An Overview of Speech-Language Impairments
& The Services We Provide

To help you gain a thorough understanding of Speech-Language disorders and the remediation therapies and treatments that Albemarle Speech and Language Center provides, we have organized this section in the manner below:

Understanding Speech and Language Impairments

What is Speech?

Humans express thoughts, feelings, and ideas orally to one another through a series of complex movements that alter and mold the basic tone created by voice into specific, decodable sounds. Speech is produced by precisely coordinated muscle actions in the head, neck, chest, and abdomen. Speech development is a gradual process that requires years of practice. During this process, a child learns how to regulate these muscles to produce understandable speech.

What are Speech Impairments?

By the first grade, roughly 5 percent of all children in the U.S. have noticeable speech disorders. It is important to note that the majority of these speech disorders have no known cause. For example, one category of speech disorder is fluency disorder, or stuttering, which is characterized by a disruption in the flow of speech. It includes repetitions of speech sounds, hesitations before and during speaking, and the prolonged emphasis of speech sounds. More than 15 million individuals in the world stutter, most of whom began stuttering at a very early age.

Other examples include phonological or articulation impairments (inability to produce/say sounds properly), speech impairments due to hearing issues (such speech may be difficult to understand, nasal-sounding, unusual in pitch or rhythm), apraxia ( difficulty planning and producing the precise, highly refined and specific series of movements of the tongue, lips, jaw and palate that are necessary for intelligible speech).

The majority of speech sound disorders in the preschool years occur in children who are developing normally in all other areas. Speech disorders also may occur in children who have developmental disabilities.

What is Language?

Language is the expression of human communication through which knowledge, belief, and behavior can be experienced, explained, and shared. This sharing is based on systematic, conventionally used signs, sounds, gestures, or marks that convey understood meanings within a group or community. Recent research identifies "windows of opportunity" for acquiring language--written, spoken, or signed--that exist within the first few years of life.

What are Language Impairments?

Between 6 and 8 million individuals in the United States have some form of language impairment. A language impairment affects the understanding of language (receptive language disorder), the formulation of an utterance (saying what one intends to say--expressive language disorder), or both.

Receptive and expressive abilities may be impaired together such as in a disorder called developmental language delay in toddlers and preschoolers or language learning disability in school-aged children. A child who is unable to talk (called a nonverbal child) may have good receptive language abilities. In contrast, a child who is able to express his/her thoughts well may have difficulty following directions.

Language impairments affect children and adults differently. For children who do not use language normally from birth, or who acquire an impairment during childhood, language may not be fully developed or acquired. Many children who are deaf in the United States use a natural sign language known as American Sign Language (ASL). ASL shares an underlying organization with spoken language and has its own syntax and grammar.

In adult populations, language impairments may be acquired because of stroke, head injury, dementia, or brain tumors. Language disorders also are found in adults who have failed to develop normal language skills because of mental retardation, autism, hearing impairment, or other congenital or acquired disorders of brain development.

What is Vocalization?

Voice (or vocalization) is the sound produced by humans and other vertebrates using the lungs and the vocal folds in the larynx, or voice box. Voice is not always produced as speech, however. Infants babble and coo; animals bark, moo, whinny, growl, and meow; and adult humans laugh, sing, and cry. Voice is generated by airflow from the lungs as the vocal folds are brought close together. When air is pushed past the vocal folds with sufficient pressure, the vocal folds vibrate. If the vocal folds in the larynx did not vibrate normally, speech could only be produced as a whisper. Your voice is as unique as your fingerprint. It helps define your personality, mood, and health.

What are Voice Impairments?

Approximately 7.5 million people in the United States have trouble using their voices. Impairments of the voice involve problems with pitch, loudness, and quality. Pitch is the highness or lowness of a sound based on the frequency of the sound waves. Loudness is the perceived volume (or amplitude) of the sound, while quality refers to the character or distinctive attributes of a sound. Voice impaired individuals may be characterized with a hoarse, breathy, or strained/tense voice). Voice impairments are often caused by changes in the shape of the vocal cords (e.g., swelling of the vocal cords, growths on the vocal cords such as vocal nodules). Many people who have normal speaking skills have great difficulty communicating when their vocal apparatus fails. This can occur if the nerves controlling the larynx are impaired because of an accident, a surgical procedure, a viral infection, or cancer.

Evaluation and Diagnosis of Speech, Language and Voice Impairments

At Albemarle Speech and Language Center, we begin the process of treating speech and/or language disorders by thoroughly gathering and analyzing information about a person’s linguistic, speech and physical abilities (as they relate to speech and communication). We also look at the individual’s environmental influences as they can have a significant impact. The brain, the body, and a host of other behaviors and automatic processes interact to produce speech and language. Our body of knowledge is based on two key areas: speech and language. Speech and Language are different, yet overlapping concepts.

Language occurs in the brain, and is the ability to understand what we hear or read and express our ideas in words (spoken or written). A useful analogy is to think in computing terms...Language is the "software."

Speech also originates in the brain, and is the audible output of language. Think of it as the "hardware."

When we speak, our brains program components of the oral cavity such as the lips, tongue, jaw, and components of the larynx, or “voice box,” such as the vocal cords, for movement. These anatomical structures (body parts) are the “hardware” for speech, whereas the actions of these parts constitute the “software” for speech. For example, the respiratory system (lungs, trachea or windpipe, ribcage) allows us to breathe, but it also helps us speak by providing air to make the vocal cords vibrate, producing sound. Another important system is our auditory system (outer and inner ear, auditory canal, auditory nerve, auditory receptors within the brain). This system allows us to monitor our own speech and understand and respond to others’ speech. Thus, the brain is essential in both speech and language. It interprets language and helps us generate language. It also programs bodily organs and muscles to act together to generate clear, well-articulated speech.

When we evaluate a person in need of speech and/or language therapy, We examine examine the individual’s anatomical and physiological state, either directly or through the reports of other health professionals (e.g., audiologists, psychiatrists, physicians, neurologists, etc.).

Speech-language pathologists, audiologists, occupational therapists, physical therapists, and other such professionals specifically treat problems of physiology, or function, of bodily systems. For example, we may learn about a client seeking help by reading his/her physician’s reports to learn about anatomically based problems and treatments. We we also conduct direct observations of the client ourselves to determine his/her functioning. Sometimes a client’s difficulties do not have any clear pathological (e.g., a disease, some type of physical deformity, etc.) origin. These problems are functional in nature. This means that the impairment has occurred without any detectable anatomical or physiological abnormality or dysfunction.

After learning about a client through talking with and/or gathering documentation from other professionals, and then conducting direct observations through an assessment process, our speech-pathologist makes a diagnosis. A diagnosis is a "labelling" of the client's condition. Speech and language impairments are often named with codes for clarity among professionals and others involved in the health care process (e.g., for insurance coverage, for other health professionals’ evaluations, etc.). We also note the severity of the condition.

The next step is developing the best treatment strategy. Treatment type and duration vary based on the client’s needs. For example, voice disorders such as hoarseness or vocal fatigue are usually more easily and quickly treated than conditions that involve brain dysfunction or damage, such as severe autism or a stroke.

Families of persons with speech and language impairments are in key positions to help that individual progress in therapy. In fact, in many cases, we highly encourage an active involvement in the treatment process. Think homework! Examples include helping a smoker with voice problems stop smoking; helping in the set-up, use, and maintenance of special communication devices; cleaning and maintaining hearing aids, etc.

Speech and language are amazingly complex. In fact, when you consider the number of processes and bodyparts that make up the components of speech and language, you'd be amazed that you can speak at all!

For such a complex activity, complex problem solving is required. A vast amount of knowledge, experience and decision-making are involved in finding a diagnosis and planning treatment. Speech-language pathology is complex and constantly changing, it's a field absolutes simply do not exist, and numerous solutions may be effective for any single problem.