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
www.speechtherapycentres.com
 

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: http://www.edu.gov.on.ca/eng/curriculum/elementary/grades.html

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

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
www.speechtherapycentres.com

Back in School

With the start of a new school year already upon us, here are some activity ideas to help you and your kids as they get back into the grind.

By incorporating activities for listening, language expression, reading and writing into your daily routine, and creating a language-literacy rich environment, you can help ensure smoother transitions at school.

Simon Says: This is a great game to sharpen your child’s listening skills. This game can help to improve verbal attention, following directions, language processing skills, and self-regulation. You can increase the difficulty level of the game based on your child’s skill level.  You can also incorporate multi-step directions (e.g., ‘Simon says take your back pack, put on your shoes, and wait in your seat’); opposites (e.g., ‘Simon says do the opposite of walk’); negatives (e.g., ‘Simon says don’t clap’); rhyming (e.g., ‘Simon says tell me a word that rhymes with bat’); segmenting words into syllables (e.g., Simon asks you to clap for the word potato’)…The possibilities are endless!

Shared book reading: Set aside some time for shared book reading. Look through the book with your child and encourage them to tell you the story. Encourage your child to read the words if the book is at their reading level. Encourage them to use the pictures in the book to support their story narration. Ask them to predict what will happen next in the story. Retell the story to your child including important details. Ask your child to recall the main ideas, main characters, and the plot of the story. Ask your child to make inferences about the feelings of the characters and other events in the story (e.g., How do you think she feels? Why does she feel this way? What would make her feel better?)

 Name-Place-Animal-Thing: Here’s a fun group word game that stimulates
vocabulary and targets literacy skills. Ask one person in the group to call out
a letter of the alphabet. All the members of the group then take a couple of
minutes to write down a ‘name’, a ‘place’, an ‘animal’, and a ‘thing’ that
starts with that letter. When all members in the group have finished writing
down all four fields, each one calls out their list. Participants will get full
credit for any responses that don’t overlap and half credit for any overlapping
answers. You can build on to this game, and have your child identify the
‘category’ the ‘thing’ belongs to. Have them add on one more member to that
category. Give them an opportunity to describe how the members of that category are related. You can further expand this game to include adjectives and verbs as well. Encourage your child to think of synonyms (words with similar
meanings-e.g., scold, yell, shout) and antonyms (opposites-e.g., angry vs.
happy).

Young writers in the making! What did your child do this summer? Travel to a new and exciting place? Watched a movie that they’ve been waiting for forever! Encourage your child to write about it. If they travelled to a new place, enrolled in a summer camp, visited some exciting local attractions, ask your child to write about it in a descriptive paragraph. Start with brain storming ideas together. Support your child’s writing with a topic and conclusion sentence (e.g., Topic sentence- ‘This summer, I had a lot of fun’. Conclusion sentence- ‘I can’t wait for another fun-filled summer next year). Watch them as they write. If you see them struggling with their spelling, encourage them to sound out the sounds in the words and to come up with ‘possible’ spellings (e.g., conclusion,
conclution, conclushan). Discuss what is an ‘accepted’ spelling (e.g., conclusion). Once they have finished writing, encourage them to check their work. Provide them with guidelines for checking: Punctuation (i.e., periods, commas, question marks), Capitalization, Spelling, and Articles (and, the, an).

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

How to Help People With Communication Disorders in the Community

Last week I was in Tim Horton’s when I saw a man trying to order a coffee but he was struggling because of a communication disorder. He was having a difficult time being understood by the Tim Horton’s employee and needed help getting his money out of his wallet because of physical difficulties. Although the people around him – both the employee and bystanders – all seemed to want to help the man they were all hesitant and did not seem to know what to do or how to help this man.

One of our jobs as speech-language pathologists is to advocate for those with
communication disorders.  As part of that we try to increase awareness and knowledge on how to interact with people in the community who have various communication disorders. This may include people with disabilities (cerebral palsy, developmental disorders), people who have had a stroke or head injury, people with dementia (such as Alzheimer’s), people who communicate with assistive technology/computers, or people with speech that is difficult to understand. Here are some communication tips that you can use with almost any kind of communication difficulty:

First and foremost – always be respectful and ask the person if they would like your assistance! Remember: a communication disorder does not mean they are unintelligent!!

To help the person understand you:

  • Keep your messages short and to the point (for example: say “Do you want help?” not “I noticed you’re trying to order and I thought that I could help by…)
  • Wait! They may need more time to process the information
  • Keep your message short but grammatically correct so they do not feel that you are insulting them (for example: do not say you….help….get….coffee??”)
  • Repeat if necessary or try to say your message in a different way
  • If they are still having difficulty understanding you, use gestures (pointing to objects or locations) or use objects around you (if they don’t understand “what size coffee do you want?” show them the different sized cups)
  • If open ended questions are difficult (“what do you want?) give choices (“do you want a drink or something to eat?” “do you want coffee or tea?”)

To help the person express themself:

  • Give them specific feedback on what you did not understand. Instead of just saying what?” try saying  “you want a coffee, what do you want in it?”
  • As explained above – if they are still struggling have them gesture, use objects around the room, or give them choices
  • If they are using assistive technology – wait for them to finish creating their message. Avoid reading their message over their shoulder or guessing what they might be saying.
  • Most importantly – be patient, give them time, and don’t give up!
Carla Montgomery, M.H.Sc. SLP(C)
Speech-Language Pathologist, Reg. CASLPO
 
The Speech Therapy Centres of Canada
www.speechtherapycentres.com

Bullying

When I was a kid I had a pet hamster, that I adoringly named Grover. Unfortunately, I was not able to produce my /R/ sound, so Grover shortly became known as “Gwova.” By being teased and imitated at school, I quickly learned what other people heard when I spoke… and I was very embarrassed about my speech. Looking back years later, I consider myself to be incredibly fortunate that this teasing did not lead to bullying, but sadly not the case for most children.

It has been a goal of mine, since becoming a speech-language pathologist, to not only work on the communication difficulty itself, but to target self-esteem. Speech-language pathologists often find themselves faced with the bullying epidemic. They may work in schools, where most bullying typically occurs, or they may work outside of schools, but with students that are frequently susceptible to bullying, for example, children with communication, developmental, and/or social difficulties.

A professor from Pennsylvania State University, Gordon Blood, has done extensive research on bullying and feels that speech-language pathologists have a role in managing and reducing social bullying. Examples of social bullying are: a child not being allowed to join a game, to participate in conversation with peers, or becoming the subject of teasing or negative gossip, in turn causing children to experience emotional and/or academic difficulties. Blood says, “In all bullying, there’s intent to do harm, and a perceived power imbalance.” Speech-language pathologists are in a position where they can often have a strong role in restoring the balance of power that is disrupted in bullying. Instead of encouraging a child to ignore the problem, or pretend not to be bothered, it is recommended that professionals, such as speech-language pathologists, teachers, and parents do the following: 1) Listen to the child. Give them non-interrupted time to speak. 2) Praise the child for discussing the bullying – it can be incredibly hard for children to talk about. 3) Encourage the child to build his or her social network – one or two friends is all most children need to stick up to a bully.

Remember that the common goal for children that experience bullying is to develop their confidence enough to overcome bullying before it has negative effects on their learning and health.

Information obtained from Speech-language pathologists positioned to help victims of bullying, January 7, 2011, written by Gordon Blood, Ingrid Blood, Michael Boyle, and Gina Nalesnik from Pennsylvania State University.

Written by:
Michelle Cameron, M.H.Sc. S-LP(C)
Speech-Language Pathologist, Reg. CASLPO
 
The Speech Therapy Centres of Canada
www.speechtherapycentres.com
 

SLP’s, Reading, and Math

Parents often ask why, we, as SLPs work with their school-aged kids on reading and math. It is sometimes difficult to see what our role is in these subjects. We are not tutors, we are not teachers, we are language specialists. What this means is that as SLPs, we need to figure out whether your child is having difficulty with actual math and reading concepts, or if the breakdown in comprehending the language used in those particular subjects.

For examle, in math the most difficult tasks are word problems. Most children will find this to be the most difficult, but it is not the addition/subtraction/ multiplication/division that causes the breakdown; rather it’s the way the questions are worded. These students are having a problems identifying what the question is asking, distinguishing the most important from the irrelevant information among other language tasks. Without these skills,  students will not be able to answer or interpret the problem properly.

As another example, with reading tasks, so often we see kids that can read well but when it comes to comprehending the story and answering questions about the story they become lost. Once again this is a breakdown in the comprehension of story, rather than in the reading itself.

As speech-langauge pathologists, it is our responsibility to target the comprehension of language to ensure academic success. We will provide students with strategies to search for key information, as well as aid teachers in modifying questions and instructions in a way that will be understood by the students. With these strategies in place your child’s academic career will be fruitful and successful!

Melissa Oziel
M.Sc-SLP, Reg. CASLPO
Speech-Language Pathologist
 
The Speech Therapy Centres of Canada
http://www.speechtherapycentres.com/