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What are the Augmentative/Alternative Communication Clinics ?

The Augmentative/Alternative Communication Clinics assess children and adults who consistently 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 head-pointing systems, are explored when the client is unable to directly access the communication system.

The Pediatric Augmentative/Alternative Communication Clinic is an interdisciplinary clinic that includes Speech-Language Pathology, Occupational Therapy and Rehabilitation Engineering professionals involved in assessing and providing recommendations regarding communication options. The Adult Augmentative/Alternative Communication Clinic also accesses professionals involved in AAC service provision. When evaluations are complete, results are reviewed with the client and family/caregiver and recommendations are offered. Recommendations may include purchase of a specific communication device, or referrals to other professionals for further assessment or instruction in how to use the device effectively, as appropriate.


What Occurs in an Adult Speech-Language Evaluation?

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:

  • The ability to attend and participate in the exam
  • The muscles used for speaking as well as an assessment of speech and voice production
  • The ability to understand spoken language
  • The ability to repeat and read aloud words and sentences, to name pictures, recall specific words, describe a picture, answer questions and engage in conversation
  • Reading comprehension (the understanding of written language)
  • The ability to express oneself in writing
  • The ability to recall information

Results of the speech-language evaluation can be used to formulate an individualized treatment program, if appropriate. Results of the evaluation will be sent to your physician; communication difficulties may reflect specific medical diseases and test information may contribute to formulation of the medical diagnosis/treatment plan.

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What Occurs in a Videofluoroscopic Evaluation of Swallowing?

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. The VFSS is a painless x-ray procedure, which examines 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 TV monitor while being recorded on videotape. The Speech-Language Pathologist will then identify problems in the swallowing process and make appropriate diet, swallowing strategies or referral recommendations to your physician.

Common Questions:

My family member is having difficulty swallowing liquids. A friend told us to “thicken” his liquids. What do you recommend?

After a full swallow evaluation, we sometimes find that a very 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.

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What Are Videoendoscopic or Stroboscopic Evaluations?

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 a SLP to complete either or both of these procedures.

Videoendoscopy is completed using either a flexible or rigid endoscope. Flexible endoscopy involves placing a scope through the nose. Rigid endoscopy involves placing a scope into the mouth. 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 is dependent on the purpose of the evaluation 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.

Fiberoptic endoscopic evaluation of swallowing (FEES) involves insertion of the endoscope through the nose into the upper throat. The Speech-Language Pathologist 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.

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What are the services available for individuals diagnosed with head and neck cancer?

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.


What Occurs in a Pediatric Speech-Language Evaluation?

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:

  • Hearing screening, with referral to Audiology as appropriate
  • Assessment of speech sound production
  • Assessment of voice, resonance (the nasality heard in one’s speech) and fluency
  • Evaluation of the child’s ability to understand speech, including following directions and vocabulary development
  • Evaluation of the child’s ability to use speech to name items, express needs and wants and engage in age-appropriate conversation
  • Age-appropriate play and social skills as they relate to language development

The Speech-Language Pathologist may recommend more in-depth assessment of specific communication areas, based on the results of the initial evaluation.. When the evaluation is complete, the results are reviewed with the family/caregiver and recommendations are provided. Recommendations may include home language stimulation suggestions, treatment or referral to other professionals. A copy of the evaluation report will be sent to your child’s physician.

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What is the Foreign Accent Reduction Program?

The Accent Reduction Program includes a 1-1.5 hour evaluation of the client’s English speech production at the word, sentence and conversational levels. A written summary of the evaluation is provided to the client.

A profile is developed to include all phonemes (sounds) that will be included in the treatment program.  Therapy is tailored to the client’s individual needs with a focus on reducing the accented quality of speech production.  Sessions are conducted one time per week for one hour.   Each client must complete work  between sessions; daily practice is most beneficial.

Please contact Margaret Tiner, MS, CCC at 734-936-7080 or email mktiner@med.umich.edu for further information. 


What is a voice disorder?

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.

How is the voice evaluated?
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 as well as 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.

What is Voice Therapy?
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.

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What are the Augmentative/Alternative Communication Clinics ?

What Occurs in an Adult Speech-Language Evaluation?

What Occurs in a Videofluoroscopic Evaluation of Swallowing?

What Are Videoendoscopic or Stroboscopic Evaluations?

What are the services available for individuals diagnosed with head and neck cancer?

What Occurs in a Pediatric Speech-Language Evaluation?

What is the Foreign Accent Reduction Program?

What is a Voice Disorder?


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