by Vincent M. DelGiudice, M.S. CCC-SLP
The management of head and neck cancer has changed the past couple of years, and non-surgical management, a combination of chemotherapy and radiation, has become the norm. Doctors are opting to save as much tissue as possible, rather than removing the entire larynx, otherwise known as “voice box.” Although this helps save voices, other problems can occur because of radiation and chemoradiation. 50% to 60% of post-radiation and chemoradiation patients will develop a swallowing problem, also known as dysphagia.
As speech pathologists, we serve this population of patients with swallowing therapy. We use a combination of swallowing exercises, compensatory strategies, and VitalStim (electrostimulation of the neck muscles). A combination of the aforementioned has helped us here, at Vegas Voice Institute, treat and help hundreds of patients.
The damage that radiation can cause immediately and later in life seem to be under explained. I often here patients say, “well the radiation was years ago, are you sure my swallowing problem could be from that?” The answer is yes. Radiation has long lasting effects that can worsen over time. Often patients come to us years after being cancer free and start to have swallowing problems.
We treat patients with a multitude of severities. As a patient, your severity may range from not eating at all to you just feel like food gets caught up in your throat sometimes. You may have trouble opening your jaw or you may just feel like food goes down the wrong pipe.
Eating/swallowing is taken for granted by most of us. If you are struggling with eating and swallowing and its causing you distress, it may be time to talk to you doctor about swallowing therapy. You eat at least 3 times a day and it usually is a social activity. Not being able to eat with people can decrease your quality of life. Food is important to me and my family. Most of the time, family discussion during one meal is about what we’re having for the next meal. I would be lost without food. If you’re having trouble with eating and/or drinking for any reason, don’t wait any longer. Take action now and enjoy eating again by letting our team of speech-language pathologists assist you at Vegas Voice Institute.
by Vincent M. DelGiudice M.S.CCC-SLP Speech-Language Pathologist
Working with the transgender population and transition of voice, has certainly been a “learn as you go” process. That’s not to say I didn’t do my fair share of research. I scoured textbooks, research articles, blogs, apps, and everything I could think of to prepare myself for my first patient. I had all of these goals prepared for when she came in. I thought I knew exactly what we were going to do. I forgot one thing…what did the patient want? I forgot the most important part about healthcare and that is care plans should be individualized. Each goal should be tailored specifically for the person sitting in front of me.
I remember when I was explaining the goals to my client during my first MtF transition therapy session. I brought up how we will work on body language, eye contact, and gestures. She looked at me and said, “I’m not changing who I am, I just want my voice to represent who I am more accurately.” This really made an impact on me. Not because I think we should never work on pragmatics, but because I didn’t ask her what she wanted to learn from me. The first lesson I learned about transgender voice therapy is that my goals need to align with the client’s goals. Whenever I have a transgender client come in now, that is my first question. “Why are you here? What do you want to work on?”
An important part of changing the perception of a person’s voice is changing pitch. I work with female voice patients every day who vary from the “low ambiguous pitch voice range” all the way up to the “high feminine pitch voice range.” The one thing these women have in common is that they all sound like women. As important as pitch is in transitioning, it is not the only quality that matters. The perceptual sound of the voice is what makes a feminine voice which includes breathiness, prosody, resonance, and articulation. Your goal pitch is important up to the point that it’s not (that makes sense right?). Yes, we want to increase pitch but only up to a point that is necessary. Meaning the goal pitch might be 180Hz, or between F3 and G3 on the piano, but s/he might find that pitch sounds artificial and the client prefers the voice s/he produces at 165 Hz, E3 on piano. It is essential to understand that there isn’t a “right or wrong,” the voice you are creating should be what the client wants, not what you want them to sound like. Of course it should be a healthy production of voice that won’t cause problems in the future but it is about what the client wants. Transgender therapy is about guiding someone through the voice transition process, not dragging them there.
Continuing to be open to learn allows you to be efficacious as a speech pathologist in the voice transitioning process. Admitting to not knowing everything allows you to be receptive to new ideas and provide the best care. At Vegas Voice Institute we feel that listening to our clients is of the utmost importance for providing optimal care.
Voice Care in Children: Stellar Performance at School of Rock Musical
By Linda L. Ganz M.S.CCC-SLP, Speech-Language Pathologist
I had an incredible auditory experience listening to the vocally talented children in the touring musical School of Rock, written by Andrew Lloyd Weber. This Broadway musical theatre hit debuted in 2016 in New York City. Last night, I attended the School of Rock performed by the touring Troika Entertainment company at The Smith Center in Las Vegas, Nevada. The 17 children performers ranged from 9-11 years of age in this smash hit. As a speech-language pathologist and voice specialist who assists children and adults when their voices are compromised, it was a pleasure to hear the stellar vocal quality of these singers.
Children performers undergo grueling practice times and still must see tutors to keep up with their school studies while traveling abroad. Voice care in a young performer is crucial to their continued performance without vocal injury. Vocal fold nodules are the most commonly encountered cause of pediatric voice problems. Symptoms of voice injury include chronic breathy or harsh voice over a long duration. Vocal fold cysts are less common in children. If children are feeling voice fatigue or finding their voice is not performing as usual, a consultation with a speech-language pathologist who specializes in voice therapy should be considered. As for the School of Rock Cast, congratulations on a stellar vocal job well done!
By Madeline Brungardt, M.S.CFY-SLP
Speech-Language Pathologist at Vegas Voice Institute
5 Simple Memory Strategies
Has your loved one ever experienced that aggravating feeling that s/he has forgotten something but can’t remember what it could possibly be? Memory issues can be the result of many causes (traumatic brain injury, age, stroke, etc). Using simple memory strategies can be helpful. These strategies to improve memory are one of the focal points in cognitive-speech therapy. Fortunately, there are many straightforward approaches that your loved one can use to increase his/her memory and decrease the number of “I can’t believe I forgot that again” moments. Here, we will discuss 5 simple memory strategies your loved one can begin using everyday.
This strategy may seem too easy to do but often many of us do not use the power of writing items down in notebooks, sticky notes, calendars, etc. By using a calendar, it’s easy to see an entire month of plans and “to-do’s” that are always within view.
Environmental Placement Cues:
Use environmental cues to set yourself up for success. For example, if you have a package to send out, place it by the front door or by your keys, so that when you go out you remember to bring it to the post office.
Rehearsal: Rehearsal is a simple way to engrain something you want to remember later into your brain. Repeating, reviewing, and practicing material that needs to be memorized until it is firmly in your mind. For example, you may want to remember someone’s name; by rehearsing the name over and over again, you are more likely to recall later.
Associations: Group tasks, ideas, objects, or words together based on qualities they have in common. For example, you recently meet a woman named Jennifer with brown hair. You know you have a sister named Jennifer who also has brown hair so you can try to relate her name to your sister and the fact that they both have brown hair.
Visual Imagery: This strategy relies on imagining tasks step-by-step For example, you want to make spaghetti and meatballs for dinner but you went to the store without a list. By using visual imagery, run through the recipe step-by-step in your head. Imagine each ingredient needed in each step to help you recall what you need at the grocery store.
By utilizing simple memory strategies throughout the day, your loved one will be more likely to recall that information they were forgetting.
by Linda L. Ganz, M.S. CCC-SLP
Today I would like to explore with you how Parkinson affects speech and voice and what can be done to make your voice alive again. Researchers identified the 5 most common speech problems in Parkinson as: rapid speech, mumbled words, pauses when talking, short rushes of speech and getting stuck on sounds repetitively while talking to say a word. Virtually every person with Parkinson (89%) will have a speech problem that will diminish the quality of life. Some signs that this could be happening to you are: avoiding using the telephone, frequent throat clearing, people leaning in close to you while you talk, or if a loved one says “what?” often. The most common voice problem reported by Parkinson people are a weak voice and garbled speech.
We believe Parkinson folks can improve their voices and can feel alive again with some speech therapy because science has proven it and we are doing it! We hear their voices “come alive” day after day at Vegas Voice Institute. The standard speech therapy is LSVT LOUD and entails speech therapy 4 times a week for 4-5 weeks with daily homework practice. Here are some examples of people who came to us with speech affected by Parkinsonism.