by Vincent M. DelGiudice, MSCCC-SLP
Speech-Language Pathologist

Speech Therapy Talks About Strokes

When someone in our family has a stroke, it can be a very difficult event. Of course, we want to make sure our family member is going to be okay, but sometimes it can be difficult to communicate with medical professionals. Listening to doctors, nurses, & other members of the medical team can be like listening to a different language.

In speech therapy, patient education is usually the first step, because by the time you get to us, you probably have plenty of questions. We are going to break down some of the terms you may hear discussed when you or a loved one has a stroke. Let’s start with a simple one.

CVA: A CVA or Cerebrovascular Accident is another word for a stroke. You can either have an Ischemic Stroke or Hemorrhagic Stroke. Ischemic means blockage and Hemorrhagic means a brain bleed.

In speech therapy, we work with the following impairments:

Dysphagia: Difficulty or inability to swallow. This can result in aspiration (food or liquid going down the wrong pipe) which can cause pneumonia.

Dysarthria: This is when speech sounds slurred due to muscle weakness or muscle incoordination.

Apraxia: This is a neurological disorder that results in a person’s inability to perform physical movements, whether it is speaking or moving one’s arms and legs. The person wants to perform the task but motor planning is impaired. In other words, the brain knows what it wants done, it just doesn’t know how to do it.

Aphasia: The loss of one’s language resulting in difficulty communicating. A person can have difficulty with speaking or understanding others. This usually results from damage to the left side of the brain.

Some other terms that you may run into outside of speech therapy are the following:

Hemiplegia: Total or partial paralysis of the body

Hemiparesis: Weakness on one side of the body

Quadriplegia: Total or partial paralysis of all of the limbs.

TPA: Tissue Plasminogen Activator, or TPA, is a drug used to break up clots in an artery. The drug will dissolve the clot to restore blood flow to the brain. This drug is only used if there is a clot, not if there is a hemorrhage.

TIA: Transient Ischemic Attack, or TIA, is when blood flow to a certain part of the brain is cut off for a short period of time, usually less than 15 minutes. A TIA is a warning sign that something is wrong, and it should be taken as seriously as a stroke.

Thrombus: This a blood clot that forms in a blood vessel in the brain.

Lability: When a person has emotional responses that do not coincide with the current situation.

Hyperlipidemia:  High Cholesterol

Hypertension: High blood pressure.

Endarterectomy: Surgical removal of plaque from an artery.

Stenting: Placing a small mesh tube in an artery during an angioplasty.

LTAC: Long term acute care.

Skilled Nursing Facility:  A facility that offers long-term care and rehabilitation with therapy such as physical, occupational and speech therapy.

The most important thing to know is what to do if we think a loved one or anyone is having a stroke. We use the acronym act FAST. FAST is an easy way to recognize the most common symptoms of a stroke.

Face: Ask the person to smile. Does one side of the face droop?

Arms: Ask the person to raise both arms. Does one arm drift downward?

Speech: Ask the person to repeat a simple phrase. Does their speech sound slurred or strange?

Time: If you observe any of these symptoms call 9-1-1 immediately. Acting quickly is important. Note the time when you began observing these symptoms.

If you or a loved one had a stroke, and communication or speech is a problem. Contact Vegas Voice Institute for speech therapy at 702-558-9900 so we may assist.

We provide speech therapy for patients having difficulty communicating or understanding others. Let us help you regain your communication.

by Vincent M. DelGiudice, MSCCC-SLP
Speech-Language Pathologist

Does someone you know have Aphasia? This isn’t a word we hear often. People usually only learn about Aphasia when it directly affects them or a family member. You may have met someone with aphasia and didn’t really understand what was wrong, but knew something wasn’t quite right. Here is a breakdown of what aphasia is and how we deal with it in speech therapy.

Aphasia most often occurs when someone suffers from a stroke, but it can occur when there is any type of brain damage such as a brain injury. A person with aphasia may have trouble understanding, speaking, reading, or writing. Aphasia DOES NOT cause a loss of intelligence or ability to think.
People with aphasia may describe it as knowing what they want to say but unable to form the words. It is similar to when you have a word on the tip of your tongue but can’t quite think of it. When someone is newly diagnosed with aphasia, it is important that they go to speech therapy to try and regain as much language as they can. The longer someone waits to go to therapy it decreases the chances of making progress.
If we break apart language into a couple different parts we can look at different symptoms of aphasia. Here are some of the symptoms we may look for in speech therapy.

Expressive Language (or talking)

• They can’t think of words.
• They use made up words.
• They have difficulty forming sentences; maybe using single words is easier.
• They may use the wrong word in a sentence. It may be a related word, like mixing up “river” and “ocean” or it could be unrelated such as replacing “chair” with “milk”

Receptive Language (or understanding)

• This is when there is difficulty understanding what others may say whether it be because they are talking to fast or because it is too noisy.
• A person who has difficulty understanding may have difficulty correcting their own sentences because they don’t hear or feel like what they are saying is wrong.

Reading and Writing

• Any difficulty reading whether it is with books, a form to fill out at the doctor’s office, or a grocery list.
• Difficulty with spelling or writing words in the correct order.
• Difficulty with using math for basic activities such as paying a bills or adding and subtracting.

In speech therapy, we treat all these impairments. We use communication-based and impairment-based strategies. Communication-based therapy focuses on the “now.” We look at ways to help communication now, so that our patient can communicate basic needs. Impairment-based therapy focuses on repairing the impairments that a patient may be suffering from. This include programs such as melodic intonation therapy.

There are certain strategies you should employ when conversing with someone with aphasia. It isn’t always easy to communicate with someone suffering from aphasia but there are ways that it can improve just by using some simple strategies.

Tips for communicating when someone suffers from Aphasia

1. Get the person’s attention before you start speaking.
2. Give them context or tell them the topic of what you will be discussing.
3. Speak slowly and be direct. Don’t speak loudly or yell, they can hear you just fine.
4. Maintain the topic that you are discussing. If you change topics, be sure to let your communication partner know.
5. Use visuals if necessary to help explain.
6. It may help to write things down if they are not having difficulty reading.
7. Try to ask questions that have “yes” or “no” answers.
8. Don’t finish their sentences, allow the person time so that they can express what they want to tell you.
9. Let the person make mistakes and let them try to fix them on his/her own. Wait until they ask for help before jumping in.

Aphasia is frustrating for everyone involved! Although humans are able to communicate, we all know that we aren’t always the best communicators. Work hard at being patient with someone who is having difficulty with communicating. It takes hard work to make sure that everyone’s wants and needs are being addressed. Look up a speech therapy office like ours at Vegas Voice Institute, to help you and your spouse, family member, or friend improve their ability to communicate with others!

Speech therapy is a term that encompasses many different types of therapy including voice and swallowing therapy. There are many reasons why your doctor may want you to consider voice therapy. You could have a lesion or nodules on your vocal cords that could be reduced with therapy. You could have a quiet voice from a diagnosis like Parkinson Disease. Your voice could be strained or hoarse from your job. Sometimes people are sent to voice therapy because they are having asthma-like symptoms or choking sensations in their throat where they feel like they can’t breathe. This can be diagnosed as vocal cord dysfunction.

What is voice therapy going to do for me?
Voice therapy has many different approaches but the first part usually involves learning about your voice and how you should be treating it. A speech therapist will teach you exercises to make your voice feel and sound better. Voice therapy can help with hoarseness, and/or a quiet or strained voice. It can be used to strengthen and/or reduce tension in the throat. You will learn stretches and breathing exercises that will help you maximize your voice to its full potential.

Can’t they just give me the exercises for home?
Voice therapy is highly individualized as each person presents with a different diagnosis. It is difficult to say how long or what type of voice therapy you will have to adhere to without doing a thorough voice evaluation. The duration of speech therapy is usually dependent upon the origin of the hoarseness and the severity of the problem. Upon completion of your evaluation, your speech-language pathologist will talk to you about the issues you are having with your voice and discuss with you the frequency and duration of your therapy. The therapist needs to make sure you are performing the exercises correctly or you could exacerbate the problem.

Is it expensive?
Most insurances cover voice therapy. We believe in improving your voice and allowing you to recover and heal your voice versus costly alternatives such as surgery or taking time off work because you cannot talk. Some patients must pay high copays or deductibles for therapy, but voice therapy IS a covered service.

If you are having trouble with your voice, ask your doctor to send you to a speech-language pathologist or check out the rest of our website and give us a call. Vegas Voice Institute is always here to assist with your healthcare needs.

Electrolarynx

by Vincent M. DelGiudice, MSCCC-SLP
Speech-Language Pathologist

Choosing the best option for your communication after a total laryngectomy depends on several factors. Most people can use the electrolarynx while other options may be more limited.
The electrolarynx is a relatively simple device to use. The upkeep with the device is easy and only requires battery changing. An electrolarynx is a good option for someone who isn’t eligible for other types of devices. This device is easy to learn and you can communicate as soon as you start using it.
The device takes the place of your voice box. It vibrates the throat and when you mouth words, you will hear what you are saying in a slightly robotic voice. It will take some time to learn to space out words and certain sounds to maximize intelligibility. There is a short learning curve to using this device accurately. This device is a cylinder shape. It looks similar to a thick glue stick and would have to be carried in your purse or pocket wherever you went.
My grandfather uses this device and when I asked him why he chose this device, his answer was, “there were no other options. This was the only option for me.” As that may be true, he may not have been given other options, so it is important to ask before your surgery about all of the options for communication. You want to make an informed decision on how you want to communicate and there is no reason why you shouldn’t test out an electrolarynx before your surgery, as anyone can use it with or without a larynx.

You Have A Hole In Your Throat, What’s Next?

by Vincent M. DelGiudice, MSCCC-SLP
Speech-Language Pathologist

Total laryngectomy is a procedure used to save a person’s life when a doctor feels that throat cancer may spread. Disrupting someone’s natural airway and voice is not something we typically take lightly in this field, but it is something that is done. After this procedure is performed, it’s time to deal with the problems in front of us and decide how to compensate and improve the quality of the life saved.
After this surgery, you are left with a few choices to regain your “voice” or ability to communicate back. The first type is the electrolarynx. This is a device that is used to vibrate the oral and pharyngeal cavity and act as the vocal cords. It is small and can fit in your pocket. It’s a cylindrical device and you hold it to your neck. They can be expensive, so try not to get in the pool with it. You might laugh at this, but you will become so accustomed to using this device it, will be part of you.
Another for regaining your voice is called esophageal speech. This is essentially burping your speech. You remember when there was the kid in grammar school that could burp the ABC’s. This is the type of voice that you can attempt after losing your vocal cords. Some people have a great quality voice with this speech while others find it is too much work or they may not like the sound.
Lastly, you can get a tracheoesophageal puncture (TEP). This is a device that is set up during the initial surgery or during another minor surgery a few weeks following the total laryngectomy. It is a device in your stoma that when held forces air through the esophagus (food pipe) instead of the no longer existent larynx (top of the windpipe). It vibrates the top of the esophagus and creates the vibrations needed for speech. There are now also devices that are hands free so that you don’t have to reach up and hold your stoma. There are also plenty of different variations of prostheses that can be used to make you more comfortable. Discuss this with your doctor or speech pathologist to see what would work best for you.
Again all of these options are up to you. Think about it carefully and ask around. Ask your doctor and your speech pathologist to discuss ALL options with you. It is better to make a well-informed decision rather than to choose what someone else prefers. Choosing between these options can be difficult for some people. Fortunately, there’s no reason you can’t try all of them. You can practice esophageal speech and try the electrolarynx before you even have surgery to know if either of those would be good options for you. Stay tuned for the next few blogs where I will discuss these three options in more detail.

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.