Speech Therapy Frequently Asked Questions
What is a Speech Language Pathologist?
Speech Language Pathologists help people to develop and regain their ability to communicate their thoughts and feelings. They evaluate and treat disorders affecting speech, voice, verbal and written expression, auditory and reading comprehension, pragmatics (how we interact with each other), cognitive skills (i.e. attention, memory, problem solving, reasoning) and swallowing.
Who do we help?
At St. Jude our Speech Language Pathologists see people with a diverse range of challenges caused by:
- Birth defects and developmental disabilities
- Cleft lip and palate
- Cognitive impairment
- Dysphagia (swallowing disorder)
- Head and neck cancers
- Pediatric Disorders
- Swallowing disorders
- Tracheotomy and ventilator
- Other conditions that affect the ability to speak, swallow or feed properly
What services do we provide?
We believe in a comprehensive, multidisciplinary approach. In addition to treating these conditions, our services also include diagnosis and assessment, as well as health and wellness promotion.
Speech and swallowing therapy services include:
- Articulation and language rehabilitation (speech)
- Assessment and treatment of swallowing disorders
- Cleft lip and palate services
- Cognitive rehabilitation
- Family education, caretaker education
- Geriatric feeding and swallowing rehabilitation
- Head and neck cancer rehabilitation (focused on speech and swallowing)
- Pediatric feeding and swallowing therapy
- Pediatric evaluations and treatment for speech development, oral motor skills, sensory processing, and feeding and swallowing skills
- Videofluoroscopic swallowing evaluations (also known as Modified Barium Swallowing Evaluation)
- VitalStim® to stimulate muscle activity necessary for functional swallowing
- Voice assessment and treatment
Adult Speech Language Services
Along with traditional individual and group therapy sessions for adults with stroke (CVA) or brain injury, St. Jude offers the nationally known Communication Recovery Program. It is one of few programs that allows adults who are dealing with chronic aphasia and other communication difficulties to partner with loved ones or volunteers who are trained in ‘partner conversational skills.’ Through the use of these skills stroke survivors are given help, hope, and a sense of community that they would have never had without their involvement in the Communication Recovery Program. This program was established in 1999, and has been involved in several research projects which have been published in professional journals.
Dysphagia (Difficulty Swallowing)
The medical term for difficulty in swallowing is dysphagia. The problem is widespread among the elderly, particularly among stroke patients and individuals who have undergone radiation therapy. Without treatment, consequences can be chronic malnutrition, choking, or pneumonia due to bacteria in food and liquids that enter breathing passages. Some of these are potentially deadly. The psychological and social consequences can be equally devastating. For patients with dysphagia, social isolation and depression often arises.
We don't think much about swallowing. That's because, once we start the process, an automatic sequence of highly coordinated nerve impulses and muscle actions occur to make sure that our breathing tube is sealed shut and whatever we are swallowing is channeled and pushed down the "right pipe." During swallowing, one set of muscles pulls our "voice box" (or larynx) up to block off breathing passageways and prevents food or liquids from going down the wrong way. We've all experienced the sometimes frightening result when something goes wrong and we inhale a bit of food or liquid. For some people with swallowing problems, that "wrong way" experience happens regularly.
Once we've swallowed, another set of muscles pulls the larynx back down, so we are free to breathe. If the nerve impulses are not just right or the muscles are too weak to do their jobs, the process can be difficult, misdirected, or even impossible.
Symptoms of Dysphagia
- 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 or drink enough
There are many options in treating dysphagia, and to regain the ability to safely swallow food and liquid. Treatment varies greatly depending on the cause, symptoms, and type of swallowing problem. A knowledgeable Speech Language Pathologist may recommend:
- Specific food and liquid textures that are easier and safer for you to swallow,
- Electrical stimulation of the muscles used for swallowing.
Electrical stimulation for swallowing is a relatively new technique for the treatment of dysphagia. The Speech Language Pathologists at St. Jude Medical Center are experts at using electrical stimulation for dysphagia, and have had significantly increased the rate of recovery for many patients. Although not every person with dysphagia is a candidate, patients receiving electrical stimulation have been able to avoid tube feedings, and many of them are eating a wider variety of food and liquids than would have been expected prior to the implementation of electrical stimulation.
What is FEES?
Fiberoptic Endoscopic Evaluation of Swallowing is the state of the art non-radioactive alternative to modified barium swallow studies. This exam will allow for direct assessment of the swallow in order to precisely guide the dietary and behavioral management of patients with swallowing problems to decrease the risk of aspiration pneumonia.
Who is a candidate for FEES?
- People who complain of trouble swallowing liquid, food or medications.
- People who report a lump-like sensation in their throat or pain upon swallowing.
- People who have had a stroke and are experiencing difficulty swallowing, throat clearing, or choking during meals.
- People with a history of reflux.
- People with a history of upper respiratory infections, unexplained fevers, or aspiration pneumonia.
- People with a history of swallowing difficulty related to an underlying diagnosis of Parkinson's Disease, CP, Multiple Sclerosis, ALS or dementia.
- People who receive nutrition via G-tube or NGT with suspected improved function or ability to tolerate oral feedings.
- People with a tracheotomy who might be able to tolerate oral feedings or a diet upgrade.
What happens during the procedure?
A thin, flexible fiberoptic endocopes is passed through the nose to the pharynx. A swallowing evaluation is then performed, by providing patient with a variety of food consistencies containing green food dye. This allows the Speech Language Pathologist to visualize the food and liquid to determine if there is any pooling, laryngeal penetration, aspiration and/or reflux of food or secretions. Compensatory strategies and postures may be attempted to improve swallowing function and reduce the risk of aspiration.
Brain injury can result from disease such as cancer, lack of oxygen to the brain, or from a traumatic injury to the head. People who have a brain injury often have difficulty in many areas such as:
- understanding what others say
- thinking of the words they want to say
- disorientation (not recalling the date, time, or even where they are and why)
- paying attention to a simple task
- doing more than one thing at a time
- following schedules and remembering to use simple tools (i.e. calendars, taking notes, etc) to help them remember
- remembering information that has been learned recently
- planning, organizing, and sequencing activities
- prioritizing tasks
- performing tasks in noisy settings
- decreased ability to cope with the environment
Many individuals with mild traumatic brain injury do not receive rehabilitation because their symptoms are subtle and not always detected or recognized. Symptoms may range from mild to extremely severe. In some of the more mild patients, the difficulties may not be obvious at all. Studies show that even though the damage may be invisible, the effects of mild head injuries are real and require proper diagnosis and treatment to minimize any disabilities that may result. Speech Language Pathologists provide therapy for people with brain injury of all severity levels to recover skills that they have lost, and to learn new ways to compensate for areas that remain troublesome.
Voice problems are best managed in a team approach consisting of the Otolaryngologist and the Speech Language Pathologist. If the client is a singer, the vocal coach/teacher may also be involved. Voice problems can arise from a variety of problems such as:
- Chronic allergies
- Gastric Reflux
- Overuse or misuse of the voice
These problems can cause vocal nodules (similar to blisters or calluses) on the vocal cord due to chronic irritation. Speech Language Pathologists work with people with voice problems to learn compensatory strategies to eliminate vocal cord irritation, and help the vocal nodules to disappear over time.
Symptoms of vocal abuse or misuse
- Chronic hoarseness
- Pain in the throat area
- Decreased range of voice
- Lack of phonation
- Vocal fatigue
- Pitch breaks
If you are having trouble with your voice, please see an Otolaryngologist prior to contacting our Speech Language Pathologists. Your Otolaryngologists must give you medical clearance prior to beginning voice therapy to ensure that it is needed, and will be beneficial to you in your particular situation.
Pediatric Speech Language Services
St. Jude's provides treatment for a wide variety of pediatric communication or speech disorders resulting from conditions or circumstances, such as:
- Cleft palate
- Myofunctional therapy
- Apraxia of speech
- Hearing loss (intermittent or ongoing)
- Developmental delays
- And many other conditions
The Speech Language Pathologists at St. Jude Medical Center provide a wide variety of individual and group treatments for children with speech and language disorders. Each session is tailored to the child's specific needs. Some examples of our group treatments include:
- Summer group therapy programs for children with Autism, Asperger's Syndrome; including early social skills involving eye contact, anticipation and reciprocal interactions.
- Language, articulation, oral motor therapy activities.
- Activities of all groups focus on stimulating the children's use of age-level vocabulary and sentences, as well as making friends through developmentally appropriate play activities.
For more information, please contact us at (714) 578-8706.
St. Jude Medical Center Speech Therapy provides comprehensive services to help children and adults with disorders or difficulties related to speaking, understanding, cognitive deficiencies, feeding, swallowing and using language effectively. Each patient's individualized therapy program is based on comprehensive evaluation, planning and personalized goals. We are committed to providing the highest quality of care and to making a positive difference for our patients and their families.
St. Jude Medical Center is one of the few providers of electrical stimulation for swallowing for children and adults with dysphagia (swallowing dysfunction). All our Speech Language Pathologists hold a Certificate of Clinical Competence from the American Speech Language Hearing Association, and are licensed by the state of California. They have advanced certification in “Vital Stim,” a special treatment for people with a swallowing impairment (dysphagia), and we have specialized therapists who are dedicated to treating children and adults who have all types of communication disorders.
For more information, please contact Lori Peirson, Manager, Speech and Audiology Practice, at (714) 992-3000, extension 3733. If you would like to schedule an appointment, please call our scheduling desk at (714) 578-8706, extension 2327.