Services

Specializing in the evaluation and treatment of speech, language, cognitive communication, voice, and swallowing disorders for people of all ages. 

Language

Symptoms at Home

Symptoms at Work

Expressive Language Disorder 

  • Word-finding difficulties 
  • Word substitution  
  • Frequently switches sounds  
  • Uses made up words  
  • Speaks in sentences that do not make sense  
  • Forget words or say them out of order  
  • Misuses idioms.  
  • Anxiety about public speaking  
  • Trouble answering direct questions  
  • Struggles to keep up with office small talk  
  • Unable to master “vocabulary” of your workplace 

Receptive Language Disorder 

  • Doesn’t understand jokes 
  • Takes everything very literally  
  • Difficulty focusing on what someone is saying particularly if there is background noises like a television  
  • Difficulty answering questions about what was just discussed.  
  • Unable to keep up during meetings, especially if more than one person is talking.  
  • Misinterprets friendly conversation as rude or confusing.  
  • Unable to answer questions during meetings, even though you know the answer. 
  • Trouble following multi-step verbal directions. 

 

Pencil and Notepad

Writing

Signs of writing deficits: 

  • Multiple spelling mistakes
  • Errors in grammar and punctuation 
  • Sentences that lack cohesion 
  • Reluctance or refusal to complete writing tasks 
  • Anxiety or frustration

Reading

Signs of reading comprehension deficits: 

  • Confusion about the meaning of words and sentences 
  • Inability to connect ideas in a passage
  • Omission of, or glossing over detail 
  • Difficulty distinguishing significant information from minor details 
  • Lack of concentration during reading
Stack of text books

Cognitive Communication

Caused by stroke, traumatic brain injury, brain tumors, specific types of dementia, and other neurological diseases

Includes:

Attention and concentration difficulties

  • Inability to concentrate to watch a TV program or movie they used to enjoy. The person may get easily distracted or begin to chat.
  • Difficulty concentrating on conversations, causing you to end conversations abruptly or avoid them altogether. 
  • Failure to pay attention can lead to missing important information. This may cause you to say inappropriate or embarrassing things. 
  • Difficulty multi-tasking or dividing attention between two or more activities. 

Memory problems

  • Difficulties accessing information you already ‘know’ such as word recall and remembering peoples’ names. 

Literal interpretation 

  • Interpreting verbal information very concretely and taking things literally. 
  • Reduced ability to grasp humor or sarcasm, and may miss subtle nuances of conversation. 

Reduced reasoning and problem-solving skills 

  • Inability to use language to think through or resolve a problem
  • Often results in poor judgement or decision-making

Slowed speed of information processing 

  • Difficulties with rapidly flowing conversations; often in busy settings or when talking with more than one person. 

Impaired social communication skills 

  • Altered turn-taking skills (i.e. being overly talkative, or not allowing the other person their turn to speak) 
  • Frequent interrupting 
  • Impaired ability to talk around a shared topic. (i.e. switching from topic to topic, or having a reduced range of topics) 
  • Fixating on certain topics 
  • Talking in a sexually explicit way or swearing at inappropriate times. 
  • Altered ability to give information in an organized way (i.e. assuming the other person shares knowledge about a topic when they don’t) 
  • Not using or reading non-verbal cues accurately (i.e. facial expressions and body language)

Voice

  • Lee Silverman Voice Treatment (LVST)
  • Hoarseness 
  • Polyps or nodules 
  • Dysphonia 
  • Vocal fold dysfunction 
  • Voice banking
  • Voice disorders related to head/neck cancer 
  • Voice disorders related to other neurological diseases 
  • Gender Affirming Voice Training

Dysphagia

Certified VitalStim®: neurological electrical stimulation 

Difficulty swallowing food and/or liquid.  

Signs/symptoms: 

  • coughing / choking when eating  or drinking 
  • watery eyes and/or runny nose when eating/drinking 
  • regurgitation 
  • feeling or sensation of food / drink being stuck in the throat 
  • gurgly / wet noise after eating  / drinking.

Symptoms:  weight loss,  pneumonia

Speech

Stuttering  / fluency: 

Involves frequent and significant problems with normal fluency and flow of speech. 

  • Difficulty starting a word, phrase or sentence 
  • Prolonging a word or sounds within a word 
  • Repetition of a sound, syllable or word 
  • Silence in-between syllables of a word; or pauses within a word 
  • Addition of extra words such as “um” 
  • Excess tensions, tightness or movement of the face or upper body to produce a word 
  • Anxiety about talking 
  • Limited ability to effectively communicate  

Apraxia: 

  • Acquired- caused by stroke,  dementia,  brain tumors,  traumatic brain injuries,  or other neurological diseases 
  • Childhood

Symptoms:

  • Distorting sounds- difficulties pronouncing words correctly.
  • Making inconsistent errors in speech 
  • Making errors in tone, stress or rhythm 
  • Errors in prosody- the rhythm and inflection of speech that we use to help express meaning. 

Dysarthria: 

  • Conditions that may lead to dysarthria include: stroke, brain tumors, traumatic brain injury, ALS (Lou Gehrig’s disease), Parkinson’s disease,  Multiple Sclerosis, Huntington’s Disease, Muscular Dystrophy, Cerebral Palsy, Guillain-Barré syndrome, Myasthenia Gravis and Lyme Disease. 

Symptoms: 

  • Slurred speech 
  • Slow speech 
  • Inability to speak louder than a whisper or speaking too loudly 
  • Rapid rate of speech 
  • Uneven or abnormal speech rhythm 
  • Monotone speech
  • Difficulties moving your tongue, lips and/or face muscles 

Accent Modification 

Public Speaking 

Confident Speaking 

VitalStim® Therapy

VitalStim® Therapy is a non-invasive form of neuromuscular electrical stimulation (NMES) used to treat people with dysphagia.  

Neuromuscular electrical stimulation (NMES) uses a device that sends electrical impulses to nerves, causing the muscles to contract at a greater intensity than you can do on your own. In addition to improving swallowing function, NMES can increase strength and range of motion. 

In addition to traditional therapy, VitalStim® has been found to be: 

  • Safe and effective for patients
  • Accelerate the recovery time from a restricted or modified diet 
  • Help patients achieve sustained improvement and long-term results 
  • Improve quality of life 

How long does treatment last? 

Treatment sessions usually last one hour. However, due to the age and other health conditions of the patient, treatment time may decrease.   

Side effects may include redness or irritation to the skin which typically clears with a topical moisturizer in 24 to 48 hours. The electrical current may start off as a slight tingling sensation and build to a pulling sensation.

Voice Banking

What is Voice Banking? 

Voice banking is the process of digitally saving your voice for future use on a speech generating device. Individuals diagnosed with degenerative disease such as ALS can consider saving their voice before they lose their ability to speak. It involves recording hundreds or thousands of sentences so that the computer can sample the person’s vocal qualities in different contexts, and use that information to create a synthetic voice modeled after the person’s own speech. 

What is Message Banking? 

Message banking creates a pool of pre-recorded messages using a person’s natural speech while it is still intelligible.   This is done by recording phrases, sentences, and questions, the individual can then utilize to express themselves later in life when speech intelligibility has declined. In some cases, an individual may wish to create a longer video or audio recording with a meaningful message to family and friends. 

Lee Silverman Voice Treatment (LSVT) Loud

LSVT Loud is a behavioral program designed to create sustained improvement in speech and voice function. It’s an evidence-based treatment that helps patients with speech problems increase their vocal loudness and ability to be understood.

The program trains people to use their voice at a more normal loudness level when speaking, whether they’re at home, at work, or in the community. It focuses on helping people adjust their perception of how loud or softly they’re speaking, so they can feel comfortable using a stronger voice at a louder level.

Who can benefit from LSVT Loud?

LSVT Loud was initially created to address speech issues related to Parkinson’s disease, but it can help others with a range of conditions that cause significant problems with voice, speech, and communication.

People with head injury, stroke, dementia, and neurological conditions such as multiple sclerosis and Huntington’s disease are also candidates for this therapy to help them control their voice.

What can LSVT Loud improve?

The technique aims to improve volume, articulation, intonation and confidence when speaking. It doesn’t simply teach people to shout, it recalibrates the feedback mismatch between the muscles and brain to help develop a voice that’s comfortable to use and easier to understand.

LVST can also aid swallowing, improve facial expressions, and stimulate changes in how the brain processes speech.

How does LSVT Loud work?

Many people with low vocal volume have a misperception of how loud they’re being, and put less effort into vocalizing. As a result, their speech becomes quite difficult to understand.

LSVT Loud reframes motor learning (how they physically form speech) and recalibrate sensory feedback (how they perceive their speech), so patients can feel that their ‘louder’ voice is actually in normal vocal range.

The treatment is built on exercises that strengthen the voice box and speech system and redefine neurological paths from the brain to the muscles in the throat.

This kind of learning is intensive, and requires continued practice, self-monitoring, and reinforcement from others to sustain lasting change.

LVST is conducted over 16 – one hour sessions. To maintain good progress during the treatment, these sessions are delivered 4 times per week, for 4 weeks in a row. There are also 10-15 minute carryover exercises, twice daily, to be done at home.  

LSVT Loud is built using three key principles:

TARGET: Vocal loudness

Using evidence-based strategies that help the brain to learn, modify, adapt and change in both structure and function.

MODE: Intensive effort

Research strongly suggests 4 that short bursts of intensive cognitive and skills-based training is most helpful for bringing about lasting change. That’s why the LSVT Loud method is delivered rapidly and includes exercises to do at home too.

CALIBRATION: Generalization
‘Recalibrating’ sensory feedback so people recognize that their new, louder voices are within normal limits. The aim is for people to feel comfortable with their voice, and more confident when speaking to others in different environments.

Schedule an Evaluation

Evaluations will range from 60 to 90 minutes in length. Treatment sessions will range from 30 minutes to 60 minutes in length. Each session will be tailored towards what would best serve your individual needs.