Speech therapy - Harrison Speech Pathology

March 2, 2023

What can cause speech problems in the elderly?

As people age, changes in speech, voice, language, memory, and swallowing occur naturally. Communication problems are common in aged care settings with many living with at least one communication disorder.

Older people are at higher risk of stroke, or developing dementia, Parkinson’s disease, hearing loss, or voice disorder which can cause a communication and/or swallowing disorder. Stroke is a leading cause of communication impairment in older adults. One in three survivors will experience aphasia which is a language impairment causing difficulties in understanding, speaking, reading, and/or writing. The majority of people living with Parkinson’s disease have a speech or voice disorder. Voice disorders can have a significant negative impact on quality of life leading to depression, anxiety, and social withdrawal. Many older people live with a communication disorder, impacting their ability to express their needs and wants, maintain relationships, and participate socially in their community.

What services does a speech therapist provide to the elderly?

Speech pathologists work with older people to improve their communication and swallowing abilities. Services may include:

Assessment of speech, language, voice, and swallowing Provide safe swallowing strategies to clients and carers
Educate client on appropriate swallowing technique.
Plan and manage mealtimes.
Recommend modified food/fluid textures.
Provide speech therapy to improve speech intelligibility.
Provide voice therapy.
Provide language therapy through remedial and/or compensatory approaches.
To promote accessibility and inclusion, a speech pathologist may recommend communication technology to support communication in daily activities and social settings.
Individual or group therapy.

How can the elderly improve their swallowing?

Older adults may develop swallowing problems due to stroke, motor neuron disease, Parkinson’s disease, dementia, cancer of head/neck or head injury. Swallowing problems can have a huge impact on a person’s life. Eating and drinking can be frustrating and uncomfortable, causing anxiety, depression, and social isolation. Symptoms may include:

Feeling of something stuck in throat.
Coughing, choking, or frequent throat clearing during or after eating or drinking.
A wet or gurgly voice during or after eating/drinking.
Shortness of breath or changes to breathing while eating and drinking.
Difficulty swallowing certain foods.
Extra time needed to chew or swallow.
Unplanned weight loss.
Frequent chest infections with no known cause.

If you have any concerns with your swallowing or that of a loved one, see a GP who may recommend assessment with an ENT or speech pathologist.

Safe swallowing strategies that everyone can include in their meal-times:

Sit upright (90 degrees) when eating and drinking.
Stay upright for 30 minutes after drinking/eating.
Take small mouthfuls/sips, slowly.
If you start coughing, stop eating/drinking, have a good cough, wait until it has passed to continue.
Limit distractions (e.g. turn off t.v.) when eating/drinking.
Don’t talk and eat at the same time.
Don’t eat or drink too quickly.
Alternate between foods and liquids.
Take a couple of swallows for each mouthful.
Maintain adequate oral hygiene by cleaning teeth after meals.

Benefits of speech therapy for senior adults?

Help swallowing problems to support safe mealtimes and quality of life
Improve communication effectiveness to maintain/increase independence in daily life

Does speech therapy help with memory?

Communication difficulties are commonly seen in people with dementia. In the early stages of disease, a person may experience symptoms including difficulty finding words, losing train of thought, repeating themselves, and forgetting recently heard information. This can be very distressing for the person and their family. Speech pathology can provide strategies and therapy to support maintenance and/or improvements in memory and support the family through this difficult time.

If you or your loved one are having any communication or swallowing difficulties, speech pathology assessment and intervention is recommended.

If you have any concerns about something in this post, please do not hesitate to call us (02)4953 6128 regarding your concerns. All our therapists are trained and experienced in implementing therapy targeting communication and swallowing difficulties in older adults.

January 3, 2023

What do speech pathologist do when working with adolescents?

A speech pathologist can help adolescents with a variety of communication difficulties, including.

Pragmatics: This could include working on both verbal and non-verbal communication abilities that support social interaction.

Speech: Support with improving articulation and accuracy of speaking sounds.

Literacy: Strengthening reading and comprehension skills.

Language: Improving individuals’ abilities to express themselves (also known as expressive language) and their understanding of what is said to them (receptive language).

Within each of these domains, Speech Pathologists assess and treat adolescents. Adolescent assessment and intervention usually takes place in a clinic or school context. It could take place via telehealth zoom call, in a group or one-on-one, depending on the treatment appropriate or the environment.

Language is one of the primary topics that has an impact on young people in the classroom and other social environments. Adolescents who struggle with receptive language may find it difficult to follow instructions, comprehend a book they are reading, or comprehend the crucial subject-specific terminology required for an exam. Expressive language problems can make it difficult for someone to complete written projects, explain what they know about a subject, or participate in group conversations. A speech therapist can assist in setting goals that target these difficulties.

Resources for parents of teenagers who require speech therapy

There are several tools available to assist parents of teenagers who require speech therapy.

Parents of teens with communication difficulties can find advice and tools on the website Talking Teenagers.
Parents of teens who stutter can also get information and tools from the Stuttering Foundation.

Tips for working with adolescents

Working with teenagers requires specific considerations regarding the provision of speech therapy. The following factors can promote therapy attendance and clear the way for success:

Create client-directed objectives.
The Speech Pathologist can assist in breaking down a long-term objective into smaller steps, which will help a teenage client to be more motivated to attend appointments.
Encourage independence
It is important to foster independence for teenage clients to ensure that they are actively involved in determining the goals of their therapy.
Offer rewards
A prize box may no longer be of interest for teenagers, but everyone enjoys a reward! For adolescents, rewards may include using iPad play, a board game or even changing the location of therapy sessions.
Create engaging and fun sessions
Typically, teenage clients may face higher educational and vocational demands whether it be school related or extracurricular activities outside of the school day. It is imperative to add some enjoyable and interesting elements to therapy sessions to optimise engagement.

A way to do this could be to include incorporating some physical activity/movement, play games between activities, providing a visual schedule that outline break times so that they feel like they are working towards a goal and knowing the young person’s interests and integrating those interests within session activities.

April 10, 2022

An Allied Health Assistant (AHA) is someone who works in allied health settings, assisting Allied Health Professionals. This can include helping directly – providing supervised therapy sessions, or indirectly by creating resources. Allied Health Assistants can work across a variety of different allied health areas, or they might work in one specific area, such as Speech Pathology.

Who are Allied Health Assistants?

There are many ways to become an Allied Health Assistant. People who are AHAs in Speech Pathology clinics may:

have completed a Certificate 4 in Allied Health Assistance
be studying Speech Pathology at University
be a teacher’s aide
be a retired special education teacher

All the Allied Health Assistants at Harrison Speech Pathology are current Speech Pathology students at the University of Newcastle.

What can an Allied Health Assistant do?

AHAs assist professionals and clients in achieving their goals. They can provide therapy sessions under the guidance and supervision of a qualified professional and create resources to use in therapy sessions. AHAs can suggest ideas for games to play in sessions with clients to achieve their therapy goals, but all services and therapy provided by an Allied Health Assistant is always approved by the supervising clinician.

What can’t an Allied Health Assistant do?

Allied Health Professionals guide AHAs and instruct them on what goals to focus on and what activities to complete in therapy sessions with clients. Some tasks that an AHA is not suitable or qualified to do include:

Conducting formal assessments
Making a client diagnosis
Creating new therapy plans
Selecting clients for assessment or intervention
Changing the current treatment plan
Independently writing reports
Discharging clients from treatment

Should I see an allied health assistant?

AHAs support the delivery of appropriate Speech Pathology services as determined by a Speech Pathologist and can assist in clients obtaining their desired frequency of therapy services. If you wish to have more therapy sessions, an AHA may be a great addition to your therapy team to allow you to receive extra therapy appointments.

If you are interested in including an Allied Health Assistant in your therapy team contact Harrison Speech Pathology today.

March 31, 2022

A speech pathologist is an allied health professional who helps people with communication and swallowing difficulties. Their scope of practice includes assessment and intervention related to disorders of expressive and receptive language, speech, voice, swallowing and fluency.

Speech pathologists work with clients to discover their strengths and weaknesses and construct an individualised care plan to help them establish better communication skills. They often work in conjunction with other health professionals including occupational therapists and psychologists in order to provide wholistic treatment for the client.

Speech pathologists provide services to clients in a range of different settings including: private clinics, childcare or school settings, hospitals or within a clients home. Speech pathologists treat a broad range of people including babies, children, adolescents, adults and the elderly.

What do speech pathologists do?

Speech pathologists assess clients in order to identify their communication or swallowing disorder and determine the appropriate method of treatment. For children, sessions often involve interactive play as well as speech and/or language activities using games, worksheets and incorporating technology such as iPads. For adults, sessions may involve conversation and problem-solving activities or strengthening exercises for oral muscles depending on the type of communication impairment.

Do I (or someone I care for) need a speech pathologist?

You or your child might need a speech pathologist if you have difficulty communicating or swallowing. Indicators of this include:

Problems comprehending what others are saying
Struggling to articulate words, phrases and sentences
Stuttering
Problems pronouncing specific sounds
Impaired literacy skills
Issues with social skills and interacting with others
Difficulty swallowing food or drink

If you think you or your child may need a speech pathologist, please do not hesitate to contact Harrison Speech Pathology.

February 12, 2022

Why do we cough?

We cough to protect our bodies by clearing the throat, chest and lungs from irritants such as, dust, mucous and phlegm.

A cough also protects our bodies when food goes down the wrong way, or during a chest infection.

A cough can be reflexive or deliberate

A reflexive cough protects our airway from foreign particles such as food or drink and irritants.

A deliberate cough or throat clearing occurs when you have the feeling that something is in your throat, and you cough.

What is chronic cough?

A chronic cough is a cough that lasts for longer 8 weeks in response to an irritation in the absence of something to be cleared from the throat, chest or lungs. Constant throat clearing and coughing may lead to a vicious cycle causing more irritation leading to more coughing.

How speech pathologist can help with chronic cough

Chronic cough can have a negative impact on a person’s quality of life.

The good news is a speech pathologists can help you identify triggers of your cough.

This is important so that you can reduce or avoid those triggers. A Speech pathologist can teach you strategies to gain
conscious control of your cough and supress the urge to cough.

These strategies help to break the coughing cycle that causes further irritation that leads to more coughing.

If you have any concerns regarding your chronic cough, please contact us regarding your concerns.

November 5, 2020

If your child has difficulty communicating with others, it is usually due to a delay in speech or language, or sometimes both. So what is the difference?

Speech

Speech, also called articulation, is how words are pronounced. Children acquire sounds in a particular order. They also present with difficulties with speech sounds that are normal at certain stages of their development. These difficulties are called phonological processes, and they typically disappear by themselves as children develop skills.

Below is a table of phonological processes, and the age they are typically acquired

Process	Example	Age Remediated
Voicing	pig -> big	3.0 years
Word-final devoicing	red -> ret	3.0 years
Final consonant deletion	cup -> cu_	3.3 years
Fronting	kiss -> tiss girl -> dirl	3.6 years
Assimilation	dog -> gog	3.9 years
Weak syllable deletion	banana -> _nana	4.0 years
Cluster reduction	snake -> _nake	4.0 years
Gliding	rabbit -> wabbit	5.0 years
Stopping	/f/ fish -> tish /s/ sock -> tock /v/ van -> ban /z/ zip -> dip /sh/ sheep -> teep /j/ jump -> dump /ch/ chip -> tip /th/ this -> dis	3.0 years 3.6 years 4.6 years 8.0-8.6 years

(Caroline Bowen, 2011; Kilminster and Laird, 1978).

The following speech sound substitutions are atypical. If your child is presenting with any of these, contact a Speech Pathologist to discuss intervention.

Process	Example
Backing	tap -> cap dad -> gad
Affrication	car –> sar
Initial Consonant Deletion	bag -> _ag
Medial Consonant Deletion	spider -> spi_er
Vowel errors	pig -> peg, apple -> ipple
Collapse to one or minimal sounds	‘I want to go there’ -> ‘my mo moo mo mere’

Sometimes children need speech pathology intervention to assist their speech sound development. If you are concerned about your child’s speech skills, contact Harrison Speech Pathology to discuss this further and arrange an initial assessment appointment.

Language

Language is the ability to communicate by sending and receiving messages. It can be separated into two categories, receptive language, and expressive language.

Receptive language is the ability to understand information, both verbally and visually, for example written, picture or gestural form.
Expressive language is the ability to communicate your needs, wants and ideas successfully, via verbal or non-verbal means. Non-verbal expressive language includes body language, gesturing, using pictures or symbols, writing and sign language.

The following table outlines typical language development

Age	Receptive Language Skills	Expressive Language Skills
12 months	• Understand about 10 words • Respond to their name • Recognise greetings (hi, bye) • Recognise a few familiar people and objects • Make eye contact	• Start to use sounds, gestures and say words • Continue to babble • Copy different sounds and noises
18 months	• Understand up to 50 words and some short phrases • Follow simple instructions • Point to familiar objects when named • Point to some pictures in books	• Say 6-20 single words • Copy lots of words and noises • Name a few body parts • Use objects in pretend play
2 years	• Follow simple two part instructions • Respond to simple ‘wh’ questions (eg: ‘what’ and ‘where’) • Point to body parts and pictures in books when named • Understand ‘in’ and ‘on’	• Say more than 50 single words • Put two words together (eg: bye mum) • Use tone of voice to ask a question • Start to use ‘mine’ and ‘my’
3 years	• Follow more complex two part instructions • Understand simple ‘wh’ questions (eg: ‘what’ ‘where’ and ‘who’) • Understand ‘same’ and ‘different’ • Sort items into groups when asked (eg: food vs animals) • Recognise basic colours	• Say four to five words in a sentence • Use a variety of words for names, actions, locations and descriptions • Ask questions using ‘what’ ‘where’ and ‘who’ • Talk about something in the past • Have a conversation but may not take turns or stay on topic
4 years	• Answer most questions about daily tasks • Understand most ‘wh’ questions, including those about a story they have recently heard • Understand some numbers • Show awareness that some words start or finish with the same sounds	• Use words such as ‘and’ ‘but’ and ‘because’ to make longer sentences • Describe recent events • Ask lots of questions • Use pronouns (eg: ‘he’/’she’ ‘me’/’you’ and negotiations (eg: ‘don’t’ ‘can’t’) • Count to five and name a few colours
5 years	• Follow three part instructions • Understand time related words (eg: ‘before’ ‘after’ ‘now’ ‘later’ • Start thinking about the meaning of words • Understand instructions without stopping to listen • Begin to recognise some letters, sounds and numbers	• Use well formed sentences understood by most people • Take turns in longer conversations • Tell simple stories with beginning, middle and end • Use past and future verbs correctly (eg: ‘went’ ‘will go’)

(Speech Pathology Australia, 2020)

If your child is not meeting these milestones, contact Harrison Speech Pathology to discuss their language development and arrange an initial assessment appointment.

September 9, 2020

A stroke happens when the blood supply to the brain is interrupted. Blood flow to the brain is essential as it carries oxygen and nutrients to keep the brain working. If blood flow stops to an area of the brain the cells begin to die. A stroke may be caused by a blockage (ischaemic stroke) or a bleed (haemorrhagic).

If you suspect yourself or another person is having a stroke you should phone 000 immediately. Early medical treatment is an important factor for survival and recovery.

Look out for the acronym FAST. If you see any of these symptoms seek help.

F – Face: do they have a drooping face and/or asymmetry?

A – Arms: are they unable to lift one or both of their arms? have their arm(s) lost strength?

S – Speech: is their speech slurred?

T – Time: each passing minute is important so call 000 immediately

What are the common effects of a stroke?

The effects of a stroke depend on where the stroke occurred and the extent of damage to the brain. The following are common effects of a stroke:

Weakness in one side of the body (often the opposite side of where the stroke occurred in the brain)
Poor movement and difficulty coordinating movements
Not recognizing one side of the body (neglect)
Slurred speech
Difficulties understanding language
Difficulties saying words and sentences
Problems chewing and swallowing food, drinks, and saliva
Incontinence
Voice issues
Changes to senses – taste, sight, hearing, smell, touch
Vision loss
Fatigue
Change in mood and personality
Difficulties solving everyday problems
Fatality

How can a speech pathologist help a person who has had a stroke?

Speech pathology may be involved in the initial acute management of a stroke and long-term therapy.

Initially a speech pathologist may assist in determining how the stroke has affected communication and swallowing. The therapist may recommend and teach Augmentative and Alternative Communication Systems (AAC) so the person can communicate and make choices about their medical plans. They may also assist family, friends, and medical staff to communicate effectively with the person. Additionally, a speech pathologist may change the person’s diet and food/drink to ensure they can eat, drink, and take medications safely.

Following initial medical treatment, a speech pathologist is commonly involved in long term management to assist the person to return to previous activities, or to assist them to manage their changed functioning. A speech pathologist may help with the following:

Implement AAC systems to support a person’s specific communication needs
Support a person who cannot think of the word they want to say
Support a person who says the wrong words
Help a person to say sounds precisely so people understand them
Treat voice problems
Assist with memory
Improve problem solving
Provide therapy for social problems
Help manage diet changes so the person is safe to eat a drink
Train others in how to support successful communication
Educate family, medical staff, workplaces
Provide compensatory strategies

If there are swallowing and communication concerns it is important to start therapy as soon as possible. Intervention applied within the first 12 months is often when the quickest and concentrated gains are made.

How can I help someone who has had a stroke communicate?

There are many strategies to assist someone to communicate. It is best to first chat with your speech pathologist to determine the most effective strategies to apply.

The following are some common recommendations:

Speak in short sentences
Write words down, or encourage them to write
Pause between sentences/ideas so they have time to think about what you have said
Give them time to think of what they want to say and for them to communicate their message
Make sure you have their attention before you begin talking to them
If they have neglect of one side of their body, stand on the side that they can recognize
Talk about here and now topics
Monitor fatigue and talk about important topics when they are well rested
Stick to routines
Reduce distractions such as radio or tv noise in the background
If in a group setting limit it to just a few other people and make them aware of how they can help the person
Let the person know when you have understood them
Do not assume the person does not understand you
Talk to the person, even if they cannot talk back to you
Include the person in conversations
Respect the person’s wishes

If you or a loved one has experienced a stroke and would like assistance in managing the changes that have occurred, please do not hesitate to call Harrison Speech Pathology and speak directly to one of our experienced therapists.

August 4, 2020

Most people already breathe this way when they are relaxed. However, a lot of people take shallow breaths that do not engage the diaphragm very much. Diaphragmatic breathing uses the muscle called the diaphragm, which sits at the base of the lungs. When the body inhales, the diaphragm contracts and moves down. As the breath enters the lungs, the air pulls the lungs down expanding the ribs. The diaphragm then moves down and away from the spine. This is to allow the lungs to expand in all directions to increase capacity. As the body exhales, the diaphragm, the lungs, and the ribs relax back to their original shape. However, when tension or stress occurs in the body breathing becomes shallow only using a small proportion of the lungs and therefore failing to engage the diaphragm. This can be seen through the rise and fall of a person’s shoulders during breathing. This is called Clavicular or chest breathing.

Who should use diaphragmatic breathing

Everyone. Diaphragmatic breathing is crucial for every person who uses their voice. Especially, occupational voice users such as singers, teachers, childcare workers, call Centre workers, actors, media presenters, barristers, etc. These populations are most at risk of developing voice problems.

Why is breathing with your diaphragm so important?

Diaphragmatic breathing is essential for producing a strong, effective, and efficient voice. Our voice is integral to communication. It is expressive and can convey so much meaning. Our voices can tell others a lot about how we are feeling, who we are, and our physical and emotional health. When we use diaphragmatic breathing there is enough air to pass smoothly through our vocal folds without overusing any other muscles. This limits your muscles from getting tense and trying to force the air out, creating strained and weak vocalisations.

How do I breathe with my diaphragm?

Make sure you are sitting or lying in a comfortable position
Relax your shoulders
Put one hand on your chest and the other hand on your stomach
Breathe through your nose. You should notice the air moving from your nostrils to your abdomen, making your stomach (diaphragm) expand. Your chest should remain relatively still.
Purse your lips, as if you are drinking through a straw and exhale tightening your stomach muscle, slowly noticing your stomach (diaphragm) moving downward.

Diaphragmatic breathing is not always useful as a stand-alone treatment for voice disorders.

If you or your child are having any voice difficulties speech pathology assessment and intervention is recommended. Please do not hesitate to call Harrison Speech Pathology and speak directly to one of our trained therapists.

Image: Pexels

April 27, 2020

Dysphagia is discomfort or difficulty in chewing or swallowing. Anyone can have a swallowing problem at any stage of life.

What difficulties are associated with Dysphagia?

There are a number of difficulties associated with Dysphagia and can include anything such as:

Difficulty sucking
Difficulty drinking
Difficulty chewing
Difficulty swallowing
Difficulty controlling saliva
Food/liquids spilling from mouth
Difficulty taking medications
Strong coughing following a swallow
Gagging
Choking
Reflux

Types of Dysphagia?

There are different types of Dysphagia. The type of Dysphagia can be determined by a Speech Pathologist.

Oral Dysphagia is when there is a difficulty with the lips and/or tongue that affect a person’s ability to chew, move food around in the mouth and form a ball of food and drink ready for swallowing.
Pharyngeal Dysphagia is when there is a difficulty or discomfort located in the throat. This may mean food or drink may fall into the person’s throat before they are ready to swallow and food or drink going down the wrong way. In some cases, food or drink can go into the lungs. This can cause what is called Aspiration Pneumonia which can be fatal.
Oesophageal Dysphagia is when there is any pain or discomfort after a swallow. This means that food may be getting stuck in the tube on the way to your stomach.

It is also important to note that difficulties can also occur before the food goes into the mouth and these include things such as difficulty opening packets, cutting food or bringing food to the mouth with or without utensils etc.

How can a Speech Pathologist help?

A Speech Pathologist will be able diagnose the type of Dysphagia based on the difficulties reported and observed.

It is important to identify Dysphagia early to ensure safety and wellbeing while consuming food and drink and also to identify if there is any risk of Aspiration Pneumonia occuring.

Speech Pathologists also work very closely with other professionals such as doctors and dieticians for complete management of Dysphagia.

What will the appointments involve?

Initial appointments will involve gathering as much information as possible about the difficulties the person is experiencing. Following this, the therapist will then do some direct assessment tasks looking at the nerves and muscles in and around the face that are involved in eating.

This would be followed by food and drink trials to observe any difficulties with different consistencies (e.g. thin and thick liquids, puree, biscuits etc.).

Once the difficulties have been identified, recommendations can be put in place. These may include things such as:

Changing food textures
Avoiding food textures
Changing thickness of drinks
Avoiding certain drinks
Postural changes/adjustments
Swallowing techniques/exercises

Contact Harrison Speech Pathology if you would like to speak with a Speech Pathologist regarding booking in a Dysphagia assessment.

February 19, 2020

A tongue-tie, also known as ankyloglossia, is when the tongue is anchored to the bottom of the mouth restricting movement. This may mean the tip of the tongue cannot poke out past a person’s lips or when their mouth is open they may have difficulty touching the roof of their mouth. Sometimes, when a person with a tongue-tie pokes out their tongue, the tongue will form a “w” or heart-shape.

What are the effects of a tongue-tie?

A lot of children with a tongue-tie have no speech issues. This is because a lot of the sounds in English are made with the tongue tip (s, d, n) and can be produced with a slight movement of the tongue. Sounds where the tongue needs to move more (l, r and th) can still be articulated clearly with reduced movement.

Speech issues and tongue-tie are most common in children and therefore, it is not surprising that the two may co-occur. However, this does not mean that a child’s speech delay is caused by their tongue-tie.

How can a speech pathologist help?

A speech pathologist can examine and evaluate the functional impact of a tongue-tie on individuals.

This includes:

assessment and intervention for successful infant feeding
assessment to determine the impact of a tongue-tie on swallowing, chewing and the tongues ability to adequately move food from lips, teeth and other parts of the mouth.
Assessment and intervention of speech issues to determine whether a tongue-tie is impacting the clarity and intelligibility of the person’s speech.

When should surgery for tongue-tie be considered?

At birth, babies should be assessed to determine their ability to feed and latch. A Speech Pathologist and/or Lactation Consultant needs to be considered first before surgery.

Unfortunately, there is no guarantee that tongue-tie surgery will make speech clearer or resolve feeding issues.

Before considering surgery, Speech Pathology Australia recommends considering the following questions:

What type of surgery are you doing?
What will be the benefits of surgery?
What will happen if you don’t do the surgery?
Are there any side effects to the surgery?
Will an anaesthetic be required?
Will pain relief be required after surgery?
What is the recovery period after surgery?

If you or your child are having difficulties with speech, or swallowing, speech pathology assessment and intervention is recommended before going ahead with surgery.

Category: Speech therapy