Speech-Language Pathology Clinical Services

Apraxia (difficulty with the motor-planning required for speech); aphasia (impaired language, affecting understanding of spoken and written language and the ability to use language in speech and writing); dysarthria (impaired intelligibility of speech, caused by weakness, paralysis or incoordination of speech musculature).

Assessing a patient’s ability to use assistive (augmentative) communication devices, including computer-based devices, when speech is unintelligible. Speech-Language Pathologists also assist patients with tracheostomy and ventilator use in establishing audible speech.

Including participation in the Multidisciplinary Evaluation Clinic (MDEC) through the Department of Pediatric Neurology and the Autism Spectrum Disorders Program through the Department of Psychiatry.

Assessing and designing treatment plans to improve the processes that support communication: attention, thinking and memory skills. Participation in the inpatient rehabilitation units and outpatient adult and pediatric neurorehabilitation programs.

• Speech: Including the muscles used for speaking, speech sound production, voice, resonance (the amount of nasality in speech) and speech melody (prosody).
• Language: The ability to understand spoken language; to understand the written word; the ability to express thoughts in words and sentences, answer questions and participate in conversation; the ability to express oneself in writing.

Assessment of the structures and movements involved in swallowing. This assessment may include a videofluoroscopic evaluation, completed with a Radiologist, in  which an x-ray is used to observe the safety and accuracy of swallowing. At times, the Speech Language Pathologist may complete a Fiberoptic Endoscopic Evaluation of Swallowing (FEES), in which an endoscope is inserted to observe the swallowing process.

Pediatric Speech Language Pathologist participate in neonatal feeding assessment and work with families to optimize feeding of babies with a cleft palate. They also participate in behavioral feeding programs and the Department of Otorhinolaryngology’s Pediatric Aerodigestive Clinic.

Speech and language mapping prior to or during surgery for seizure management or tumor resection.

The dietitian will determine how many calories, grams of protein, and fluids should be consumed each day. In addition, the dietitian can provide input on food consistency, supplementation, and tube feeding formulas.

Regaining communication skills after surgical removal of the larynx (voice box), which may include insertion of and instruction in use of tracheo-esophageal prosthetics for voice restoration.

Including Naso endoscopic assessment and multi-view video fluoroscopy, including participation in the Craniofacial Anomalies Program.

Designed to rehabilitate voice and prevent further injury to the vocal cords. A Speech-Language Pathologist trained in singing also participates in the interdisciplinary Vocal Health Program.

In conjunction with the Department of Otolaryngology, including assessment/treatment of individuals with paradoxical vocal fold motion, habit cough and irritable larynx syndrome. Our Speech-Language Pathologist participate in the Multi-Disciplinary Voice/Swallowing Clinic.

Voice Therapy services to the transgender community. A Speech-Language Pathologist can help you target the voice, language, and communication features most reflective of your self image. We can explore pitch, resonance, and intonation styles that suit your personal needs. We provide education, tools, and speaking opportunities to practice your communication style in a supportive clinical setting.

An augmentative/alternative communication (ACC) evaluation assesses children or adults who cannot make their needs understood through speech. When speech is not easily understood, options are available to promote effective communication.

Speech-Language Pathologists evaluate adults who are experiencing difficulties with communication. The typical evaluation will be performed in a quiet office and may include assessment of:

When a person experiences a brain injury, memory and thinking processes may be affected. Cognitive skills include the ability to focus and sustain attention, store and retrieve new information, analyze and organize information, problem-solve and initiate and evaluate plans of action. Impairment in cognitive skills impact a person’s communicative effectiveness.

If your physician has referred you to Speech-Language Pathology for a videofluoroscopic swallow study (VFSS) we will complete this study in the GI Radiology Department.

These procedures are used to view the larynx (voice box), swallowing mechanism (throat) and velopharyngeal  port (the area between your nose and throat that regulates the amount of nasality present in speech).

Children may be referred for a speech-language evaluation when delays or atypical development are observed in communication skills. A comprehensive screening is completed in all areas that contribute to speech-language development:

Voice is produced when the vocal folds are set into vibration by air passing through them during exhalation. The sound produced is then shaped into words, phrases and sentences by structures contained within the throat and oral cavity to produce speech.

A diagnosis of head and neck cancer is a significant life challenge, and speech-language pathologists specializing in this area of care will work closely with your medical team to provide you with communication and swallowing options.

Head and neck cancers may occur in areas that are important to speech and swallowing. The lips, upper or lower jaw (maxilla and mandible), alveolar ridge, hard or soft palate, tongue, tonsil, thyroid gland, parotid gland, pharynx or larynx.

The tumor itself, or the required surgery, chemo or radiation therapies, may affect a person’s ability to speak or swallow.

Referral for evaluation of communication and/or swallowing disorders is generally made by one of the Oncology team members: Otolaryngologist, Radiation Oncologist or Medical Oncologist.

We also accept referrals from other members of the treatment team, including the Primary Care Physician.

What occurs during the communication skills assessment?

Formal and informal assessment measures are used during the initial assessment. Informally, voice, resonance (nasality) and speech intelligibility are evaluated during spontaneous and structured speech tasks.

A formal assessment of voice uses measures including computerized analysis of key voice components (pitch, loudness, quality) and/or imaging of the larynx with either a flexible or rigid endoscope.

For further information on voice assessment, please refer to information on Voice Disorders on this website.

Use of nasoendoscopy (flexible scope inserted through the nose) may be required to assess resonance (nasality) via assessment of the soft palate’s function.

A computerized assessment of speech resonance, using a Nasometer, may also be useful in establishing the level of nasality present in speech.

The Resonance section on this website provides additional information on resonance evaluation/treatment.

Speech evaluation includes assessment of how clear speech sounds to a listener. Objective test measures may be used to isolate imprecise production of specific speech sounds or clusters of sounds.

In individuals with laryngeal cancer, use of an alternative means of communication may be necessary. Therefore evaluation for use of an electronic communication device, an artificial larynx, or TracheoEsophageal (TE) voice, may be indicated. The artificial larynx generates sound.

This sound is transferred into the oral cavity and the patient shapes this sound into words. TE voice is generated by air flow from the lungs through a voice prosthesis placed into the esophagus.

Once the air enters the esophagus it passes through a muscular segment, the PE segment, causing it to vibrate and produce sound. The sound travels into the oral cavity and the patient shapes this sound into words. The Speech-Language Pathologist provides instruction in how to use the artificial larynx and how to produce TE voice.

Assessment of swallowing

Following treatment for head and neck cancer, individuals who experience difficulty swallowing (dysphagia) will require a clinical evaluation of swallowing.

When food or liquid is not swallowed safely, it can result in airway and medical problems, including pneumonia. Speech-Language Pathologists assess swallowing, examining the safety of various types of food consistencies (solid, semi-solid, liquid).

They may schedule, upon physician referral, specific swallowing tests, either a Fiberoptic Endoscopic Evaluation of Swallowing (FEES) or a modified barium swallow study (often called a VFSS, or 3- Phase swallow study).

The FEES is an evaluation in which a flexible endoscope is placed just below the base of the tongue to visualize the pharyngeal structures before and after the swallow.

The 3- phase (VFSS) swallow study is completed with GI Radiology. It involves eating or drinking food or liquid mixed with barium.

The barium allows the radiologist and SLP to view the food or liquid as it moves from the mouth to the stomach, essentially a “moving X-Ray” of the swallow. Please refer to the Dysphagia section for additional details on these studies.

Treatment

The need for speech or swallowing therapy will be based on the results of the evaluation. Therapy may include oral motor exercises, speech drills, swallowing exercises and training on strategies to improve speech and/or swallowing, etc.

The length of therapy will vary depending upon the type and severity of the disorder. However, in most cases therapy is short term (4-8 weeks).

The exception to the rule is management of TracheoEsophageal (TE) speech and the TE voice prosthesis.

This generally requires continued evaluation and management for the duration of a patient’s life. Treatment intervals vary.

What supports are available for patients and families, following head and neck cancer?

There is a monthly Head and Neck Oncology Support group that meets in the Walter Work Conference Room in the Otolaryngology Department.

This is open to any patient, family member, friends and/or support staff. Each month there is a different topic/speaker.

For questions, please contact Teresa H. Lyden at 734-763-4003 or at lyden@med.umich.edu.

After a full swallow evaluation, we sometimes find that a specific group of patients do benefit from a thickener to make their liquids thicker. These patients are carefully monitored and the thickener is discontinued as soon as possible. However, in most of our evaluations, we find that a thickener is not needed.

We avoid thickeners whenever possible, given that there is a risk of dehydration. Occasionally, thicker liquids can be more difficult to swallow if there is any weakness in the throat.