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.

At St. Jude our Speech Language Pathologists see people with a diverse range of challenges caused by:

• Aging
• 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

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 knows as Modified Barium Swallowing Evaluation)
• VitalStim® to stimulate muscle activity necessary for functional swallowing
• Voice assessment and treatment

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.

The medical term for difficulty in swallowing is dysphagia. The problem is widespread among the elderly, particularly among stroke victims and patients 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

Treating Dysphagia

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:

• Exercises, positions, or strategies to help you swallow more effectively,
• 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.

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 client, 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
• Bulimia
• Gastric reflux
• Stress
• 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.