Evaluations

Our process always begins with an initial screener guided by parental/caregiver concerns. We then make recommendations for the most appropriate and individualized evaluation protocol to identify unique abilities, strengths and challenges. Evaluations typically include a combination of standardized and functional assessments, caregiver interview, thorough observation, and client/clinician interaction. Standardized assessments evaluate skills in comparison to same-aged peers in order to receive a standardized score and subsequent diagnosis. These scores are included in a comprehensive evaluation report which is provided to you to submit to your insurance provider for reimbursement. Importantly, standardized scores are only one piece of the larger puzzle, therefore, we assess skills from many angles, including function within activities of daily living.

Articulation

We are experienced in treating articulation and phonological disorders (including lisps). We begin treatment with an evaluation to identify missing and/or distorted sounds. This also allows us to determine the type of articulatory difficulty the child is presenting with to guide our evidence-based treatment approach. Our approach to treating articulation and phonology also includes home-practice programs to support ongoing progress and lasting success. Unclear speech can impact significantly on how well a child can interact with adults and their peers and can affect the development of language and social skills. A child who is having difficulties being understood can become frustrated and angry which may lead to behavioural issues. Articulation is also important in literacy skills such as reading and spelling out of words.

Voice

Voice is the sound that we hear when someone talks. It is produced by air coming from the diaphragm and lungs passing through the voice box (vocal folds) causing them to vibrate and make a sound. This sound is then shaped by the movement of the articulators (i.e. tongue, lips, teeth, jaw, cheeks) to make speech sounds. Each person has a unique voice which distinguishes them from another person. The voice has a number of features including pitch, volume, quality and resonance, which are used to convey information about how a person is feeling. We are trained to treat a variety of structural (e.g. nodules), functional (e.g. transgender voice transition), and neurological (e.g. spasmodic dysphonia) voice pathologies. We are also certified in LSVT LOUD® (Lee Silverman Voice Treatment) to treat vocal weakness secondary to Parkinson’s Disease along with other voice disorders.

Expressive Language

Expressive language is the use of words, sentences, gestures and writing to express wants and needs, thoughts and ideas, argue a point of view, develop use of language in writing and engage in successful interactions with others. Expressive language skills include being able to label objects in the environment, describe actions and events, put words together in sentences, use grammar correctly (e.g. “I had a drink” not “Me drinked”), retell a story, answer questions and write short story. We implement comprehensive treatment plans to ensure every client who experiences difficulty retrieving and using language regains their individual “voice.”

Receptive Language

Receptive language is the ability to understand words and language. It involves gaining information and meaning from routine (e.g. we have finished our breakfast so next it is time to get dressed), visual information within the environment (e.g. mom holding her keys means that we are going to get the car, a green light means go), sounds and words (e.g. the word ball means a round bouncy thing we play with), concepts such as size, shape, colors and time, grammar (e.g. regular plurals: cat/s, regular past tense: fetch/ed) and written information (e.g. signs in the environment like “no climbing”, written stories).

Fluency

Fluency refers to the smoothness or flow with which sounds, syllables, words and phrases are said when talking. A child’s speech may also be dysfluent (lacking fluency) when they are trying to ‘think of what to say’ and are planning the words and sequence of words that they are going to use. We have advanced training in evaluating and treating these disorders in children as young as 3 years old. Using an evidence-based and holistic approach, we address the cognitive, emotional, and environmental aspects of stuttering. For younger children, we combine direct therapy with parent coaching. ​We are passionate about helping our clients gain confidence in their communication skills.

Social Skills

Social skills are the skills we use everyday to interact and communicate with others. They include verbal and non-verbal communication, such as speech, gesture, facial expression and body language. A person has strong social skills if they have the knowledge of how to behave in social situations and understand both written and implied rules when communicating with others. When a child has difficulties with play and social skills you may notice:

• Poor attention and concentration

• Difficulties taking turns/sharing

• Gets upset when ‘loses’ a game

• Is not aware of others and fails to read other people’s feelings based on their verbal and non-verbal cues

• Has trouble expressing/regulating emotions

• Prefers to play alone

Literacy

Literacy is the ability to read/write/use written language in a variety of contexts and targeted through:

• Phonological awareness: the awareness of what sounds are and how they come together to make words. It includes the ability to rhyme, segment words into syllables and single sounds, blend sounds together, identify sounds in different positions in words and manipulate sounds within words.

• Reading: the ability to decode written symbols and signs, understand the meaning of words and coordinating these skills together in order to read fluently.

• Spelling: the ability to arrange letters in the correct order to make words that are communally understood.

• Written communication: the physical performance of handwriting, typing, spelling, grammar and story planning.

Apraxia of Speech

Apraxia of speech is a speech disorder in which the brain has difficulty coordinating the complex oral movements needed to create sounds into syllables, syllables into words, and words into phrases. Typically, muscle weakness is not to blame for this speech disorder. Adults and parents of children with childhood apraxia of speech commonly say things like, "No one can understand my him/her," "It looks like he/she is trying to say the word, but can't get it out," and "He/she said that word one time, and then I never heard it again." Common descriptions of apraxia of speech are:

• Inconsistent errors on consonants and vowels in repeated productions of syllables or words (for example, saying the same word differently each time one tries to produce it).

• Difficulty producing longer, more complex words and phrases.

• Inappropriate intonation and stress in word/phrase production (for example, difficulty with the timing, rhythm and flow of speech).

Cognition

A cognitive disorder can range from a mild cognitive impairment to advanced dementia. Cognition includes areas of attention, concentration, orientation, word retrieval, and executive functioning skills such as problem solving and reasoning. There are normal age-related changes that occur, and part of our role is educating patients and families about typical versus atypical changes. For example, it is common for individuals to forget names of new acquaintances as they get older, but it is not typical for them to forget the names of familiar friends and family members. It is also common for individuals to have more difficulty multi-tasking as they age, but attention to one activity should be sustained. Once weaknesses are identified through evaluation, we can set up a treatment plan that consists of therapeutic exercises, compensatory strategies, and education to both adult and caregivers.

Dysphagia

Dysphagia is the medical term for swallowing difficulty/disorder. That means there can be a difficulty with any part of the swallowing process from the preparation for feeding/swallowing, to the esophagus where digestion begins to take over. Signs and symptoms of dysphagia can include:

• ​All behavioral, sensory, and preliminary motor acts in preparation for the swallow, including cognitive awareness of the upcoming eating situation, visual recognition of food, and all of the physiologic responses to the smell and presence of food such as increased salivation.

• Positioning food in the mouth and the oral manipulation preceding the swallow, including suckling, sucking, and masticating.

• Coughing, choking, or frequent throat clearing immediately and/or after mealtime​.

Dysarthria

Dysarthria is a motor-speech disorder that results in unclear speech. This inability to speak clearly is because of weakness, slowness, or lack of coordination in the muscles of the mouth, voice, and lungs. Dysarthria can be caused by a stroke, head injury, or brain tumor. It can also be caused by a congenital disorder such as cerebral palsy (CP), or a degenerative disease such as motor neurone disease (MND / ALS) or Parkinson’s disease (PD). Dysarthria can also be a symptom of autoimmune disorders like myasthenia gravis (MG), multiple sclerosis (MS), or Guillain–Barré syndrome (GBS). Dysarthria affects different people in different ways. Some people sound like they’re mumbling or slurring their words. Some sound like they’re talking through their noses, while others sound stuffed up. Some speak in a monotone, while others make extreme pitch changes. Some speak slowly, some speak very quickly, and some fluctuate. Some speak loudly, some speak softly, and some are irregular in volume. Their voices may sound unusually hoarse, breathy, or strained.