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Q.1 What are the conditions that place an individual at risk for communication or swallowing disorders?

An individual may be at risk for communication and feeding/swallowing problems if there is a history of the following:

  • Cleft lip or cleft palate
  • Craniofacial anomalies
  • Velopharyngeal insufficiency
  • Dental malocclusion
  • Macroglossia
  • Oral-motor dysfunction
  • Neurologic disease or dysfunction
  • Brain stem injury
  • Respirator dependency or respiratory compromise
  • Tracheostomy
  • Vocal fold pathology
  • Paralysis or paresis of the vocal folds
  • Developmental delay
  • Psychosis
  • Autism, Prematurity or traumatic birth
  • Hearing loss or deafness


Q.2 At what age should speech/ language therapy be started?

Some children begin therapy between the ages of two and five years, since communication disorders become apparent in that age range. However, infants can benefit from treatment if they are "high risk" due to traumatic birth history, exhibit feeding or swallowing problems, have signs of developmental delay, are diagnosed with a hearing impairment, or do not begin to coo and babble appropriately. While early intervention is critical for the best long-term prognosis, noticeable improvements can occur in older individuals who have not received treatment. Indeed, some treatment would only be initiated in older individuals as a result of their age or changing medical condition.


Q.3 What are the characteristics of the common speech, language and swallowing disorders and when is an evaluation appropriate?

1. Language Disorder:

Characterized by difficulty understanding language or following directions, or the inability to choose appropriate words and combine them correctly for sentences. The individual lacks age appropriate language comprehension and expressive abilities.


Inductions for Referrel

  • The individual does not use any meaningful single words.
  • The individual does not follow simple instructions, such as "Give me your shoe," or he cannot point to body parts or common objects following a verbal request.
  • The individual does not combine words for short utterances.
  • The individual does not communicate with complete sentences.
  • The individual echoes parts of questions or commands rather than responding appropriately. For example, when asked, "What's your name?" the individual responds, "Your name."
  • Sentence structures are short and noticeably defective.
  • The individual uses words incorrectly, or frequently substitutes an associated word for the intended word.
  • The individual responds with single word utterances.
  • The pre verbal individual also lacks sign language ability.
  • The individual is unable to name common objects and activities.
  • The individual cannot combine words to form short meaningful sentences.
  • The individual is unable to take turns during a conversation (speaking and listening).
  • The individual becomes frustrated or angry when he cannot express his emotions, thoughts and ideas.
  • The individual cannot understand simple instructions.
  • The individual has difficulty in solving simple problems.

2. Articulation (Speech) Disorder:

Characterized by the inability to produce individual speech sounds clearly and difficulty combining sounds correctly for words. Speech sounds may be incorrectly substituted (tun for sun), omitted (ool for school) or distorted (shlun for sun)


Indications for Referral

  • The individual doesn't use consonant sounds.
  • The individual uses mostly vowel sounds and gestures for communication.
  • The speech is primarily unintelligible.
  • The individual frequently omits consonants in words.
  • The speech is difficult to understand.
  • The individual is unable to produce some speech sounds correctly.


3. Fluency Disorder:

Characterized by an abnormal amount of involuntary repetitions, hesitations, prolongations, blocks or disruptions in the natural flow off rate and rhythm of speech.


Indications for Referral

  • The individual physically struggles to initiate and complete speech utterances.
  • The staff, family members or advocates are concerned about stuttering.
  • The individual has an abnormal number of repetitions, hesitations, prolongations, blocks or disruptions in the natural flow of speech.
  • The individual exhibits tension or abnormal movements during speech.
  • The individual avoids speaking to strangers due to a fear of stuttering.
  • The individual is embarrassed or disturbed by his speech.
  • The individual's rate of speech is too fast making him difficult to understand.


4. Voice Disorder :

Characterized by abnormal vocal pitch, loudness, quality or resonance.


Indications for Referral

  • The voice is chronically hoarse, harsh, breathy or of poor quality.
  • The voice is always too loud or soft.
  • The pitch is inappropriate for the consumer's age or sex.
  • Pitch breaks occur frequently.
  • The voice is hyponasal or hypernasal.
  • After chewing food, experiences difficulty swallowing.
  • Has difficulty keeping food and drink in mouth while chewing
  • Does not chew food properly (swallows unchewed or partially chewed food).


5. Feeding or Swallowing Disorder (Dysphagia):

Characterized by difficulty with normal oral feeding or swallowing.


Indications for Referral

  • The individual has difficulty sucking from a straw or drinking from a cup.
  • The individual has difficulty taking foods from a spoon or has difficulty chewing foods.
  • The individual avoids certain types of foods or certain food textures.
  • The individual gags, chokes or coughs with feeding.


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