Category Archives: Healthcare

6 Facts About Aphasia

Do you know the word “aphasia?”  Most people don’t.  In fact, more than 80% of people who completed the 2016 National Aphasia Awareness Survey never heard the word “aphasia.”  The purpose of this video/blog post is to help spread awareness on aphasia by sharing 6 important facts about this invisible disorder.


Fact 1: Aphasia is a communication disorder

Aphasia affects a person’s ability to speak, read, write, and/or understand words.  It affects everyone differently.

Fact 2: Aphasia does not affect intelligence

Because aphasia impacts a person’s ability to understand and formulate words and sentences, it is often wrongly assumed that the person has a form of intellectual disability.  However, this is not the case.  A person with aphasia can still think and generate ideas as s/he did before.  But s/he may struggle to express those thoughts and ideas in words.

Fact 3: Aphasia can happen to anyone

Aphasia can occur at any age, but is most commonly seen in adults.  It used to be thought of as an old person’s condition.  However, there are adults in their early 20s (and individuals even younger) who have aphasia.  There are at least 2 million people in the USA who have aphasia.  In fact, there are more people with aphasia than there are with many well-known conditions.  For example, more people have aphasia than have Parkinson’s Disease or multiple sclerosis.

Fact 4: Aphasia is commonly caused by stroke or brain injury

Approximately 1/3 of strokes result in aphasia.

Fact 5: Aphasia and stroke can occur at any time

Because they can happen at any time, it’s important know the warning signs.  A common phrase used to help people remember stroke signs is “Act FAST.” F is for face – individuals who suffer a stroke typically suffer facial drooping.  A is for arm – people who are having a stroke demonstrate arm weakness.  S is for speech – slurred speech is a common symptom of stroke.  T is for time – Although time is not a sign or symptom of aphasia or stroke, the T is to remind us that the sooner someone receives medical treatment when experiencing stroke symptoms, the better the outcomes can be.  For more information on stroke, read this Stroke 101 post.

Fact 6: There is currently no “cure” for aphasia

There is currently no pill or medical treatment that can cure/completely reverse the effects of aphasia.  However, most people with aphasia can make progress over time even several years after onset.  There are numerous resources available for people with aphasia and their caregivers to assist with recovery.

Please share this video or blog post to help us spread the word about aphasia!


5 Tips for Aphasia

If you’ve made your way to this post, it’s probably because you are currently caring for someone with aphasia.  Unfortunately, most people have never heard the word “aphasia” unless they or a significant other has received that diagnosis.  So without much knowledge on this diagnosis, it can be tricky to provide the best care for your loved one.  Although no two people are alike or present with the same aphasia characteristics, there are simple ways you can enhance your interaction and communication with your loved one.

Here is a list of easy-to-implement tips you can use while caring for someone with aphasia.  By using these tips, you can improve your communication and interaction with your loved one.

1. Reduce noise

A signature difficulty for people with aphasia is understanding spoken language.  If you are talking in a crowded restaurant or with a loud TV in the background, it will be harder for your loved one to understand what you’re saying.

2. Speak slowly

Slowing your rate of speech can enable a person with aphasia to understand you better.  It’s not necessary to speak unnaturally slow, but be mindful of your rate.  Add a few more pauses in between phrases or sentences to give your loved one time to process.

3. Use visuals

Visuals, such as pictures, gestures, drawings, and written words, can provide an extra layer of support for people with aphasia.  For example, if a person with aphasia cannot understand the spoken word “spoon,” you can provide additional support by showing him/her a picture of a spoon or demonstrating what to do with a spoon.  These visuals will allow the person with aphasia to successfully understand your message.

4. Shorten your sentences

It’s important that you speak to your loved one like an adult, but modify your sentence length so that processing is easier.  You can continue to talk about topics of interest (e.g., hobbies, politics, family), just keep it short and sweet.

5. Modify your questions

In everyday conversation, we use a lot of open-ended questions.  For example, we might say something like, “what are you doing today” or “why did you do that?”  However, for people with aphasia, these types of questions can be tricky.  Open-ended questions require them to find the word/words needed to answer the question, which may not be easy.  There are two different ways you can modify your questioning to assist your loved one.

1) Give possible answer choices for your questions.  For instance, if you wanted to ask, “what are you doing today,” you could provide pictures or written words of possible answers.  By providing choices, the person with aphasia will be better able to say an appropriate response or can point to the appropriate picture if s/he still can’t access the words to say them aloud.

2) Ask yes/no questions when possible.  For example, instead of saying, “what are you doing today,” you can ask “are you going to the store today?”

Introduction to Telepractice

Telepractice (AKA telemedicine, teletherapy, telehealth, telespeech, telerehabiliation, virtual speech therapy) is the delivery of health services via a telecommunications system. This service model is becoming increasingly more popular in the fields of speech-language pathology and audiology. Large factors that have driven the use of telepractice are reducing travel time for the client and/or professional and expanding the reach of services. Telepractice is becoming a more widely used and accepted method of providing speech-language pathology and audiology services. However, many families are skeptical that the services provided through a computer could be beneficial or equally as productive as those provided face-to-face. Despite family reservations, researchers (e.g., Gorgan-Johnson and colleagues) have found that children receiving virtual speech therapy do as well as those receiving services in person.

Benefits of Telepractice

  • Decreases the rate of cancelations or no shows
    • Sessions can still occur in bad weather or when the speech-language pathologist (SLP) or client are sick.
  • Allows underserved populations to receive evaluations and treatment
    • Individuals living in rural towns may struggle to find local in-person services for their needs. Furthermore, individuals from culturally or linguistically diverse backgrounds may struggle to find appropriate services in their area. By using telepractice, these clients are able to receive the services they deserve.
  • Increases family involvement in the sessions
    • Family members can have a more active involvement by assisting clients with the session activities.
  • Increases interest or attention with clients that are motivated by and/or more comfortable in front of computers
    • Clients may be more engaged during their sessions because they enjoy being on the computer. They may also feel more comfortable asking and answering questions and performing difficult tasks with the computer screen as a safety net.
  • Allows clients to connect with professionals who specialize in their disorder or disability and/or can provide services in their native language
    • Speech-language pathology is a broad field. Although all SLPs receive some degree of training in all aspects of speech, language, and swallowing disorders, most  specialize in certain areas over areas.  For example, some SLPs may specialize in working with children with autism while others may have extensive training in treating adults who have aphasia. In addition, the majority of SLPs are monolingual and/or do not have the training to provide appropriate services to a bilingual client.
  • Makes sharing information easier
    • Clients and SLPs can share their computer screens and upload files to enhance the therapy session.
  • Helps clients and families to remember and understand what occurred during the session
    • Virtual therapy sessions can be recorded (with permission) and used for later review. By recording the sessions, clients and family members can watch what occurred. Watching the recordings assists clients with practice and carryover of skills. Moreover, watching previously recorded sessions allows everyone to observe the progress that has occurred.

How can we help?

At Liberty Speech Associates LLC, we provide telepractice sessions for the following purposes: accent modification, counseling, speech-language evaluations and treatment, speech-language screenings, and collaboration with related professionals. For more information on our telepractice services, contact us today.


  1. Grogan-Johnson, S., Alvares, R., Rowan, L., & Creaghead, N. (2010). A pilot study comparing the effectiveness of speech language therapy provided by telemedicine with conventional on-site therapy. Journal of Telemedicine and Telecare, 16(3), 134139.
  2. Grogan-Johnson, S., Gaebel, R., Taylor, J., Rowan, L. E., Alvares, R., & Schenk er, J. (2011). A pilot exploration of speech sound disorder intervention delivered by telehealth to school-age children. International Journal of Telerehabilitation, 3(1), 3141.
  3. Grogan-Johnson, S., Schmidt, A. M., Schenker, J., Alvares, R., Rowan, L. E., & Taylor, J. (2013). A comparison of speech sound intervention delivered by telepractice and side-by-side service delivery models. Communication Disorders Quarterly, 34(4), 210220.

What to Expect During an Adult Speech and Language Evaluation


Adults may undergo speech and language evaluations for a variety of reasons, including, but not limited to, difficulty pronouncing sounds or words, speaking clearly, retrieving and using familiar words, understanding words they hear, speaking fluently, remembering peoples/places/events, and swallowing. Adult speech and language evaluations may be performed differently depending on the speech-language pathologist (SLP), the setting of the evaluation and/or the reason for the referral. To help you and your loved one prepare for a speech and language evaluation, below you will find detailed descriptions of what you can expect during a typical evaluation.


Intake Interview

The purpose of the intake interview is to gather information about you. This is the most important aspect of any speech and language evaluation as it helps the SLP understand why you are seeking the evaluation, how your current communication difficulties are impacting your daily life and what you hope to get out of the evaluation and/or therapy. During the intake interview, the SLP will ask you about your medical history, education and employment, cultural and linguistic background, and current and past evaluations and therapies.


Oral Mechanism Examination

The purpose of an oral mechanism examination is to assess the structure and function of your oral mechanism (e.g., lips, tongue, teeth, hard/soft palate) to support speech and/or swallowing. Examples of tasks you may be asked to do during this portion of the evaluation include moving your tongue from side-to-side, opening your mouth and saying “ah,” and raising your tongue to try and reach your nose.
Assessment of



Articulation is the manner in which sounds are produced using the oral mechanism and phonology is the manner in which we organize sounds to form words. Assessment of articulation and phonology is important if you are difficult to understand. The purpose of this assessment is to determine what sounds you have difficulty saying and if there is a pattern to your difficulties. In addition to general pronunciation concerns, this type of assessment is important if there is suspected apraxia and/or dysarthria. General assessment of articulation and phonology typically includes obtaining and analyzing a speech sample (this is exactly how it sounds – a sampling of your speech) obtained during conversation with the SLP, as well as administration of a standardized test (e.g., Goldman Fristoe Test of Articulation, Arizona Articulation Proficiency Scale, Hodson Assessment of Phonological Patterns, Apraxia Battery for Adults, Frenchay Dysarthria Assessment). During standardized testing, you will be asked to look at and name various pictures and/or objects, repeat a variety of words and phrases of varying lengths and complexities, and/or perform different actions with your mouth. The evaluator will transcribe what you say during the assessments for later analysis.


Assessment of Voice

Voice refers to the quality, loudness, pitch, resonance and prosody of one’s speech. A person typically undergoes a voice assessment due to vocal concerns as the result of a neurological condition (e.g., Parkinson’s Disease), a vocal pathology (e.g., nodules, cyst), or dysarthria. A thorough voice assessment cannot be completed without prior evaluation from an otolaryngologist (ENT) to determine the potential etiology of the vocal concerns. After a patient has been seen by an ENT, a voice assessment can be completed by an SLP and components of the assessment may include a discussion of how you use your voice and your feelings about the current status of your voice, use of computerized software to analyze your speech compared to other adults of similar ages, and/or use of laryngeal imaging.


Assessment of Fluency

Fluency refers to fluidity of one’s speech. Assessment of fluency is crucial if you have concerns that you stutter. A fluency assessment typically involves engaging in conversation with the SLP on topics of interest so she can obtain a speech sample for later analysis, as well as discussing your feelings about your stuttering administering a standardized fluency test (e.g., Stuttering Severity Instrument). During the standardized test, you will likely be asked open-ended questions, instructed to read passages and describe pictured scenes, and/or tell a story.


Assessment of Language and Cognition

Language refers to receptive and expressive language. Receptive language is an individual’s ability to understand language; where as expressive language is an individual’s ability to use language. Language goes beyond the spoken word and also encompasses written words, gestures, and facial expressions. Cognition describes a person’s memory, attention, problem solving, executive function, reasoning, organization, perception, and judgment. Assessment of language and cognition is typically completed when there is a suspicion of aphasia and/or a noted neurological decline, which may be the result of a traumatic brain injury, stroke, or neurological condition (e.g., Alzheimer’s, Parkinson’s). Assessment of language and cognition includes obtaining a language sample, as well as administering standardized tests (e.g., Western Aphasia Battery, Boston Diagnostic Aphasia Examination, Montreal Cognitive Assessment, Cognitive Linguistic Quick Test). The tasks you would be asked to do would depend on the test(s) administered; however, like with most standardized tests, you are likely to be asked questions about different pictures, words, objects, stories, and concepts. For example, you may be asked to find a letter or word named by the SLP.


Assessment of Swallowing

The purpose of a swallowing assessment is to determine what, if any, difficulties you have swallowing, at what stage the difficulties occur, and what types of food and liquid consistencies are safe for you to consume. Swallowing assessments can be done with and without instruments. Non-instrumental swallowing assessments involve the SLP watching you as you eat different foods and taking notes on what happens as you eat (e.g., do you cough after swallowing?). Instrumental swallowing assessments (e.g., videofluoroscopic swallowing study, fiberoptic endoscopic evaluation of swallowing) involve using medical equipment to watch your swallow internally.


Discussion of the Results

At the conclusion of the evaluation, the SLP should discuss the results with you. The discussion should include information related to her findings (diagnoses, observations) and recommendations (e.g., if additional testing by an SLP or related professional is recommended or required and/or if speech/language therapy is warranted). You should also be given the opportunity to ask any questions you may have.

Hearing 101

Our hearing ability has a great impact on our communication, from birth through adulthood.  Yet, when I recommend hearing tests to current or potential clients, I am often met with the same response, “My child hears fine” or “I hear fine.” Although one’s hearing may appear “fine,” it is not guaranteed that the person can truly hear everything. What we hear is broken down into frequencies (pitch) and decibels (loudness).  It is possible to experience hearing loss at certain frequencies rather than others. So even though you or your child may appear to hear everything, it is not necessarily the case.

Hearing Loss and Communication


For children, hearing loss can lead to a variety of communication difficulties.  For example, a child with hearing loss may experience difficulty formulating grammatically correct sentences.  S/he may also have trouble developing an age-appropriate vocabulary.  In addition, a child with hearing loss may mispronounce consonant and vowel sounds.  Other difficulties may include: following directions, responding to questions, understanding class material, and socializing in large groups.


For adults, hearing loss can also lead to communication difficulties.  For example, speaking on the phone or in loud environments (e.g., restaurant) may be difficult.  It also may be hard to fully understanding someone’s message.  Hearing loss may impact an adult’s willingness to engage in group social situations.

Hearing Tests for Everyone

Because hearing loss has such a significant impact on our lives, it is crucial that all individuals get their hearing checked regularly.  Usually when we think of a “hearing test” we envision the experience we had in the nurse’s office at school; however, this “test” is actually a hearing screening. A hearing screening is a quick test that determines if an individual requires a complete audiological evaluation (hearing test). A hearing screening is on a pass/fail scoring system; if a person does not respond to a tone on the screening, s/he automatically fails and is referred for a complete evaluation. Hearing screenings are also done with newborns. A complete audiological evaluation is conducted in a soundproof booth and is done by an audiologist.

If you or a loved one are having difficulty hearing or communicating, a hearing test is a must.  Even if you don’t have specific hearing or communication concerns, regular hearing tests are strongly recommended.  Refer to American Speech-Language-Hearing-Association website for guidelines on when and how often to have your/your child’s hearing tested.

Living with Parkinson’s Disease

I first noticed something was wrong with the left side of my body when I was at a 50s summer concert with my wife Donna. We were holding hands and she noticed my hand tremor; she asked me about it and I blew it off and told her that it happened once in awhile. She then convinced me to go to a neurologist who sat me down and asked me questions and had me do some fine motor skills with my hands and walk away from him down a hall. After this he told me I had symptoms of Parkinson’s one of which was infrequent eye blinking; as he was talking to me he counted how many times I blinked my eyes during our conversation and I didn’t blink as much as I should. I then decided to keep it a secret from work and co-workers afraid I would lose my job because of it. The only ones I let know were my kids, immediate family, and a couple of close friends.


I felt so guilty because my wife had just been diagnosed with breast cancer and I didn’t want her to be worrying about me. My wife took the proactive approach and started researching Parkinson’s, whereas I was trying to bury my head and not think about it. My wife then found a neurologist that specialized in Parkinson’s that was in our area (there aren’t many in NJ, most are in New York City). She is a perfect match for me and my wife; she was very easy going and very positive that Parkinson’s could be controlled with medication and exercise. She has grey long curly hair with glasses and looks like a 60’s child. She told me I could call any time I had any questions – something you don’t hear from to many doctors.  I never took her up on yet, but I may as I get worse.


Since I was diagnosed, my daughter Courtney became a speech pathologist, which has come in handy because my voice has become affected. She got me involved in a program at Montclair State University, where she supervises graduate students who are becoming speech pathologists. I do voice exercises with clinicians that are students that are supervised by speech pathologists. I like interacting with the students. I also started doing Yoga with my daughter, which helps me with my flexibility. My daughter has also gotten my wife and I to exercise more by joining a gym together, which we are enjoying.  Thanks Court!


I feel the biggest thing about Parkinson’s that affects me now is that I feel that everyone is looking at me when I’m doing things, such as when I’m putting on coats and I struggle to get my arms in.  When walking, I have to over exaggerate my walk so that I don’t shuffle my feet. And when I’m eating, I feel everyone is looking at me struggling to get food on my fork. Also when I try to get money out of my pocket or my wallet. And before Parkinson’s I never thought twice about people looking at me and now I feel self-conscious. I also worry that I won’t be able to do things with my grandchildren (when the day comes) that I did with my kids. My wife, kids, friends and I try to laugh a lot about my shaking and things I do; one of my friends even nicknamed me “slim shaky.” And that was my team name at two Parkinson’s walks in Central Park. Thanks to my wife, kids, and friends for all your support.