Solutions for Food Enjoyment When Swallowing Problems Require a Modified Diet

For most people, food is one of the most pleasurable aspects of life and many would agree that food increases our overall quality of life.  All great events in life include food.  So what happens to those adults, who have experienced this type of enjoyment and then have to shift their lives to one of a modified diet due to a difficulty swallowing?

Why Modify a person’s diet? 

Modified diets are often needed for adults that have begun aspirating (choking) on foods they are eating. This problem can happen for multiple reasons. The diets are prescribed by doctors or speech-language pathologists to reduce the chances of food or drink entering the lungs. This risk can be very serious and life threatening as it can cause pneumonia.

Modified Diets and Quality of Life

Modified diets, are stereotypically not as enticing as a regular diets since they may include soft-textured food, thickened liquids, inability to eat certain foods unless blended first etc.  The difficulty lies in balancing a modified diet with quality of life.  As SLP’s we consider quality of life when the client and their families are asking us questions about the modified diet recommendations.  We modify the diet as minimally as possible, to improve overall swallowing function, while trying to maintain pleasure of eating.  It is therefore important to let your practitioner or SLP know if there are any foods that you just can’t live without.

For example, my grandmother was put on a feeding tube, after being diagnosed with multiple mini strokes.  These strokes affected her overall functioning; she was wheelchair ridden, eating through a feeding tube and most of her day was spent on a respiratory machine.  The only joys in her life at that time were having her children, grandchildren and great-grandchildren visiting, but the family felt that wasn’t enough.  In our culture, food is everything, and what my grandmother loved was chocolate.  Although my grandmother was not supposed to be eating anything orally, her SLP said that if she couldn’t live without her chocolate, she could eat some chocolate pudding to improve her overall quality of life.  The role of the SLP was to provide our family with all of the information on swallowing risks. Since the family decided that chocolate was worth risking from time to time, and we were open and told this to our SLP, she was able to give us the information we needed to give my grandmother chocolate in the least risky format. This did not mean it was without risk, but it was a risk we were all fine with taking. At the same time, it allowed my grandmother to have one more pleasurable thing in her life, her love… of chocolate!

Melissa Oziel
Speech-Language Pathologist
The Speech Therapy Centres of Canada

Ho, Ho, Ho Holiday Conversations

Holiday time is an exciting time for everyone: celebrations, food, and time with loved ones. With many families and friends coming together and reuniting, often after long periods of time, come many loud group conversations. These conversations can feel quite overwhelming to some people, especially those with acquired brain injuries (ABI). Many clients with ABI find it difficult to attend to the conversations, keep up and/or add meaningful information to the conversation, or remember what has been discussed.

Some tips for keeping up in group conversation:

  • Prepare. If you anticipate that it will be a long night, take a proper rest and cognitively prepare yourself. This could include deep, relaxation breathing or going for a brisk walk.
  • If you are nervous that people are going to be asking you about your injury, plan a script ahead of time and try to re-direct the conversation back to the speaker. This will help you feel more comfortable and confident, knowing that you have anticipated this exchange in advance. E.g., “It’s been a long year but things are moving along, thank you. And how is Johnny enjoying college?”
  • Try and eliminate background noise– if you are hosting the party, keep the noise to a minimum e.g., turn music low, turn off the television. If you are attending a party, ask the hostess if they do not mind to turn down the volume.
  • Seating is important. Try and sit close to the person you feel comfortable conversing with. Try and seat yourself away from distractions e.g., away from the kitchen, or washroom.
  • If you are finding it difficult to carry on a large conversation, try and create a smaller sub-group conversation. Smaller conversations are much easier to maintain and require less brain energy, than those larger, louder ones.
  • If you are having trouble concentrating, ask 1-2 people if you can go in the other room to talk. It may be easier to have a productive conversation when you have decreased the amount of distractions.
  • Repeat the question back to the listener. This helps you remember the information shared and also shows the listener that you are following the conversation. E.g., Q-“What do you plan on doing during the holidays?” A-“What do I plan on doing during the holidays? Well this week….”
  • Summarize the information back to the listener to confirm your understanding. E.g., “So you are leaving to Mexico next week and going with the family for 7 days. What a nice time!”
  • If you are stuck and are having trouble keeping the conversation going, transition to another topic. You can use the surrounding context if you are having difficulty choosing a new topic, such as commenting on the food, decorations, host or hostess, holiday plans.
  • Don’t be afraid to ask for repetition! Everyone needs clarification sometimes, and your participation matters.

 Use these strategies to help communication during the holiday season! The Speech Therapy Centres of Canada hopes to make your holiday conversations enjoyable and successful. Speak with your S-LP for more social communication strategies.

 Ashleigh Wishen, M.H.Sc. S-LP (C)
Speech-Language Pathologist, Reg. CASLPO
The Speech Therapy Centres of Canada Ltd.

Causes of speech and language disorders: Some answers to parent’s “why’s”

When parents walk through our door, they often want to know ‘WHY’ their child is not understanding and talking like other children; ‘WHY’ they aren’t pronouncing sounds like others; or ‘WHY’ they’re stuttering. Listed below are some factors that are known to predispose or precipitate speech and language disorders.

Neurological factors: Specific areas in the brain control our speech and language functions. Understanding what others say to us, expressing our thoughts and needs, remembering details of what was said, reading, and writing are all controlled by regions in the brain. There is evidence in the literature to suggest that children with language disorders may have a neurological involvement contributing to their speech and language difficulties. This means that there may be obvious or subtle differences in the brain which makes the child susceptible to a language disorder. No one pattern of brain architecture has been consistently shown in all individuals with language impairments, which makes this all still a bit of a mystery.

Motor and Sensory factors: Our senses serve as channels for us to perceive the external environment. Be it our sense of vision, hearing, touch, taste, and smell; they offer us with different ways to perceive things from the external environment. If any of these senses are not functioning optimally, it would limit the essential information that we receive from our environment. For example, children with vision or hearing problems will not be able to use those senses to see by reading, or hear someone speaking in their environment, making them more susceptible to a speech or language disorder. Having adequate motor skills is also essential to speech and language development. Early on, children move around and explore their environment. This exploration fosters early language and cognitive development as they are exposed to new ideas and vocabulary. Children who have limited motor abilities may be at a disadvantage because of not being able to actively explore their environment. Adequate motor abilities are also required for the movement of the voice and oral structures (lips, teeth, tongue etc.) required for speech. Thus, any difficulty with speaking movements may impact a child’s speech and language development.

Cognitive: Intact cognition (the ability to think, know, perceive, judge, reason etc.) is an important foundation on which we build our speech and language skills. Vice versa, developing our speech and language skills helps us improve our cognitive abilities. Hence, children with cognitive challenges may be at risk for developing speech and language disorders. These children may have trouble associating different words with their meanings, remembering words, recognizing patterns and sorting words into different categories, and learning new concepts in general.

Genetic factors: Speech and language disorders tend to run in families, suggesting a possible genetic involvement in causing these disorders. However, it is also true that many people with speech/language disorders’ children do not have any difficulties, and that children with speech/language disorders have no family history of it in the past.

Environmental factors: Environmental information is key in fostering speech and language development. Providing a language rich environment with an adequate amount of stimulation is necessary to support children in developing age-appropriate speech and language skills. Children who have a less language rich environment and stimulation may be at risk for developing speech and language disorders.

Acquired factors: Some individuals may acquire speech and language skills as per typical milestones and then lose some of these skills due to an acquired injury or illness. Some examples of these include a traumatic brain injury, infections such as meningitis, tumors, strokes, etc.

It is important to note that this list is not exhaustive, but is an overview of some of the reasons we may see speech-language disorders.

If you are concerned about  your child’s speech and language development, see a Speech-Language Pathologist to address your concerns.

Nisha Balakrishnan M.A. SLP, Reg. CASLPO
Speech-Language Pathologist
The Speech Therapy Centres of Canada

Reference: Paul, R. (2007). Language Disorders from Infancy through Adolescence- Assessment and Intervention. (3rd ed.). St. Louis, Missouri: Mosby Inc.

Exercise Your Brain

The body undergoes many changes as we age.  As kids, humans typically grow taller, get stronger, and learn.  Our brain is made up of little things called neurons which connect and essentially “talk” to each other to make our brain function.  We start out with thousands.  At age three we have approximately 15000.  Then by the time we’re adults, we’re down to about half the neurons we were born with.  What has happened is that our brain has recognized which areas are being used the most and devoted more of its energy there, cutting back on other areas.  As humans age, our thought processes get slower which can have an effect on our language.  The words can be harder find.  We need extra time to respond to what is being said.  We are slower to respond.  The thought of losing half our brain by the time we’re adults is pretty depressing…

So how can we combat our aging brain?  Good news.  Recent research is suggesting our brains can change.  If you work hard at strengthening the connections you have, not only might they become stronger, you may even build new connections.  So put your brain to the test, and add mental exercises to your physical exercise regimen.  Build some new connections!  Here are some suggestions on how:

  • Play word games: Scrabble, Boggle, Scattergories, Catchphrase, Taboo etc.  These expand the way you think about letters and words.  Notice how after you have played a few rounds, you have improved.  That’s your brain in action .
  • Try to learn a new language:  Even the act of trying causes your brain to think differently than you normally would, therefore, exercising your brain.
  • Read! You’ll be exposed to new words, words you may not hear often and will open your brain to new ideas.  Reading stimulates thinking.  If you usually read one type of book, try another to give your brain that extra challenge.
  • Try to remember: Ever notice how we no longer remember phone numbers?  How we rely on all our gadgets to remind us of things?  Take a step back from the gadgets and focus on remembering.  Use mnemonic devices like acronyms to help you remember (for example: Never Eat Shredded Wheat…for North East South West) Challenge your brain to be your best gadget.
 Jana Zalmanowitz M.Cl.Sc
Speech-Language Pathologist (C) 
The Speech Therapy Centres of Canada

Communicating with People who have Hearing Loss

According to Statistics Canada, more than one million adults across Canada reported having a hearing-related disability. This number is 50% greater than the number of people reporting problems with their eyesight (StatsCan, 2002). With this many people reporting some type of hearing loss, it leaves friends and family asking the question…. How can I effectively communicate with someone who has a hearing loss?

Difficulty following conversations, especially in groups or in environments with a lot of background noise, can be very challenging for someone with a hearing loss. Unfortunately, people with a hearing loss often withdraw from the conversation or avoid these events all together. Here are a couple of tips to help facilitate conversations with someone who has a hearing loss:

Tips for the talker

  • Make sure you are face to face and close to the person. Look at them while speaking.
  • Speak at a slightly louder volume. Don’t shout…it distorts the sound.
  • One-on-one conversations are much easier! Avoid having important conversations with a group of people.
  • For group conversations make sure only one person speaks at a time.
  • Repeat or rephrase if they do not hear you the first time
  • Avoid eating, chewing gum, or covering your face when speaking to them – it can distort the sound
  • Avoid rapid topic changes – this can make it difficult to follow the conversation
  • Keep your message short, simple, and to the point

Tips for the person with the hearing loss

  • Advocate for yourself! Let people know you have a hearing loss and what they can do to make it easier for you to understand
  • Pay attention to the ‘non-verbal cues’ (facial expression, gestures)
  • Let the person know exactly what you did not understand (e.g. ‘I missed the last word’) instead of just saying ‘what?’
  • Use any hearing devices you have (hearing aid, FM system etc)

Tips to create a good listening environment

  •  NO background noise! Turn off the radio, tv, etc.
  •  Sit close to the person you are speaking with
  •  Communication is easier in well lit, distraction free environments
  •  If conversing in loud environments, for example, a restaurant: try to choose a quiet restaurant, request a table in a quiet area (e.g. away from the kitchen, big groups, washrooms) and use the ‘one person speaking at a time’ rule.

If you, or someone you love, suspect they have a hearing loss, consult an audiologist. And always remember, despite any challenges you may experience, there is always a way to laugh, have fun, and make the most out of your interactions!

Carla Montgomery, M.H.Sc. SLP(C)
Speech-Language Pathologist, Reg. CASLPO

The Speech Therapy Centres of Canada

20/20 Interview tonight

Diane Sawyer will be interviewing Gabby Gifford and her husband Mark Kelley on 20/20 tonight at 10.
Clips of this incredible interview include the role of the S-LP and
others. It looks truly inspirational.

The Speech Therapy Centres of Canada


Social Communication – What does it Really Mean?

Think back to a recent cocktail party you attended with distant relatives or unfamiliar co-workers in a new job setting…did you dread getting ready for the event? Did you feel awkward trying to start a conversation with your distant Aunt? Did you feel your heart pounding faster and harder as your new boss approached? Welcome to the world of many adolescents and adults, especially those on the Autism Spectrum or with an Acquired Brain Injury (ABI). Similar to those cocktail parties, social settings that require conversing, initiating  and keeping conversations going can lead to feelings of anxiety, anger, confusion and even depression.

At the center of all our interactions lies the foundation of communication: to flourish academically, to build successful friendships, to develop professional relationships, and to create intimate bonds with our partners. However, the fundamental requirements of successful social communication are far from basic.  One must have: the motivation to interact, be aware of their surroundings and how to modify them appropriately (eliminate distractions), recognize their own intentions, have the flexibility to shift perspectives, understand the “hidden”
social conventions appropriate to different contexts, and formulate their  response in an organized manner.

A Speech-Language Pathologist works with individuals who have difficulties with social communication using a one-on-one direct model, or through group programs. You start increasing your or your child’s communicative competence by:

  • Anticipating topics and/or vocabulary that will come up during the social interaction. Predicting conversational topics allows you to prepare ahead of time and thus increase your social confidence. E.g., if you or your child is going to a sports event;
    research about the teams, rules, scores, and players or if you will be attending a work conference; read about the lectures ahead of time and familiarize yourself with the content of the day.
  • Using ice breakers that you find helpful in starting conversations, such as “it’s a beautiful day today” or “how is your day going?”
  • Practicing the tricky skill of making small talk. You can do this in the car on the way to an appointment, in a coffee shop or even at the dinner table.
  • Using surrounding context to guide the conversation, especially when stuck on what to say next to keep the interaction going. For example, if you or your child are at a baseball game, comment on their favourite player, the uniforms, a great pitch. If you are at a wedding, comment on the bride and groom, the food, their opinion of the band.
  • Shifting the conversation back to the speaker. Many clients with ABI dread answering questions about their accident or the details of their recovery. Instead of going into detail, briefly state how you are doing and then divert the conversation back to the partner, for example, “I am doing well, thank you. I heard you started a new job, and how is that going?”

These are a few tips that can help build communicative competence. If you are concerned about someone’s social communication skills, speak with a Speech-Language Pathologist for additional suggestions, recommendations and/or strategies.

Ashleigh Wishen,
M.H.Sc. S-LP (C)
Speech-Language Pathologist, Reg. CASLPO

The Speech Therapy Centres of Canada

Swallowing Reflex and Muscles: Considerations as we Age

Many people do not realize that the act of swallowing is actually a complex reflex.  As we chew our food, it forms a nice moist ball in our mouth, called a bolus, which is eventually propelled to the back of our throat with our tongue. When a bolus reaches a certain point in the back of our throats, our bodies recognize that we need to swallow. Think of it as similar to the doctor hitting your knee with a small hammer, and your leg jerking in response: the bolus hitting the back of the throat is like the hammer, and your muscles moving to close off your airway and open up your swallowing tube, esophagus, to your stomach is like the leg jerking. It is a magnificent mechanism to transport your food to your stomach, and protect your lungs from food and drink entering them.

It is important to keep in mind that as we age our reflexes begin to slow down, and this includes the swallowing reflex. In addition to our reflexes slowing down, our muscles also may not be as strong as they once were when we were younger – this goes not only for your arms, legs, and abs, but also for your swallowing muscles.  These changes can at times cause problems with the safety of our swallow. When problems do arise, they can lead to illness, the most significant being pneumonia. For example, if your swallow reflex is not as fast as it once was, it may not trigger your muscles to close off your airway in time to protect it from that tasty bite of a meal or sip of a delicious beverage from penetrating into your airway. You may tear up, start to cough, feel the need to clear your throat, or sound as if you have a ‘frog stuck in your throat’ when you start to speak. For another example, if your swallowing muscles are not as strong as they once were and they can’t squeeze and propel the food down strong and fast enough through your esophagus to your stomach, you may have left over pieces of food hanging around the back of your throat when your airway re-opens. The food that  remains can be sucked into your airway as you breathe. It is when food or drink slips into the airway and down into our lungs, along with some bacteria from our mouths, that a case of pneumonia can develop.

Many people never develop swallowing difficulties or pneumonia, but it is good to be aware of some red flags that indicate you or your loved one’s swallow should be looked at. Here are some of those red flags:

  1. During or shortly after you eat or drink you feel as though it is getting stuck in your throat.
  2. You cough, or clear your throat when you eat or drink, or shortly thereafter.
  3. You notice that your voice changes in quality during or just after eating or drinking.
  4. Your eyes tear up when you are eating or drinking.
  5. You feel like you have to swallow many times in order to get things down ‘properly’.
  6. You feel as though you choke on your food more than the average person does.
  7. You have a hard time clearing your mouth of all of the food you have been chewing.
  8. You find that food collects in different parts of your mouth, and you need to physically clear it with a sip of a drink, by really working at it with your tongue, or by using your finger.
  9. You find that food is collecting in parts of your mouth, and you aren’t noticing it until a later time.

This list is not exhaustive, but should give you a good idea of what to look for if you feel your swallow isn’t as efficient as it once was. If you have noticed any of these things, or are concerned about something that is not on this list, speak to your doctor about having a swallowing assessment done with a speech-language pathologist (SLP). By having your swallow examined, you can partner with your SLP to do some exercises, and/or use some strategies to help improve your swallowing safety.

If your swallowing profile is more complex, the SLP may recommend that you have a modified barium swallow study (MBS) completed. This means the SLP recommends you have an x-ray done of your swallowing in order to better understand what is going on as you swallow. It gives a more definite picture of what is going on as you swallow with the timing of the reflex and how the muscles are moving. From this study the SLP may give you additional
recommendations or strategies to improve the safety of your swallow.

The great news is, depending on the reason for your swallowing issues, that swallowing strategies and exercises can improve the safety and/or the strength of your swallow.

Megan Wood Pagonis, M.Sc. SLP(C), reg. CASLPO
Speech-Language Pathologist
The Speech Therapy Centres of Canada

The Kindergarten Reading Curriculum – How to help your child achieve literacy objectives at home!

As a speech-language pathologist I find that it is helpful if parents are aware of some of the early reading or “pre-literacy” skills that children must develop before they can become an effective reader. Below are a list of some of the expectations from the Ontario Kindergarten curriculum and suggestions on how you can work on these skills at home:

“They learn to pay attention to the way print and books work” Make reading together a part of your daily routine! Draw your child’s attention to the title of the book and let them turn the pages to increase their knowledge that we read books front to back. Trace your finger along the words as you read so they understand that we read left to right. Start one of their favorite books from the back “by accident” and see if your child notices.

“They become aware that some words rhyme” Have fun with rhyming games! Read books with lots of rhymes (for example Dr. Seuss books). Point out the rhymes to your child (for example: I do not like them in the house, I do not like them with a mouse. Look! House and mouse – they rhyme!) Take turns coming up with rhymes for simple words (“what rhymes with cat”? mat, hat, bat, etc.) Have fun by coming up with nonsense words that rhyme (for example ‘Dora’ can rhyme with ‘tora’ ‘mora’ ‘ sora’ etc!)

“Learn that writing can communicate a message” This can be during book reading activities or during everyday activities! Make signs to put up around your house such as “John’s room” or “Amanda’s toy box” and draw your child’s attention to these signs. Point out different types of print including print on menus, birthday cards, toys, recipes, and more. Work with your child to ‘write an e-mail’ to an aunt, uncle, grandparent etc. Help them come up ideas for the e-mail, you type the e-mail, then read it aloud and show them that their message is in print.

“They use approximate spelling for words that is based on their ability to hear, identify, and manipulate sounds” The ability to hear, identify, and manipulate sounds is called “phonological awareness” and is very important in learning to read.

  • Clap the syllables of words – start with 2 syllable words that are easy to separate like toothbrush, bookmark, baseball then try more difficult 2 syllable words (pirate, brother), 3 syllable words, and even 4 syllable words. Practice with words during daily activities: for dinner we’re having chicken, lets clap ‘chi-cken’, clapping family members names, words you see on signs, or clapping words that you find in books.
  • Point out the first sound (not letter) in words. For example: Sarah starts with the ‘sss’ sound. Talk about other words start with the ‘sss’ sound. Choose your child’s favorite toys and talk about the sound they start with (example: car starts with the ‘kuh’ sound, ball starts with the ‘buh’ sound). Once your child gets this, you can talk about the sounds at the end of words.

Have fun with these different reading activities to help your child be successful in the Kindergarten classroom!

Note: information about the curriculum was taken from:

Carla Montgomery, M.H.Sc. SLP(C)
Speech-Language Pathologist, Reg. CASLPO
The Speech Therapy Centres of Canada

Suggestions for Teachers of Students Who Stutter

When I was in elementary school, there were about 5 students in my class that would always raise their hands to ask and answer questions. They always participated in class discussions and actually seemed to enjoy talking aloud. The rest of the class slouched in their seats, wouldn’t make eye contact, and prayed they would not be the one called upon.

Talking in class is hard enough for the average child, but for children who stutters, being called upon in class can be a nightmare. As a teacher, there are many things that you can do to help students who stutter to talk more easily, participate more fully in class, and most importantly, feel better about talking
aloud.  If you are a parent of a child who stutters, share this information with your child’s classroom teacher.

  1. Talk with the student openly about their stuttering, but don’t make a big deal about it. Ask what classroom activities are more difficult for him/her to speak in.  Ask the student for some suggestions that could make him/her more comfortable speaking in class.
  2. Give the student who stutters plenty of time to answer questions in class.
  3. Don’t finish the student’s sentences or try to offer words when they are stuttering. If you guess the wrong word (or finish the sentence incorrectly), the struggle multiplies.
  4. Don’t tell the student to “slow down”, “relax” or “think before you try to speak” as this advice can be discouraging and keep the student from wanting to speak in class.
  5. Use a random method to call on students in the class instead of going up and down the rows.  This wait time can greatly increase the apprehension and tension of a student who stutters.
  6. If a student has an extremely difficult time talking in front of the whole class, modify the activity. Don’t excuse him/her from the activity but for example, instead of having students say their speeches in front of the whole class, they can say them in front of smaller sized groups. Be flexible.
  7. Most people who stutter have “good” and “bad” days. If you see that your student who stutters is having a day when their speech appears easier, offer them more opportunities to speak that day and fewer opportunities on their “bad” days.
  8. Give the student positive reinforcement for participating verbally in class.  Praise what they say, not how they say it.
  9. After a stuttered utterance, summarize what the student said to show them you understood, and reinforce their participation in the classroom activity or discussion (e.g., that’s a great point!).
 Michelle Cameron, M.H.Sc. S-LP(C)
Speech-Language Pathologist, Reg. CASLPO
The Speech Therapy Centres of Canada