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Voice Disorders
Voice Disorders
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A voice disorder is characterized by changes in voice quality, pitch, loudness or vocal effort (also known as dysphonias) that may be inappropriate for the individual’s age, gender or cultural background or are creating discomfort of frustration with meeting daily vocal demands. These changes can be as a result of structural changes (nodules, aging or altered vocal fold tissues), Neurogenic changes (vocal tremors, spasmodic dysphonia or vocal fold paralysis) or functional changes (improper use and care of the vocal mechanism (vocal strain, neck tension, over use, fatigue)

Signs and symptoms of dysphonia include:

  • Roughness, breathiness, hoarse or raspy voice

  • strained or strangled quality

  • abnormal pitch (too high, too low, pitch breaks, decreased pitch range)

  • abnormal loudness (too high, too low, decreased range, unsteady volume)

  • abnormal resonance (hypernasal, hyponasal)

  • aphonia (loss of voice)

  • voice breaks

  • asthenia (weak voice)

  • gurgly/wet sounding voice

  • Pulses during phonation

  • Glottal fry

  • shrill voice (as if stifling a scream)

  • tremulous voice (shaky voice; rhythmic pitch and loudness undulations)

  • increased vocal effort while speaking;

  • decreased vocal endurance or onset of fatigue with prolonged voice use

  • vocal quality changes throughout the day or while speaking

  • running out of breath quickly

  • frequent coughing or throat clearing

  • excessive throat or laryngeal tension/pain/tenderness.

Speech and Language Disorders
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Aphasia is an acquired neurological disorder as a result of injury to the brain from a CVA - Cerebral Vascular Accident also known as a stroke.  The language centers of our brain are located in the left hemisphere which are commonly affected by strokes leaving the individual with minimal or no ability to communicate verbally.  Intellect, memory and executive functioning are often spared which can result in a great deal of frustration for individuals who have lost most of their ability to speak. Traditional therapy can be effective in the short and long term to help regain some language skills that were lost, or develop compensatory strategies to help facilitate language in your daily life.  A Lingraphica assessment may also recommended to see if you or your loved one would benefit from a speech generating device (See Lingraphica below to learn more.) 

Common language deficits associated with Aphasia: 

  • spoken language expression 

  • spoken language comprehension

  • written expression 

  • reading comprehension


Dysphagia is the medical term for swallowing difficulties. This can occur as a symptom following neurologic changes from a stroke, Parkinson’s Disease, Dementia, ALS, TBI, myasthenia gravis or multiple sclerosis.  Swallowing difficulties may also occur as a part of the normal aging process or from stress or anxiety.  Dysphagia may also be present if you are missing teeth, have dry mouth, changes in taste, increased mouth sensitivity or you find you require more time to complete a meal; anything that impacts your ability to consume food and liquid effectively.  Swallowing is a complex act requiring coordination of muscles in the mouth, throat and esophagus.  If something inhibits this coordination or the muscles aren’t getting the signals they need from the brain, it can cause dysphagia.

Signs you may have dysphagia:

  • Globus feeling in your throat (a feeling something is “stuck” in your throat)

  • Difficulty swallowing liquids

  • Difficulty swallowing pills

  • Difficulty swallowing food

  • Difficulty chewing

  • Coughing while eating/swallowing

  • Frequent throat clearing

  • Excessive amount of time to complete a meal

  • Weight loss due to food avoidance

  • Decreased interest in eating

  • Recurrent lung infections

  • Regurgitation of food

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Orange Flower

Dysarthria is a motor speech disorder caused by muscle weakness following a stroke, TBI (traumatic brain injury), or as a result of Parkinson’s disease, ALS, Huntington’s Disease, MS (Multiple Sclerosis), CP (Cerebral Palsy) or Muscular Dystrophy that may make it difficulty to move and adequately coordinate the articulators (tongue, lips and jaw) for speech.  Speech therapy can help you strengthen your muscles, learn strategies for better communication, assess for need of AAC (augmentative and alternative communication) and train loved ones on compensatory and cueing strategies to assist during communication breakdowns.

Signs you may have dysarthria: 

  • Slurred or mumbled speech

  • Speech is slow or too soft/quiet/inaudible

  • Speech is too fast

  • Poor control of tongue, lips and jaw

  • Robotic or broken sounding speech/voice

  • Vocal quality changes including hoarse or breathy voice

  • Hyper or Hyponasality

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Cognitive Communication Disorders
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Cognitive-Communication Deficits typically result from neurological changes following a stroke, brain tumor, or from progressive degenerative disease like Dementia or Parkinson’s Disease .  Deficits vary from person to person but in general, they affect how you think and how you use language to interact with the world and your ability to participate in daily life tasks.  Speech therapy can provide a thorough cognitive assessment to determine the severity of the deficits that are present as well as an in-depth interview with you and your loved ones to determine which deficits impact your life the most.  Goals will be catered to each individual’s needs to work toward a more functional, meaningful life. 

Cognitive-Communication Deficits:

  • Executive Functioning (Organization/planning)

  • Memory

  • Attention

  • Problem Solving/Reasoning 

  • Insight/Safety Awareness

  • Pragmatics (Social Communication)

Cog Comm Disorder

Gender Affirming Voice Care

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More Information COMING SOON

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Parkinson's Voice Project

SPEAK OUT! is a speech therapy program from the Parkinson Voice Project. Together, though twelve session, the patient and speech-language Pathologist complete speech, voice, and cognitive exercises using a specialized workbook that Parkinson Voice Project provides to every SPEAK OUT! patient in the U.S.

Learn More here


Speech and Swallowing Screening

  • Do people ask you to repeat?

  • Does your voice sound hoarse, scratchy, or breathy?

  • Does your family say you speak too softly?

  • Do you clear your throat often?

  • Is your voice strong on some days, weak on others?

  • Do you cough when you eat or drink?

To learn more about SPEAK OUT!® click here:


Symptoms of Parkinson’s Disease:

  • Voice may be too soft or mumbled

  • Speech may be too fast, and slurred together

  • Handwriting is slow or looks cramped and small

  • Tremor in hands, arms, legs, jaw or head

  • Stiff, slow, uncoordinated movements 

  • Impaired Balance often leading to falls

To learn more about LSVT LOUD® click here:

Lee Silverman Voice Therapy

LSVT LOUD is a speech and voice therapy protocol scientifically studied and designed to help individuals with Parkinson’s Disease (PD) regain normal loudness levels while speaking with friends, family and in the community.  Therapy trains people with PD to ‘recalibrate’ their sensory perception of normal volume to help them speak with confidence and be heard. Your voice matters!  Don’t let PD take it away from you! 

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Lingraphica is a company dedicated to improving the communication skills and lives of adults living with aphasia. Their research and dedication have led to the development of speech generating devices (SGDs) also known as an AAC device (Augmentative and Alternative Communication) designed specifically for people with Aphasia.  As a Lingraphica Certified Technology Specialist, I have in-depth, hands-on training and experience with all of Lingraphica’s technologies and can complete a full assessment to determine which device is right for you or your loved one.  We will then focus our therapy goals on personalizing your device and training you and your loved ones to use the device effectively to support your daily communication needs.  To learn more about deficits related to aphasia, see SPEECH AND LANGUAGE DISORDERS above. 

Benefits of AAC devices:

  • Decrease frustration with communication difficulties

  • Improve ability to participate in meaningful conversations and life events

  • Improve ability to communicate with friends and family

To learn more about Lingraphica and their devices click here:

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