Park Slope Speech Therapy - Speech & Language Therapy
Speech is that part of the Communication Continuum that deals with speech sound production. Speech Therapy is provided by Speech & Language Pathologists, more commonly referred to, simply, as "Speech Therapists." Speech & Language Pathologists help remediate or foster improvement in speech sound production, language, and in our case (having substantial experience in, and having developed novel and highly successful techniques) reading and all language arts. If you'd like make an appointment, or talk about your child or yourself, please call us at 718.768.3526 or email us at firstname.lastname@example.org. If you are seeking information on language problems, such as Language delay, Language disorders in children, Language Disorders in adults, Auditory/Language processing disorders, Pragmatic disorders(difficulty with expressing or understanding ideas or thoughts, communicating with others, decision making, aphasic speech, engaging in conversation, or similar issues), or Autism Spectrum Disorder, please visit the language section of our website.
If you are seeking information on speech problems, or wish to improve your speaking abilities, you are in the right place. We treat (remediation and/or improvement) all speech issues, such as:
- Speech Sound Disorders: Articulation and Phonological Processes
- Childhood Apraxia of Speech
- Orofacial Myofunctional Disorders
- Stuttering and other fluency disorders
- Voice disorders
- Accent Reduction
- Public Speaking
Children with speech and language disorders may be at risk for later reading problems. In an attempt to mitigate such problems, we not only provide direct remediation for these disorders but (where appropriate), additionally, work with your child using textual material, and provide our highly successful assistive learning technique (software) for home use, along with training. We have had cases over the years where, when textual material was incorporated into Speech/Language therapy, children excelled at reading. In addition, with pre-school children, we provide pre-literacy training to parents.
Speech Sound Disorders
Speech sound disorders include articulation disorders and phonological processing disorders. Speech sound disorders (common until a certain age, and not considered a disorder) include substituting one sound for another, such as saying "wabbit" for "rabbit," or omitting sounds, like saying "nana" for banana. Phonological disorders, on the other hand, consist of a pattern of speech production errors, such as producing sounds in the back of the throat that should be produced by tongue against the soft palette.
Children with articulation disorders mispronounce sounds on testing and/or in spontaneous language. They may substitute one sound for another, as in "th" for "s". Some children distort sounds such as the lateral lisp, in which the "s" sound is produced with air coming out of the mouth between the tongue and the cheek, rather than the tongue tip and the ridge behind the front teeth. Most significant are omissions. Some children will routinely omit a particular sound, for example, say "home", "here" and "hop" as "ome", "ere" and "op." Adults may have this disorder as well, if they were not treated as children.
Phonological Processing Disorders
Phonological processing disorders refer to patterns of errors. For example, Final Sound Deletion is a disorder where children tend to omit all ending consonants, as in saying "I lie tuh hi the bay baw" instead of "I like to hit the baseball." Backingis another example of a phonological processing disorder, in which the child says sounds that should be made in the front of the mouth in the back, so /t/ and /d/ are pronounced as /k/ and /g/.
How we help
Subsequent to an evaluation to determine the specifics and severity of problems, speech therapy sessions are typically scheduled 1 to 3 times per week. If there is more than one error sound, we generally pick the sound or pattern of sounds that is developmentally easier to produce or easier for them to produce. We utilize a multisensory approach to error-sound correction, depending on what kind of input is most effective. We may provide visual stimuli in the form of a mirror and use demonstration (either live or on video) to facilitate correct production. Auditory stimuli may also be helpful. We provide a model to be imitated or we record the client so they may hear their own production and evaluate it. Sensory stimuli are often very helpful, and we provide tactile input to those muscles that should be firing to produce the sound or sounds correctly. We use some or all of these methods, depending on what works for a particular individual. The child's age also needs to be taken into account, and sessions planned accordingly. For example, a three year old may not have the maturity to use a mirror without great distraction. We use similar techniques with adults who demonstrate errors in sound production.
Childhood Apraxia of Speech (CAS)
This is a motor speech disorder characterized by an inability to initiate and sequence speech movements. The child knows what he or she wants to say but is unable to coordinate the movements. It is not a disorder of muscle weakness; rather, the brain is unable to produce the required firing of the muscles in an organized fashion. Apraxia can produce inconsistencies in speech sound production. A word may "pop out" clearly but be very difficult to produce when there is an intention to do so. Apraxic children often have a history of very little babbling or sound play, and even though these are the same muscles used for eating, eating is frequently not a problem. These children may have a history of delayed acquisition of speech and language milestones. Another that may occur in connected speech is distortion of vowels. Also, a lack of normal melody and inflection is not uncommon.
Adults may exhibit a similar disorder; however in their case it is not developmental. Apraxia in adults may be the result of a brain trauma, such as a stroke or a car accident.
Treatment for Apraxic children
First, an evaluation is conducted to make a differential diagnosis. Treatment should be frequent and intensive, at least three times per week. Home practice is essential for success. Treatment includes providing visual, auditory and tactile cues with intensive drilling. The goal is to develop automaticity in speech, thereby bypassing the need for the brain to mediate speech movements. In some cases, CAS may be so severe that the child will require alternative augmentative communication know (frequently referred to as AAC). However, when the focus in therapy is on planning, sequencing and coordination of the movements required for speech production, most children do well. The duration of treatment is generally several years and it is important that client and parent be aware of that and that and be active participants in the therapeutic process.
Dysarthria is a motor speech disorder, a disorder of weakness, paralysis or incoordination of the speech musculature. Typically, there is a slurred speech pattern. In addition, speech volume is often problematic. Drooling and difficulty with chewing and swallowing are often present. Voice quality may be hoarse and/or hypernasal. Inflection may be atypical and the oral musculature may present with limited movement. This disorder may be seen in adults or children.
Treatment depends upon which of the above dysarthric symptoms are present. If there is a lack of oral motor movement, therapy includes increasing the mobility and accuracy of the articulators. Therapy may also include improving oral resonance of the voice. Working on breath support will improve volume, and help with rate as well.
Orofacial Myofunctional Disorder
With Orofacial Myofunctional Disorder, also known as tongue thrust, the tongue is maintained in a low and forward position in the mouth. It often protrudes between the teeth and may even be visible between the lips during rest. Children with a tongue thrust may have articulation impairments and are noted to especially have difficulty with the s/z sounds, although the /sh/, /ch/, and /j/ may be affected. Since the tongue is forward in the mouth, the front teeth may be affected and may require orthodonture. The tongue thrust swallow literally pushes food out of the mouth, so swallowing may also be problematic. The tongue thrust swallow is often associated with generalized motor problems; however, it is also seen in children with chronic congestion, asthma and allergies.
Tongue thrust is corrected utilizing a well organized and effective tongue thrust program, which incorporates oral motor exercises plus specific swallowing exercises. If there are misarticulations, they are treated using an articulation protocol. Once progress has been made with correction of the tongue thrust swallow, articulation is much easier to correct. If there is dental misalignment, a referral to an orthodontist is required. If tongue thrust intervention takes place in a timely fashion, adult teeth may grow in with no misalignment.
Stuttering and other fluency disorders
Stuttering is a disorder that affects the forward movement of speech. It begins in childhood and, based on recent research, seems to have some genetic foundation. Children often begin treatment when their parents notice they are repeating parts of words, whole words or phrases, or prolonging sounds. Adults usually note that they have been stuttering since they were children. They may report times when they stuttered much less or much more.
Another fluency disorder is called cluttering. It is neurological in origin, and is fairly rare. The clutterer speaks very rapidly and irregularly. Medial syllables are often omitted, and are often slurred together, most likely as a result of excessive rate. Cluttering and stuttering can co-exist.
An evaluation is performed to determine the type of disfluencies exhibited, the rate of disfluencies, and whether or not there are secondary symptoms, such as foot stamping, eye blinking, etc. If a child is in preschool, therapy comprises play therapy with modeling of "slow, easy talking" and parent counseling. For older children and adults, treatment utilizes a more directive approach, and works specifically on extinguishing disfluent behaviors. In addition, therapy focuses on helping the individual feel less like a "stutterer" and more like a person who "happens to stutter." Stuttering group sessions, where every-day situations, as well as ideas and thoughts are shared, can also be helpful.
With respect to clutterers, treatment focuses primarily on rate and organization of expressive language, using a variety of techniques.
Voice disorders include:
- Disorders of resonance-hyper or hypo nasality-due to motoric or health reasons,
- Vocal nodules-callous like growth on the vocal cords caused by vocal abuse
- Vocal polyps-growth of vascular tissue also caused by vocal abuse
- Vocal hoarseness-caused by vocal abuse, and health issues
- Use of incorrect pitch-generally a behavioral issue
Treatment depends upon the underlying root cause of the voice problem. If there is a behavioral problem, an organized approach is utilized to eliminate the cause of the problem. So, for example, if excessive shouting caused a nodule to form, we make a chart and a graph of the behaviors that need to be eliminated and ask the client to keep a count of these behaviors, and as we chart and graph these numbers, we see them gradually go down. Medical problems such as polyps are sometimes treated surgically while others are treated behaviorally and with medication. To treat use of incorrect pitch, we use a variety of techniques to find the optimal level and then use behavioral approaches to help the client maintain that pitch.
With respect to disorders of resonance, the speaker may need to work on proper movement (perform exercises) of the soft palate
Some people from foreign countries or people who just wish to get rid of their Brooklyn accents come to our center.
Initially, a test of phonology, as in the Compton Phonological Assessment of Foreign Accent, is administered. This is a comprehensive exam that identifies exactly what sounds needs to be worked on. Then, materials are organized that will help the client speak more like a native speaker. The client's motivation is paramount to the success of this program as it requires diligence and lots of practice.
Calls are received from people who feel that they don't present well when speaking publicly. There are two major aspects that we explore: 1.) How they speak, make eye contact, and connect with the audience, and 2.) Organization of information to be presented.
Speech production is analyzed to determine what areas need intervention. A test such as the Compton, or another articulation test, is administered. Treatment then focuses on whatever sound production errors are noted during testing. Speech rate is focused on as well, as nervous speakers tend to speak quickly.
Clients are assisted with planning the presentation of their material. Activities are incorporated to replicate a public speaking situation such as adding audience members, having the "audience" ask questions, etc. Improvement is proportional to amount of work and practice clients put into it. Observing a client progress from mumbling, with poor posture, to a proud presenter, standing up straight and tall and speaking clearly out to their audience is the ultimate goal of treatment.