Adults
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We provide speech-language therapy services to adults for articulation, language, apraxia of speech, oral apraxia, fluency, voice, and orofacial myofunctional disorders. Our team also helps those seeking Accent Modification, Corporate Speech Training and Gender-Affirming Voice Care.
How We Help
Speech Sound Disorders
Apraxia Of Speech (CAS) (Neurological Speech Sound Disorder)
CAS is a motor planning disorder and occurs when an individual demonstrates inconsistent speech sound (phoneme) production error despite an attempt to produce the correct phoneme. Typically, adults acquire apraxia of speech from a traumatic brain injury (TBI) or cerebrovascular accident (CVA)/stroke. Many with apraxia know what sounds they want to produce, but their articulators (jaw, lips, tongue, soft palate) will not complete their target production. Individuals may produce sounds and words spontaneously but cannot replicate upon request and/or with direct model. Our team utilizes the Kaufman approach modified for adults for treatment with amazing success.
An individual may demonstrate one or more of the following:
- consonant errors or distortions
- vowel errors or distortions
- increased difficulty with increased syllables and words
- schwa (“uh”) insertions in words
- decreased rate of speech (ROS)
- prosody errors
- articulatory (lips, tongue) groping
- devoicing (produce a voiceless phoneme, i.e., /t/ for a voiced phoneme /d/)
- groping
Oral Apraxia
Oral Apraxia is a motor planning disorder that can impact speech and non-speech tasks, such as eating. It occurs when an individual demonstrates oral movement errors despite an attempt to produce the target task. Many with oral apraxia know what movement they want to initiate and/or coordinate, but their articulators (jaw, lips, tongue, soft palate) will not complete their target movement. Individuals may spontaneously lick peanut butter off their lips but cannot replicate the action upon request and/or with direct model; or an individual may not be able to lick residue off the lips at all.
Those with oral apraxia may demonstrate one or more of the following:
- difficulty with lingual elevation
- difficulty with lingual depression
- difficulty with lingual lateralization
- difficulty with lingual protrusion
- difficulty with lingual retraction
- difficulty with lip protrusion (kiss)
- difficulty with lip retraction (smile)
- groping
- swallows food without chewing
- history of nursing and feeding difficulties as infant
- selective diet
Social Communication Disorder
Social Communication Disorder (also referred to as Social Pragmatics) occur when an individual demonstrates difficulty with the social use of verbal and nonverbal communication. In other words, knowing what to say, how to say it, and when to say it. These individuals may or may not have autism spectrum disorder (ASD); some may acquire the disorder from a traumatic brain injury (TBI).
Social Communication Disorders may include difficulty with:
- social communication and interaction, such as greeting, commenting, and asking questions
- social understanding
- language processing
- showing interest in what others say
- changing speech and language characteristics to suit the listener and setting
- following rules for conversation and storytelling, i.e., turn-taking, staying on topic
Free Screenings
Fluency Disorders
Childhood Onset Disfluency (Fluency Disorder)
Fluency Disorders also called stuttering, can be progressive or sudden and occurs when the individual demonstrates an involuntary disruption within the natural flow of speech affecting continuity, rate, rhythm, and effort. Many adults come to us who either never received help as a child, or who want to re-learn old strategies and/or learn new strategies to manage their stuttering.
Stuttering can be genetic, males are more likely to develop disfluencies than females, and it usually presents between ages 2 and 6 years old. Our team utilizes a treatment approach that focuses on managing disfluencies as well as emotional and cognitive aspects utilizing the Solution Focused Brief Therapy model.
Some Primary Characteristics:
- repetitions of phonemes (sounds), i.e., P-p-p-please be quiet.
- syllables, i.e. The bay-bay-baby is sleeping.
- words, i.e. My name-name-name is…
- blocking, with or without sound
- prolongations, i.e., French fries aaaaand a hamburger.
Some Secondary Characteristics:
- eye blinking
- hand movements
- body movements
- facial grimacing
- changes in pitch or loudness
Acquired Disfluency (Neurogenic Fluency Disorder)
Acquired Disfluency also called stuttering, can be caused by a traumatic brain injury (TBI), a cerebrovascular accident (CVA)/stroke, medicines, or degenerative diseases. It occurs when the individual demonstrates an involuntary disruption within the natural flow of speech affecting continuity, rate, rhythm, and effort. Our team utilizes a treatment approach that focuses on managing disfluencies, and addresses the emotional and cognitive aspects if needed, utilizing the Solution Focused Brief Therapy model
Some Primary Characteristics:
- repetitions of phonemes (sounds), i.e., P-p-p-please be quiet.
- syllables, i.e. The bay-bay-baby is sleeping.
- words, i.e. My name-name-name is…
- blocking, with or without sound
- prolongations, i.e., French fries aaaaand a hamburger.
Some Secondary Characteristics:
- eye blinking
- hand movements
- body movements
- facial grimacing
- changes in pitch or loudness
Cluttering (Fluency Disorder)
Cluttering occurs when an individual demonstrates an increased rate of speech (ROS) (i.e., a fast talker) or a perceived increase ROS due to atypical pauses during speech and speech errors, thus making the message difficult for the listener to understand. Our team utilizes a treatment approach that focuses on managing cluttering with proper pausing, breathing, and/or articulation techniques. We also addresse the emotional and cognitive aspects utilizing the Solution Focused Brief Therapy model.
Some other signs and symptoms of cluttering are:
- sound (phoneme) deletion
- syllable deletion
- word-ending deletion
Augmentative And Alternative Communication (AAC)
AAC systems are utilized for individuals who demonstrate difficulty with verbal communication. Some examples of AACs are:
- a picture exchange communication system (PECS)
- speech-generated devices (SGDs)
- non-speech generated devices (NSGDs)
Orofacial Myofunctional Disorders (OMDs)
OMDs are not a new disorder, as many believe. They have been recognized and treated since 1906. OMDs present as patterns involving oral and orofacial musculature that interfere with normal growth, development, or function of the orofacial structures. Both children and adults suffer from OMDs. Our Orofacial Myologists have completed a minimum of 23 hours of The Myo Method OMD training by Hallie Bulkin, MA, CCC-SLP, COM. Your OMD team may be comprised of your SLPSLP/Orofacial Myologist or SLPA/Orofacial Myologist, airway centric dentist, otolaryngologist (ear, nose and throat or ENT) and somnologist (sleep doctor). Some OMD signs and symptoms are:
- abnormal labial (lip) rest posture (i.e., open mouth posture and mouth breathing) *Approximately 31% of children who mouth breath present with articulation disorders.
- enlarged tonsils
- abnormal lingual (tongue) rest posture (i.e., pushed against or between the front teeth (tongue thrust), on the floor of the mouth). *33-50% of the gen pop of school-aged children present with tongue thrust.
- tethered oral tissues (tongue tie and/or lip tie)
- bruxism (teeth grinding)
- atypical swallow pattern (tongue protrusion/tongue thrust, poor mastication (chewing) and bolus (food) management) *55% of children with articulation disorders present with tongue thrust swallow
- selective eating/eats only limited foods
- chews on one side of the mouth
- excessive saliva production
- drooling
- high and/or narrow palate
- venous pooling under the eyes
- airway issues (snoring, audible breathing, mouth breathing, congestion, sleep apnea)
- poor sleep
- atypical oral placement for speech (articulation issues) *Approximately 81% of children with a speech sound disorder have an OMD.
- noxious oral habits (digit habits and sucking habits, such as nail biting)
- pelvic tilt (forward or backward)
- head and neck forward posture
- ADHD
- anxiety
- neck pain
- migraines
- Temporomandibular Joint Disorder (TMJ Disorder) (approximately 98% of individuals with TMJD have an OMD)
Voice Disorders and Voice Care
Voice Disorders
Voice Disorders occur when an individual engages in vocal abuse such as overuse, yelling, screaming, or laryngopharyngeal reflux (LPR) also known as Silent Reflux. These can all cause vocal nodules or polyps, and if left untreated can become cancerous. Not all vocal abuse and voice disorders present with nodules or polyps, however. Some other causes are vocal fold trauma (i.e., intubation or chemical exposure), neurologic disorders, and psychogenic causes (i.e., stress, anxiety, depression). Our team provides vocal hygiene training and education, we teach the patient how to produce appropriate resonance taking the strain off the vocal folds and surrounding muscles, and in the case of LPR, diet modifications to balance the gut pH. Don’t worry, we don’t order you to stop drinking your coffee or eating your chocolate. That would be sacrilege.
Some signs and symptoms of a voice disorder are distorted or inappropriate:
- vocal quality (i.e., hoarseness)
- volume (i.e., too loud, too quiet)
- pitch (i.e., high, low)
- resonance (i.e., vocal intensity)
- respiration (i.e., breathing difficulty, breathing at the wrong time during speech)
Gender-Affirming Voice Care
Gender-Affirming Voice Care is for individuals seeking to alter their voice from male-to-female, or female-to-male. We highly recommend this approach prior to surgery. Dr. Daniel Keller published an article in Medscape Medical News on 09/15/2022 stating that, “More than half of patients undergoing gender-affirming laryngoplasty to alter their voice experienced complications, according to a retrospective study of 41 patients presented at the annual meeting of the American Academy of Otolaryngology–Head and Neck Surgery (AAO-HNS).” Though this is a small cohort study, it requires consideration. Our team provides a safe place for individuals seeking vocal change with the following treatment approach:
- vocal hygiene training and education
- teach the patient how to produce appropriate resonance in a safe and healthy way taking the strain off the vocal folds and surrounding muscles
- non-verbal communication, such as body language and facial expressions
Other Services
Accent Modification
Accent Modification is not a speech or language disorder. Some individuals choose to pursue Accent Modification to increase intelligibility. Our team helps the individual to alter articulation, rate of speech (ROS) (Do you need help speaking slower or faster to increase intelligibility for the listener?), and prosody (Do you need help with syllable stress and/or word intonation?). The goal of Accent Modification is not to eliminate the client’s native language, customs, or accent completely. We wish to maintain a connection between individuals and their communities and identities.
Not all accents are unintelligible. Some individuals may choose to pursue Accent Modification for reasons other than increasing intelligibility, such as:
- maintain attention on the communicator’s message rather than the accent
- decrease bias or discrimination
- break through barriers in educational, work and/or social environments
- learn a new accent for plays and other productions
*Accent Modification services cannot be billed to insurance. Some employers are willing to pay for these services for their employees. You may wish to inquire with your employer or HR department.
Corporate Speech Training
Corporate Speech Training is for the individual who wishes to improve verbal communication skills without the presence of a disorder. This can be combined with Accent Modification if needed. Corporate Speech Training may include:
- Rate of Speech (ROS) - Do you need help speaking slower or faster to increase intelligibility for the listener(s)?)
- Prosody - Do you need help with syllable stress and/or word intonation?
- Presentation Skills – Are you pausing in the right places for your listener(s)?
- Voice – Do you need help with vocal quality, volume, pitch, resonance, respiration?
- Vocal Hygiene - Are you taking care of your vocal folds to reduce hoarseness, vocal fatigue, etc.?
*Corporate Speech services cannot be billed to insurance. Sometimes employers are willing to pay for these services for their employees. You may wish to inquire with your employer or HR department.
Speech-Language Pathology
Who Are We and What Do We Do?
Erin Harty Speech-Language Pathology, PC is a TelePractice headquartered in Monterey, CA. Our team is made of Speech-Language Pathologists (SLPs), Speech-Language Pathology Assistants (SLPAs) and Orofacial Myologists. We provide 100% TeleTherapy services helping children and adults across the state of California. Some of our services include early intervention (EI), articulation, language, apraxia, fluency, social pragmatics, voice, orofacial myofunctional disorders (OMD) and augmentative and alternative communication (AAC). We also offer Accent Modification and Gender-Affirming Voice Care services.
