Speech Language Pathology

We often take our voice for granted; we open our mouth, start talking, and words magically come out! BUT our voice needs to be protected and cared for just like any other part of our body. Here are some helpful tips for a healthy voice:

GULP… KEEP HYDRATED! Your vocal cords need moisture to work efficiently. Drinking 8 to 10 cups of water per day will help keep your throat hydrated and your vocal cords lubricated! Make sure you have access to good tasting water all day so it’s easy to grab a drink whenever it suits you. Why not challenge your colleagues or friends to a water challenge and see who can drink the most during a day?

ARHEM… AVOID EXCESSIVE THROAT CLEARING OR COUGHING! When you cough and clear your throat, you are slamming your vocal cords together – which has the potential to cause damage to them. When you feel the need to clear your throat, try a) to sip some water, b) to do a silent throat clear by closing your mouth and saying the “h” sound, followed by a swallow, or c) sniff and swallow. If you can’t avoid clearing your throat, do it as gently as possible without using your voice – the louder you clear it, the more damage you can do!

BZZZ… LIMIT CAFFEINATED OR ALCOHOLIC BEVERAGES! Caffeine (including coffee, tea, pop, and chocolate) and alcohol have a diuretic effect (meaning it increases the amount of urine you produce) that can dehydrate the vocal cords. If you are going to have a cup of joe in the morning or a drink after work, pair it with a nice tall glass of water… or two!

KICK THE HABIT! Smoking irritates the tissues of the mouth and throat, including the vocal cords. If you aren’t able or ready to quit, consider cutting down on smoking. Making a schedule of how you will cut down and keeping score of how well you are doing will motivate you to keep going! Better yet, put all the money you would spend on cigarettes into a savings account and see how quickly you have enough money for a trip!

USE YOUR “JUST RIGHT” VOICE! Optimum voice production occurs at your natural pitch, at a moderate loudness (conversation level), and with the least amount of effort. Avoid yelling, cheering, speaking over loud music or the TV, communicating from different floors or areas of your home, loudly calling the dog, etc. Instead of raising your voice, reduce background noise whenever possible or use non-verbal methods to get the attention of others (e.g., clap your hands, blow a whistle, turn lights on and off, etc.). If your job requires you to speak to large crowds (e.g., public speakers, teachers, etc.) use an amplification system so that you do not have to raise your voice. Remember, your optimum voice is what you want to use, so also avoid prolonged whispering or unconventional vocal sounds (e.g., animal sounds, machine noises, etc.).

TALKING INVOLVES YOUR WHOLE BODY! When you are speaking, keep your throat muscles relaxed as you begin to speak and use your breathing muscles and airflow to start speech phrases. Don’t speak beyond a natural breath cycle – rather, speak slowly and pause often. Allow your body to stay aligned and relaxed so breathing is natural. Allow your abdomen and rib cage to move freely. Don’t clench your teeth, tense your jaw or tongue.

RELAX! Manage your stress and make time for you! Make time every day to relax, take a few deep breaths, go for a walk, dance, laugh… whatever works for you. If you do not already have a hobby, try to find something that interests you, whether it is learning how to do a new craft, joining a book club, or going to the movies! Why not start a walking group at work for lunch hour power walks or take a yoga or tai chi class? Whatever it is, make sure it is something that reduces your stress and leaves you feeling calm and rejuvenated.

Stuttering, sometimes known as ‘stammering’ or ‘dysfluency’ are breaks or disruptions in the flow of speech, such as repetitions (li li li like this), prolongations (lllllike this) or blocks (___like this).

No one speaks perfectly all the time, but for people who stutter, these disruptions happen more often, and are more severe.

Signs of physical tension and struggle (facial tension, extra head or limb movements) may accompany moments of stuttering.

When people stutter, they feel they have lost control of their ability to speak. Over time, the difficulties experienced when speaking can lead to feelings of embarrassment, anxiety, and fear about speaking.

Stuttering usually begins in early childhood. For most, stuttering goes away but for others, it persists throughout adulthood.

Occasionally, stuttering occurs after a brain injury, stroke or other illness and very rarely, after severe psychological trauma. This form of stuttering, known as ‘acquired stuttering’ is different than ‘developmental stuttering’ that begins during childhood.

It is estimated that one per cent of the adult population stutters; in Canada this means there are more than 300,000 adults who stutter.

Stuttering is about three or four times more common in men than in women.

What causes stuttering?

We don’t know the exact cause of stuttering.

Most researchers think there may be small differences in the brain that control the production of speech. These differences may be genetically passed down from one’s parents.

The areas of the brain responsible for language may look and work differently in people who stutter. The longer that stuttering continues after the age of seven years or so, the less likely it is that the person will recover from stuttering.

Stuttering is not a psychological problem (although it can have psychological effects), a sign of brain injury or reduced intelligence.

How is stuttering treated?

Although there is no simple cure for stuttering, people who stutter can learn to speak more easily, feel better about themselves and their speaking ability and communicate more effectively.

There are different therapy approaches designed to help adults who stutter learn how to accept and manage their stuttering, so it is less of a burden in their lives.

The long-term goal for the person who stutters is a feeling of control in any speaking situation, meaning they are able to communicate confidently in many different speaking situations.

Effective speech therapy for adults who stutter not only addresses reducing stuttering moments, but also aims to help people communicate in situations they may have been avoiding due to their stutter.

Speech-language pathologists also help advocate for those who stutter by educating others in the workplace, community and school.

Therapy for adults who stutter may vary in length and duration, but generally it is a long-term commitment that requires patience and understanding.

Researchers continue to investigate other methods of treating stuttering, such as medication, but these are not ready to be marketed yet.

Some electronic devices, such as the ‘SpeechEasy’ have also been used successfully by some adults who stutter, though it is not a cure for stuttering.

How to react when speaking with someone who stutters:

• Avoid making comments like: “Slow down,” “Take a breath,” or “Relax.”
• Instead, wait patiently and maintain natural eye contact until the person is finished.
• You may be tempted to help by finishing sentences or filling in words but try not to do this.
• Let the person know by your manner and actions that you are listening to what he or she says – not how they say it.
• Use a relaxed speaking rate when you are taking your speaking turn.
• Be aware certain speaking situations may be more difficult for people who stutter. For example, it is very challenging to use the phone or place an order at the drive-through. Be extra patient during these demanding speaking situations.
• Let the people who stutter in your life know that you support them – create an open and safe space for them to stutter and talk about stuttering.
• If you are unsure about something or how to help, the best thing to do is ask the person who stutters. For example, you can ask:
  • What can I do?
  • How can I be helpful?
  • How can I support you?
  • If that happens again, is there anything I can do?
  • Recognize that it is the individual’s choice to seek, accept or decline therapy.

Patient Information Resources:

National Stuttering Association www.WeStutter.org

Canadian Stuttering Association www.stutter.ca

Stuttering, or dysfluencies, are breaks or interruptions in the flow of speech.

You may hear your child repeat sounds or syllables (li-li-li-like this), prolong sounds (lllllllike this) or get stuck and block on sounds ( ___like this).

Stuttering usually appears between the ages of 2½ and 5 years, when children are going through periods of rapid development and learning.

About 5 per cent of preschool children may go through a period of stuttering and most will recover on their own, without any special intervention.

What causes stuttering?

The exact cause of stuttering is unknown, but it is related to small differences in the way the brain sends messages to coordinate muscle activity in the lungs, voice box (small area inside the neck) and mouth.

Stuttering tends to run in families and occurs more often in boys. Therefore, children may have inherited these differences which makes them more vulnerable as they grow and develop their language skills.

Is my child stuttering?

It is normal for a child’s speech to sound like stuttering, especially when they are 2- to 3-year-olds, and quite a bit in 4- to 5-year-olds. You may hear them repeat words and phrases, hesitate as they try to speak, then finally say what they mean to say in a way that is free from tension or struggle. This is normal as a child’s speech and language skills develop.

True stuttering is more likely to sound tense, sticky or stuck.

You may also see signs of physical effort – eye blinking or extra movements of the head, facial grimacing, tension around the mouth.

Children may also express awareness or frustration about their bumpy speech, saying, “I can’t say it,” or “never mind.”

How can I help?

• Give your child lots of time to take their speaking turn.
• Use a slightly slower but still natural rate of speech during your speaking turn.
• Practice good turn taking amongst all family members and avoid interrupting each other.
• Avoid directly correcting your child – instead model correct pronunciation and grammar.
• Be mindful of the amount and type of questions you ask. Balance questions with comments.
• Resist the impulse to ask your child to “slow down,” “take a deep breath,” “say it again,”, or “think about what you want to say.”
• Avoid putting your child in a position where they may feel pressured to talk.
• Instead, wait as long as needed, then calmly reflect/rephrase what your child was saying. This way, they knew you understood their message, and you also provided a model of how they could say it smoothly and easily.
• If your child says, “I can’t say it!” or reacts with fear or frustration following a moment of stuttering, it’s ok to acknowledge their struggles with talking. For example, you might say, “It was hard to get that word out wasn’t it? It’s ok – I’m listening, and I would like to hear the rest of your story.”
• Share these guidelines with family and other relatives as well as caregivers so everyone is aware of how to respond to a child’s stuttering in a supportive manner.

When should I take my child for a speech-language evaluation?

Although you can talk to a speech-language pathologist at any time to discuss your concerns, it is generally recommended that you seek a consultation if:

• There is a family history of stuttering, especially if the stuttering continued into adulthood;
• The stuttering has lasted longer than 6 months;
• The stuttering first appeared after of 3½ years of age;
• The child is reacting to his bumpy speech by with fear, frustration, changing words or not talking in certain situations;
• The stuttering is increasing in frequency and severity.

What will happen in the initial assessment?

The speech-language pathologist will collect a detailed history to learn more about your child’s stuttering. They will assess the child’s speech, language, social and play skills by administering tests and during free play.

They will assess your child’s fluency skills throughout the evaluation, in different speaking situations and during play. You may be asked to provide videos from home or other settings.

The speech-language pathologist will check the inside your child’s mouth.

Your child may be referred for a hearing evaluation if this has not already been completed.

Following the assessment, which may take an hour to an hour and a half, the speech-language pathologist will review their findings with you and discuss next steps.

What will happen during treatment?

For young, preschool children, the goal of therapy is complete recovery from stuttering. However, for those children who continue to stutter, an early start in therapy helps to lay the foundation for healthy communication attitudes at a young age. Early intervention helps to prevent the development of negative reactions, increased tension, struggle and avoidance of speaking situations.

The speech-language pathologist may plan to meet with you to share strategies and activities you can do on a daily basis to support your child’s fluency skills, and create a positive communication environment at home and/or daycare. Periodic monitoring and reassessment may be scheduled to check in on your child’s progress.

If weekly therapy is needed, the speech-language pathologist may discuss with you the different research-based therapies available for young children. Therapy for young children who stutter is play-based and it is also best if you continue to be very involved in your child’s treatment at home and during the therapy sessions.

Patient Information Resources:

Stuttering Foundation www.sutteringhelp.org

National Stuttering Association www.WeStutter.org

Canadian Stuttering Association www.stutter.ca

The Michael Palin Centre for Stammering Children www.stammeringcentre.org

Stuttering Therapy Resources, Inc. www.StutteringTherapyResources.com

Australian Stuttering Research Centre http://sydney.edu.au/health-sciences/asrc.ca