Speech Language Pathology Clinical Services

AAC (Augmentative and alternative communication) describes multiple ways to communicate that can supplement or compensate for the impairment of individuals with severe communication disorders. This can include evaluation and acquisition of computer-based speech generating devices.

Autism, or ASD, refer to a broad range of conditions characterized by challenges with social skills, repetitive behaviors, speech and nonverbal communication.  Several pediatric speech-language pathologists participate in specialty clinics, including the Multidisciplinary Autistic Spectrum Disorders Clinic at the Rachel Upjohn Building in conjunction with Child Psychiatry, the Autism Care and Treatment Clinic (ACT) through Pediatric Behavioral Psychology, and the Multi-Disciplinary Evaluation Clinic (MDEC) through Pediatric Neurology.

Cognition involves processes that support communication, including attention, memory, organization, problem solving and executive functioning.  Speech-language pathologists at University of Michigan Health assess and design treatment plans to improve these processes and participate in many multidisciplinary outpatient adult and pediatric neurorehabilitation programs.

• Speech: The act of using muscles to produce speech sounds. This includes evaluation and treatment of voice, resonance (the amount of nasality in speech) and prosody (the intonation, rate and speed of speech).
• Language: The ability to understand spoken and written language, to express thoughts using words and sentences, to answer questions, participate in conversation and express through writing.
• Stuttering: Characterized by repetition of sounds, syllables or words, prolongation of sounds, and/or interruptions in speech known as blocks. An individual who stutters knows what they would like to say but has trouble producing a normal flow of speech.  

Dysarthria is a motor speech disorder caused by weakness, paralysis or incoordination of speech musculature and may affect intelligibility. Apraxia of speech is a motor speech disorder caused by difficulty with the motor planning required for speech. Aphasia is a language disorder that affects the understanding of spoken and written language as well as the ability to use language in speech and writing.

Dysphagia is a diagnostic term used to describe a swallowing disorder.  Speech-Language Pathologists are trained to complete a clinical swallow evaluation which may or may not lead to more formal assessments. Formal assessments can 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 Flexible Endoscopic Evaluation of Swallowing (FEES), in which an endoscope is inserted to observe and evaluate the swallowing process. 

Pediatric Speech-Language Pathologists may participate in infant feeding and swallowing assessments and work with families to optimize feeding of their babies with a wide variety of medical conditions, such as cleft palate or tracheal conditions.  They also participate in behavioral feeding programs such as the Complex Infant Feeding Clinic with Pediatric Psychology or the Pediatric Aerodigestive Clinic and Pediatric Otolaryngology.  

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

Speech-Language Pathologists can help in 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.

Resonance disorders can result from too much or too little nasal and/or oral sound energy in the speech signal and can result from structural or functional causes.  The assessment can include nasoendoscopy and multi-view video fluoroscopy, with speech-language pathologists participating 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 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.

U-M Health is proud to provide speech therapy services to the transgender community. Voice and communication play a distinct role in one’s identity. A Speech-Language Pathologist can help in targeting the voice, language, and communication features most reflective of one’s self-image.  

Speech-Language Pathologists provide education, tools, and speaking opportunities to practice communication styles in a supportive clinical setting. Interested individuals should obtain a referral from their physician and check with their insurance provider for coverage.

Speech-Language Pathologists at U-M Health aid in the assessment and treatment of certain upper airway disorders such as Inducible Laryngeal Obstruction (also known as paradoxical vocal fold motion disorder) and chronic cough. In conjunction with Otolaryngology, they participate in multi-disciplinary clinics dedicated to voice, swallow and upper airway concerns.

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 through Otolaryngology.

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. 

These options may include dedicated augmentative communication devices or computer programs that produce speech or provide a visual display of a person’s thoughts and ideas. Various devices, such as switches and eye-gaze systems, are explored when a client is unable to directly access the communication system. 

The pediatric augmentative/alternative communication program provides a comprehensive assessment of communication and communication options. The Speech-Language Pathologist will coordinate the evaluation; the expertise of an Occupational Therapist or Rehabilitation Engineer may contribute to recommendations for specific communication systems. 

Prior to scheduling an augmentative/alternative communication assessment, please provide the AAC Speech-Language Pathologist with records of past device use and school program information, which are important for ensuring that the assessment is both efficient and effective. 

Adult augmentative-alternative communication assessment is focused on assisting adults with acquired communication disorders (for example, ALS, traumatic brain injury, stroke) to adopt an effective communication method. When the evaluation is complete, results are reviewed with the client and family/caregiver and recommendations are offered. 

Recommendations may include a specific speech generating device or other methods to enhance communication.

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 plans of action. Impairment in cognitive skills impact a person’s communicative effectiveness. 

Cognitive-communicative therapy follows an evaluation that identifies cognitive areas of strengths and weaknesses. The therapy plan will address specific components of cognitive functioning, building on cognitive strengths and working with the patient to develop strategies to compensate for remaining areas of weaknesses.

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

The VFSS is a quick and painless x-ray procedure, which examines the oral (mouth) and pharyngeal (throat) stages of the swallow system in order to assess the nature of the swallowing difficulty. 

Typically, a patient is given different types of food and liquid from a spoon, cup and /or straw, as if eating a meal. The foods involved may include applesauce, pudding, fruit cocktail, a graham cracker or a cookie. The food is coated with a small amount of barium. 

Each swallow is watched on a monitor while being recorded digitally. The Speech-Language Pathologist will then identify problems in the swallowing process and make appropriate diet recommendations, swallowing strategies or referral recommendations to your physician. 

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). As part of the diagnostic or therapeutic process, your referring physician may ask an SLP to complete either of these procedures. 

Nasoendoscopy is completed using a flexible endoscope that is placed through the nose.  

For more detailed viewing of the vocal folds during voice production, a stroboscopic light is used to evaluate vocal fold movement and closure patterns. Breathing patterns may also be observed, in conjunction with vocal fold movement. 

The type of endoscope used for the procedure depends on the evaluation’s purpose and the patient’s tolerance for a particular endoscope.  In assessment of velopharyngeal functioning, the flexible endoscope is inserted along the floor of the nose to the junction of the posterior nose and throat. 

The patient is then asked to speak and the movement and closure patterns of muscles are observed.  Flexible endoscopic evaluation of swallowing (FEES) involves insertion of the endoscope through the nose into the upper throat by the SLP who then observes the throat and larynx while the patient swallows foods of various types.

Endoscopic evaluation of voice, breathing patterns, swallowing and velopharyngeal functioning is completed by a SLP who has been trained in the performance of endoscopy evaluations. 

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 voice disorder may exist when the pitch, loudness or quality of the voice is atypical for the age or gender of an individual. Symptoms of vocal difficulties can include hoarseness, breathiness, vocal fatigue, increased vocal effort, inappropriately high- or low-pitched voice, and pain with voicing. 

Associated laryngeal issues that can be included in the spectrum of voice disorders include chronic non-productive cough and upper airway respiratory difficulties (paradoxical vocal fold motion). 

The Otolaryngologist diagnoses the voice disorder and refers the patient to Speech-Language Pathology for voice therapy. A variety of medical professionals may be involved in assessment and treatment of voice disorders. 

There are several techniques used to evaluate a person’s voice. The speech-language pathologist interviews the patient to obtain insight into the individual’s perception of their voice. 

A perceptual analysis is completed, with the clinician analyzing the quality of the voice in various contexts. Specific computerized testing provides objective data regarding the perceptual attributes of the voice and airflow used during voice production. 

Finally, imaging of the larynx (voice box) with either a flexible or rigid endoscope under halogen or stroboscopic light (videostroboscopy) supplies valuable information as to how the larynx functions when in use. 

The primary goal of voice therapy is to promote coordination of the three subsystems of voice: respiration (breathing), phonation (voicing), and resonance, thus restoring an individual’s voice to an optimum level of functioning.

The 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

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. 

Assessment

Formal and informal assessment measures are used during the initial communication skills 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. 

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. 

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. 

Treatment

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 the 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. 

Trouble Swallowing

Following treatment for head and neck cancer, individuals who have trouble swallowing (dysphagia) will benefit from 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, and based on the initial clinical swallowing test, either a Flexible 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. 

Therapy

The need for speech or swallowing therapy following a head and neck cancer diagnosis 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. 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.