repair followed speech therapy. Speech, eating and resonance call all be impacted by cleft lip and palate.

Cognitive impairments can cause memory loss and other thinking problems including changes in attention, organization, problem solving, and planning/execution of daily tasks. Everyday tasks like remembering appointments, taking medicine, and paying bills may be harder to do.

Cognitive impairments can occur due to medical diagnoses, such as brain injuries, dementia, Alzheimer’s disease, strokes, Parkinson’s disease, etc. Sometimes it is more difficult to identify the exact cause of cognitive difficulties.

Dysarthria is a motor disorder caused by central nervous system damage which, can cause paralysis, weakness, or in-coordination in the muscles of speech. Dysarthria can be caused by cerebral palsy, head injury, degenerative diseases, tumors, and strokes. Dysarthric speech sounds slow, slurred and very labored.

Dysphagia is a term to describe impaired swallowing functions. A disordered swallow can lead to coughing, choking and aspiration. A Modified Barium Swallow Study (MBSS) should be performed by a Radiologist to identify the severity and type of swallowing disorder. During treatment, strategies to improve swallowing function, safety and diet will be addressed.

• Receptive language – what the child understands when spoken to (ex. Follows directions, understands vocabulary, etc.)
• Expressive language- what the child says (ex. Age appropriate vocabulary, irregular forms of words (eat vs. ate), all grammar, etc)

The term “Language Impairment” covers a wide range of errors, which occur when a child is learning language.
• Receptive disorders impact a child’s ability to follow directions, understand vocabulary, and further understand and process what is said to them.
• Expressive disorders are characterized by a limited vocabulary, grammatical errors (word order, past tense, plural ‘s’, etc.), sentence length, etc.

There are several varieties of resonance disorders. They can occur due to oral structural abnormalities, surgical procedures (having tonsils removed), and improper use of the velopharyngeal mechanism during speech causing too much, too little nasality in speech or distorted voice and resonance

Stuttering is a disorder in the fluency of speech. It can occur as repetitions (m-m-m-m-my), blocks (long pauses), and prolongations (mmmmmommy). It is common for children of the preschool age to have some dysfluent speech. A parent should contact a speech therapist for an evaluation if their child is past the preschool age, has longer periods of dysfluent speech than fluent speech, has blocking in their speech (long periods of silence when it appears they are trying to make a sound), is showing frustration with not being able to say words, or has secondary behaviors such as stomping their foot or nodding their head in attempt to make the words come out.

Tongue thrust is a reverse swallow pattern, which interferes with successful orthodontics and can impact speech production. Tongue thrust can impact oral structures and facial features. Therapy will focus on education, remediating the swallow pattern with all consistencies of food, and improving tongue placement at all times.

Injury to the brain from an outside force, often leads to deficits with language, memory, attention, organization, appropriateness, reading, writing, etc. Impairments from TBI will be specific to each person and area/severity of injury. A full evaluation is necessary to identify and prepare a treatment plan.

VCD occurs when the vocal cords are involuntarily closing, making it difficult to breathe. This disorder is often misdiagnosed as asthma and is commonly identified by an allergy/asthma doctor.

An Ear Nose and Throat (ENT) doctor typically diagnoses voice disorders. An ENT will use a videoscope to view the vocal cords and properly diagnose the cause of the symptoms. A disordered voice can sound hoarse, have a change in pitch, sound shaky, or breathy. It is important to visit your doctor to obtain a proper diagnosis of your symptoms. The following are common causes of voice disorders:

• Vocal Nodules: a small node that develops on the vocal fold, similar to callus.

• Polyps – similar to nodules but they are softer and may be filled with fluid or have vascular tissue

• Papilloma – a wart like growth caused by HPV, usually treated by surgery and often requires speech therapy after surgical treatment

• Vocal Fold Thickening -prolonged use of vocally abusive behaviors can cause the vocal folds to thicken (chronic cough, throat clearing, screaming)

• Granuloma – ulcer on vocal cords

• Laryngeal Trauma – injury to the larynx (burns, car accident, sports-related accidents, attempted strangulation, etc.)

• Laryngeal Web – a membrane that grows across the anterior portion of the glottis (area between the vocal folds)

• Gastroesophageal Reflux (GERD) – voice disorders can result due to chronic GERD (heart burn), caused by acid from the stomach spilling into the esophagus, which can then lead to sore throat, hoarseness, and possibly contact ulcers on the vocal cords

• Paralysis and Ankylosis – a vocal cord can be paralyzed when the nerve supply is cut off (injury during surgical procedures, progressive neurological diseases, malignant diseases, intubation trauma, stroke, etc)

• Spasmodic dysphonia – involuntary movement of the vocal cords during speech, voice will have audible tremors and can be difficult to produce

• Carcinoma and Laryngectomy – laryngeal cancer often results in voice disorders following treatment. Laryngectomy is the removal of the larynx requiring treatment for esophageal speech, or assistive device for voice production.

• Other neurological diseases with associated voice disorders
Multiple Sclerosis
Myasthenia Gravis
Amyotrophic Lateral Sclerosis (ALS)
Parkinson’s Disease

People may seek gender affirmation speech services to make their voice and/or other aspects of their communication congruent with their gender and/or gender expression.