Johnson City, Tennessee

Speech - Frequently Asked Questions: Speech Language Pathology What is a Speech Language Pathologist? Speech-language pathologists (SLP), sometimes called speech therapists, assess, diagnose, treat and help to prevent disorders related to speech, language, cognitive-communication, voice, swallowing and fluency. Speech-language pathologists work with people who cannot produce speech sounds or cannot produce them clearly; those with speech rhythm and fluency problems, such as stuttering; people with voice disorders, such as inappropriate pitch or harsh voice; those with problems understanding and producing language; and those with cognitive communication impairments, such as attention, memory and problem solving disorders. They also work with people who have swallowing difficulties. Swallowing Disorders What are some signs or symptoms of swallowing disorders? Several diseases, conditions, or surgical interventions can result in swallowing problems. General signs may include: • coughing during or right after eating or drinking • wet or gurgly sounding voice during or after eating or drinking • extra effort or time needed to chew or swallow • food or liquid leaking from the mouth or getting stuck in the mouth • recurring pneumonia or chest congestion after eating • weight loss or dehydration from not being able to eat enough As a result, adults may have: • poor nutrition or dehydration • risk of aspiration (food or liquid entering the airway), which can lead to pneumonia and chronic lung disease • less enjoyment of eating or drinking • embarrassment or isolation in social situations involving eating How are swallowing disorders diagnosed? A speech-language pathologist (SLP) who specializes in swallowing disorders can evaluate individuals who are experiencing problems eating and drinking. The SLP will • take a careful history of medical conditions and symptoms • look at the strength and movement of the muscles involved in swallowing • observe feeding to see posture, behavior, and oral movements during eating and drinking • possibly perform special tests to evaluate swallowing, such as • modified barium swallow – individual eats or drinks food or liquid with barium in it, and then the swallowing process is viewed on an X-ray • endoscopic assessment – a lighted scope is inserted through the nose, and then the swallow can be viewed on a screen What treatments are available for people with swallowing disorders? Treatment depends on the cause, symptoms, and type of swallowing problem. A speech-language pathologist may recommend: • specific swallowing treatment (e.g., exercises to improve muscle movement as well as NMES) • positions or strategies to help the individual swallow more effectively • specific food and liquid textures that are easier and safer to swallow What is NMES Treatment? NMES is routinely used by physical and occupational therapists to help restore muscle function. The VitalStim® Therapy device was specifically developed in 2002 for the small muscles on the throat used for swallowing. The FDA has mandated that only clinicians that are VitalStim certified may use this treatment for swallowing therapy. VitalStim® Therapy administers a small, carefully calibrated electrical impulse to the swallowing muscles in the throat through electrodes attached to the skin. The electrical current stimulates the nerves that make the muscles contract. By applying this current during exercise, NMES can cause a greater number of muscle fibers to contract during the exercise which in turn can make the therapy more effective.  VitalStim® Therapy is painless, and patients describe that it feels similar to the tingly sensation when a part of the body, like the foot “falls asleep”.  The use of NMES in swallowing treatment is well supported by clinical research. Studies have shown that using this equipment during swallowing exercise greatly improves the effectiveness of the treatment. Voice Therapy Why is voice therapy recommended for hoarseness? Voice therapy has been demonstrated to be effective for hoarseness across the lifespan from children to older adults (Ramig & Verdolini, 1998; Thomas & Stemple, 2007).  Voice therapy is the first line of treatment for vocal fold lesions like vocal nodules, polyps, or cysts (Anderson & Sataloff, 2002; Johns, 2003. These lesions often occur in people with vocally intense occupations like teachers, attorneys, or clergymen (Roy et al., 2001). Another possible cause of these lesions is vocal overdoing often seen in sports enthusiasts; in socially active, aggressive, or loud children; or in high-energy adults who often speak loudly (Boone et al., 2005; Rubin et al., 2006; Stemple et al., 2000; Trani et al., 2007). Voice therapy, specifically the Lee Silverman Voice Treatment method, has been demonstrated to be the most effective method of treating the lower volume, lower energy, and rapid rate of speech in persons with Parkinson’s disease (Dromey et al., 1995; Fox et al., 2006). Voice therapy has been used to treat hoarseness concurrently with other medical therapies like botulinum toxin injections for spasmodic dysphonia and/or tremor (American Academy of Otolaryngology-Head and Neck Surgery, 2005; Murry & Woodson, 1995; Pearson & Sapienza,2003). Voice therapy has been used alone in the treatment of unilateral vocal fold paralysis (Miller, 2004; Schindler et al., 2008) and has been used to improve the outcome of surgical procedures as in vocal fold augmentation (Rosen, 2000) or thyroplasty (Billiante et al., 2002).  Voice therapy is an important component of any comprehensive surgical treatment for hoarseness (Branski & Murray, 2008). What happens in voice therapy? Voice therapy is a program designed to reduce hoarseness through guided change in vocal behaviors and lifestyle changes. Voice therapy consists of a variety of tasks designed to eliminate harmful vocal behavior, shape healthy vocal behavior, and assist in vocal fold wound healing after surgery or injury. Voice therapy for hoarseness generally consists of one to two therapy sessions each week for 4–8 weeks (Hapner et al., 2009). The duration of therapy is determined by the origin of the hoarseness and severity of the problem, co-occurring medical therapy, and, importantly, patient commitment to the practice and generalization of new vocal behavior outside the therapy session (Behrman, 2006). Who provides voice therapy? Certified and licensed speech-language pathologists are the health care professionals with the expertise needed to provide effective behavioral treatment for hoarseness (American Speech- Language-Hearing Association, 2005). Vocal Cord Nodules What are vocal cord nodules and polyps? Vocal cord nodules are benign (non-cancerous) growths on both vocal cords that are caused by vocal abuse. Over time, repeated abuse of the vocal cords results in soft, swollen spots on each vocal cord. These spots develop into harder, callous-like growths called nodules. The nodules will become larger and stiffer the longer the vocal abuse continues. Polyps can take a number of forms. They are sometimes caused by vocal abuse. Polyps appear on either one or both of the vocal cords. They appear as a swelling or bump (like a nodule), a stalk-like growth, or a blister-like lesion. Most polyps are larger than nodules and may be called by other names, such as polypoid degeneration or Reinke's edema. The best way to think about the difference between nodules and polyps is to think of a nodule as a callous and a polyp as a blister. What are signs and symptoms of vocal cord nodules or polyps? Nodules and polyps cause similar symptoms: • hoarseness • breathiness • a "rough" voice • a "scratchy" voice • harshness • shooting pain from ear to ear • a "lump in the throat" sensation • neck pain • decreased pitch range • voice and body fatigue  How are nodules and polyps diagnosed? If you have experienced a hoarse voice for more than 2 to 3 weeks, you should see a physician. A thorough voice evaluation should include: • a physician's examination, preferably by an otolaryngologist (ear, nose, and throat doctor) who specializes in voice, • a voice evaluation by a speech-language pathologist (SLP), and • possibly a neurological examination. The team will evaluate vocal quality, pitch, loudness, ability to sustain voicing, and other voice characteristics. An instrumental examination may take place that involves inserting an endoscope into the mouth or nose to look at the vocal cords and larynx in general. A stroboscope (flashing light) may be used to watch the vocal cords as they move. Videostroboscopy What is videostroboscopy? Videostroboscopy is one of the most practical methods for viewing and recording the motion of the vocal cords during speaking or singing. A digital computer and strobe light are used to make the images of the vocal cord vibrations appear in slow motion, so that any abnormal patterns of vibration may be detected. What are the advantages of videostroboscopy? • The vibrations of the vocal cords are much too rapid to be observed by the unaided eye under a regular light source. Stroboscopy provides illumination of the larynx with quick pulses of light, which allows for accurate, detailed assessment of vocal cord movement. • By viewing these images of the larynx and vocal cords, the speech pathologist, physician and patient can obtain a better understanding of the way the vocal folds are functioning, and develop a specific treatment plan. This helps to determine what changes need to be made in order to treat the problem. Other structural or tissue abnormalities may be detected as well. • If a repeat videostroboscopy is needed at a later date, the results can be compared to the previous exam. This allows the voice care team to evaluate the patient's progress. • Formal reports, still photos and portions of the video exam can be provided to the other members of the patient's healthcare team.