Speech Language Therapy

Aphasia is a difficulty with language. This could include difficulty talking, understanding, reading and/or writing. Other health professionals may refer to Aphasia as Dysphasia.

Aphasia is most common after a stroke or head injury, but can also be a part of other neurological conditions. Talk to your GP to see if you are eligible for public Speech Language Therapy services.

Resources

• This booklet from Australia contains lots of useful information about Aphasia, which can be viewed here
• If you have had a stroke, click here for NZ-specific information about communicating after a stroke.
• Want to know what it’s like to have Aphasia? Visit this website here.
  

Have you seen an Ear, Nose and Throat Specialist?

We require all patients (except those with Parkinson’s Disease) to first have an assessment by ENT. Ask your GP for a referral if required.

Caring for your voice
These are some general tips that may be helpful for your voice.

Things that are great for your voice:

• Talk gently
• Stay hydrated - drink plenty of water
• Manage reflux if this is a problem for you
• Relaxation time
• Keep the atmosphere moist - (e.g. open the window)

Reduce strain on your voice by avoiding;

• Talking against background noise
• Shouting
• Singing
• Whispering
• Calling from room to room
• Effortful speech

Avoid things that can irritate your voice:

• Smoking
• Coughing and excessive throat clearing
• Smoky, dusty, or dry atmospheres
• Excess caffeine and alcohol as these can have a drying effect
• If you have reflux, avoid foods that cause it for you

The Stuttering Treatment and Research Trust (START) provide specialist assessment and therapy for stuttering. This a paid service but there are supportive funding options available if finances are a barrier.  For more information please go to https://www.stuttering.co.nz/  or call (09) 579 6775.

If you are unable to access START or other specialist providers, you may be eligible for public services. Ask your GP for a referral and a Speech Language Therapist will be in touch to discuss your situation.

This website here provides useful information about stuttering and the therapy process.

Dysarthria is a motor speech disorder. This means that there is a change in how your speech muscles move. It can be caused by stroke as well as other neurological disorders such as Parkinson’s Disease. Dysarthria may cause a person’s speech to sound:

• slurred or distorted
• too fast or slow
• breathy, hoarse, harsh or strained
• too loud or too quiet
• nasal
• laboured or ‘out-of-breath’

Dysarthria can be very mild, severe, or anywhere in between.

Clear Speech Strategies

If you are having difficulty being understood, you can try these strategies: 

• Speak slowly
• Speak loudly (project your voice using your breathing - don’t strain or shout) 
• Over-pronounce (“over-articulate”) your words  
• Take pauses between words 
• Take a breath before speaking – speak as soon as you start to exhale 

You can also try the following tips to help you to communicate more easily with others: 

• Communicate face-to-face
• Make sure there is good lighting 
• Reduce background noise (e.g., turn down the TV) 
• Reduce the distance between you and the listener 
• Get your listener’s attention before speaking to them 
• Have important conversations when you aren’t tired and your speech is at its best 
• Get feedback from someone - ask a friend to be honest with you about whether they could understand 
• Tell your listener what they should do if they haven’t understood you (e.g., raise your hand if you need me to repeat something)  

Dysphagia is a swallowing disorder which can occur for many reasons.

Some conditions commonly associated with dysphagia are stroke, intellectual disability, brain/spinal injuries, head and neck cancers, and progressive neurological conditions (such as Dementia, Parkinson’s Disease, and Motor Neurone Disease).

Dysphagia can be very mild, severe, or anywhere in between. If you are losing weight unexpectedly or have recurrent chest infections, see your GP ASAP.

A person with dysphagia may experience:

• a feeling of food/drink being stuck in their mouth or throat
• coughing or choking during or after eating/drinking
• a gurgly, wet-sounding voice after eating/drinking
• drooling or coughing on saliva
• difficulty chewing
• food/drink spilling out of the mouth
• weight loss
• chest infections

Dysphagia also sometimes occurs without a person knowing, especially in neurological conditions or with nerve damage. In this case, they may not cough or feel anything when food/drink ‘goes the wrong way’.

If your symptoms are mainly to do with your oesophagus (food-pipe), this is usually managed by your GP and Gastroenterology.

What to expect from Speech Language Therapy input?

• A thorough assessment including history of your swallowing difficulties and trials of different food and drinks.
• You may be recommended exercises or strategies to improve the comfort and safety of your swallowing
• You may be recommended to modify the texture of your food/drink. There are international guidelines on how to do this, which can be viewed here.
• You may be recommended to have a more in-depth assessment of your swallowing
  • Flexible Endoscopic Evaluation of Swallowing (FEES) involves inserting a flexible camera through your nose to see what is happening in your throat when you swallow. For more information, click here.
  • Videofluoroscopic Swallowing Study (VFSS) is an x-ray of swallowing which helps give a clearer picture of what is happening in your mouth and throat when you swallow. For more information, click here.

Tips for safe swallowing

• Keep your mouth clean, including before and after meals. This reduces the risk of developing a chest infection.
• Always sit upright whenever eating or drinking, preferably in a chair at a table
• Take extra care when tired
• Eat and drink slowly, one mouthful at a time
• Take small mouthfuls/sips
• Avoid distractions (e.g., turn off the TV/radio and limit conversation)
• If required, have assistance while eating. This may be help with cutting your food up or with bringing food to your mouth.

Have you seen a Respiratory or Ear, Nose and Throat Specialist?

We require all patients with chronic cough/airway disorders to first have an assessment by ENT or Respiratory. Ask your GP for a referral if required.

Treating Chronic Cough

If your specialist recommends SLT input for your chronic cough, treatment will focus on:

• Understanding chronic coughing/throat clearing
• Identifying triggers and managing these
• Implementing strategies to manage your cough
• Looking after your voice

Your specialist may also recommend medical treatment to target triggers such as reflux, asthma or allergies.

For detailed information on chronic cough treatment, click here. [PDF, 250 KB]

Airway Disorders

You may also be referred to SLT for assistance with airway disorders such as PVFM (paradoxical vocal fold movement), “vocal cord dysfunction”, ILO (inducible laryngeal obstruction), “laryngospasm”’ etc.

Always seek urgent medical help if you are experiencing severe difficulties breathing.

The therapy process is similar to those who experience chronic cough. Click here for some more information and begin practising the “Rescue Breaths” while awaiting further SLT input.

You may choose to have gender affirming services with a Speech Language Therapist. This can involve working on your voice and overall communication.

Communication coaching can explore the ways that your voice and communication can represent you and how you express yourself in different settings.

The Speech Language Therapist will also talk to you about vocal health, which is important for anyone using their voice in new ways.

The following are some of the things you may choose to work on with a Speech Language Therapist:

• pitch—or how high or low your voice sounds
• intonation—or the rise and fall of pitch in your speech
• resonance—or the quality of the sound of your voice
• the rhythm of your speech
• rate—or how fast or slowly you speak
• volume—or how loudly you speak
• nonverbal communication—such as your body language and facial expressions
• language—or the words you use
• pragmatics—or the social rules of communication, such as how to adjust your voice for different situations and to express different emotions

It can take some time to find a voice that you connect with and you feel expresses who you are. A Speech Language Therapist can help to give you the tools to communicate in a way that feels authentic.

Useful websites:

• www.PATHA.nz
• www.genderminorities.com
• www.wpath.org

Please note, you may be eligible for WINZ funding towards private Speech Language Therapy services. This will not affect your eligibility for publicly funded services in the Waikato District. For further information please visit the Gender Minorities website.

You can find detailed information about how communication and swallowing can be affected in Parkinson’s here.

In the Waikato, SLT currently provide sessions of loud voice therapy targeting improved voice volume and clarity. For more information and taster sessions, click here.

You do not require a Speech Language Therapy assessment to trial a SpeechVive Device for your communication. If you are interested in learning more about the SpeechVive device, click here. Enquiries about funding options can be directed to the NZ suppliers Medix21.