STUTTERING AND CLUTTERING THERAPY
Julie is our specialised Stuttering Therapist. She studied for a postgraduate degree (ESS) and followed countless courses and workshops on stuttering and cluttering.
Stuttering
In a nutshell, stuttering (or stammering) is disfluency in speech characterised by repetitions, prolongations, and/or blockages. At these times, someone who stutters briefly loses control over their speech. Unpleasant experiences and reactions to stuttering can lead to negative associations with stuttering over time. These can then create a bigger problem of excessive tension, avoidance, negative feelings, and more, exacerbating the stuttering. Everyone who stutters is different; thus, stuttering treatment is always tailored to the individual.
In therapy, we look at your story and work on the feelings and thoughts that might hold you back in your day-to-day communication. We also work with valuable communication skills and speaking techniques. We will quickly take your new skills out of the four walls of the therapy room and implement them into your real life.
Cluttering
Cluttering is a communication disorder in which a person talks very fast or at an irregular speed, leading to intelligibility problems. Symptoms can include high numbers of disfluencies, imprecise articulation, ‘swallowing’ parts of the sentence, and loss of control over sentence structure.
It is difficult for someone who clutters to monitor their speech inaccuracies on the spot. They often only realise the unintelligibility when the conversation partner reacts confused. Cluttering can be frustrating for the person who has it and the people in their environment.
Following diagnosis, the person who clutters and those closest to them learn how to manage the speech monitoring issues so that daily communication goes smoother. After gaining a thorough insight into your speaking habits, we learn and practice techniques for you to employ whenever you find them useful.
Stuttering and cluttering can exist separately, but they can also present together in a person.
SPEECH AND VOICE THERAPY
Voice disorders
People with voice disorders can face a range of issues, including hoarseness, voice fatigue, throat pain or irritation, and pitch problems.
Causes range from voice misuse/overuse, trauma, surgery and radiotherapy, hormonal imbalance, and more.
Treatment and expectations will be adapted according to goals and needs, ensuring that everyone, including professional voice users such as teachers, singers, lawyers, and actors, receives the best possible care. That said, depending on the issues, voice therapy will include a referral for an ENT exam, customised voice hygiene advice, and exercise therapy. You will learn skills to use the different facets of your voice in a healthy, effortless way.
Speech disorders
In adults, speech disorders often manifest as phonetic issues, where specific speech sounds are mispronounced. For instance, a lisp is a common phonetic disorder where the tongue is incorrectly positioned when producing certain sounds. Speech therapy for adults focuses on strengthening and flexing the involved speech organs, followed by progressively challenging exercises to improve the targeted speech sound(s).
In some cases, a structural problem causes articulation problems. In this case, collaboration with an orthodontist or other involved clinician is warranted. Speech disorders can also be neurological in nature.
NEUROLOGICAL COMMUNICATION DISORDERS
Neurological communication disorders most often occur in adults. One or multiple functions of communicating are impaired after acquired brain injury (stroke, head trauma, tumor, etc.) or neurodegenerative diseases (Parkinson’s, dementia, MS, ALS, etc.). The functions that are affected depend on the localisation of the problem in the brain or peripheral nervous system.
People with neurological communication disorders often receive their diagnosis in the hospital or with their neurologist, but sometimes, the cause of the communication problems is not identified yet.
Depending on the cause, type of disorder(s), and severity, speech and language therapy will look very different. Assessment and treatment are always tailored to the individual’s specific communicative needs. I also value close cooperation with other healthcare providers and encourage the person’s environment to participate actively. This way, we create a multidisciplinary treatment plan.
These are the most common neurological communication disorders:
- Aphasia: an acquired, neurological language disorder
Depending on the localisation of the brain lesion(s), aphasia can affect different regions in the language areas of the brain. This means there can be difficulties understanding written or spoken language, speaking, writing, or multiple functions.
For example, someone with aphasia may have a clear idea of what they want to say but may not find the words or have trouble putting them together to form correct sentences. - Dysarthria: an acquired, neurological motor speech disorder
In dysarthria, one or more body parts needed for speaking are weak or hard to control, often making the person less intelligible. Some symptoms include imprecise or weak articulation, insufficient breath support, a very soft or strained voice, and problems with prosody, such as speech rate and intonation.
Acute dysarthria is often caused by acquired brain injury, while chronic dysarthria is a result of neurodegenerative disorders, such as Parkinson’s disease. Sometimes, dysarthria presents with a form of facial paralysis. Speech therapy will look differently based on the cause of the dysarthria and the affected speech muscles. - Verbal apraxia: an acquired, neurological speech planning disorder
Apraxia of speech occurs when the part of the brain that plans and sequences speech movements is damaged. In a stand-alone diagnosis, the person still has the necessary language skills and muscle function to talk, but the words come out differently than the person intended. Consequently, this affects intelligibility.
Symptoms include variable, distorted speech sounds, continuous searching for the right sound, trying to correct a word multiple times, and unreliable prosody such as variable speech rate and rhythm. - Cognitive communication disorders: acquired, neurological communication problems due to an underlying cognitive deficit
Communication is more complex than a combination of just the language and speech areas of the brain. You need many parts of the brain to communicate, like those responsible for thinking, social, and conversation skills. When one or more of these regions are impaired, this will reflect to a greater or lesser extent on the person’s communication.
Possible cognitive communication problems include difficulty maintaining attention during a conversation, remaining on topic, remembering what was said, responding accurately, or following instructions.
Because brain areas lie close together, it is usual for someone to receive more than a single diagnosis after brain injury.
Neurological communication disorders often co-exist with swallowing disorders or ‘dysphagia’. Read more about it below.
SWALLOWING DISORDERS
Dysphagia
Dysphagia is difficulty processing and swallowing food or drinks. There can be different causes for dysphagia, such as:
- Acquired brain injury (stroke, head trauma, tumor, etc.)
- Neurodegenerative diseases (Parkinson’s, MS, ALS, etc.)
- Trauma or surgery in the mouth or throat area
- Oncological treatment in the mouth or throat area (such as radiotherapy and chemotherapy)
Examples of symptoms are pain, discomfort, or a feeling of having foods ‘stuck’ while swallowing, food or drinks coming back up, liquids spilling over the lips, hoarseness, and coughing during or after the meal. Swallowing disorders are diagnosed in collaboration with an ENT, who performs a swallowing exam.
Treatment includes a combination of customised compensation measures and exercise therapy of the affected structures, such as targeting tongue strength and flexibility or lifting capacities of the voice box. Prophylactic dysphagia therapy is a separate kind of treatment that takes place before and during radiotherapy of the mouth or throat area, to prepare and protect the swallowing structures by strengthening and flexing them.
Dysphagia often co-occurs with speech or voice problems. We will adapt the therapy plan to fit your needs in each area.
