Speech-Language Therapy

Adult Therapy Services

• Dysphagia Therapy
• Aphasia Therapy
• Voice Therapy
• Cognitive Therapy
• Staff Credentials
• Cancellation/No-Show Policy

The Speech Language Therapy Department offers a continuum of care from the acute stages of hospitalization, through sub-acute rehabilitation, with follow-up also occurring at the outpatient level.

All stages of intervention include comprehensive assessments of speech, language, functional communication and cognitive disorders. Specialized evaluations and treatments for dysphagia, voice disorders and augmentative communication are also available.

At all levels of care patients are involved in treatment planning and setting functional, realistic goals for themselves.  Input from family and caregivers are also used to facilitate the best outcomes.

With over 60 years of combined experience, the Speech Language Pathologists at Mercy Medical Center are certified in the most advanced treatment modalities. They offer a wide variety of treatment options to meet the needs of any patient.

What is dysphagia?

Dysphagia is a disorder of swallowing or the inability to swallow. It can have sudden onset or be long-standing in nature. The mildest symptom can be having a dry mouth, while the most severe can cause a person to choke and have food lodged in the airway. The highest risk for a patient with dysphagia is aspiration, where food and/or liquid enters the airway below the level of the vocal cords. There are many causes of dysphagia, some of which are listed below:

• Brain injury, brain tumor or stroke
• Parkinson’s disease
• Multiple Sclerosis
• Alzheimer's disease and other dementias
• Head/neck cancer or surgery
• Motor neuron or muscle disease
• Guillian Barre Syndrome
• Amyotropic Lateral Sclerosis (Lou Gehrig’s Disease)
• Cranial Nerve Palsies

*This list is not comprehensive, and specific information about any of these disorders or diseases should be obtained from your physician.

What options for evaluation are available?

At Mercy Medical Center, we offer two of the most comprehensive assessments for dysphagia:

• Modified Barium Swallow
  studies include an x-ray assessment of the swallow function while the patient consumes various food and liquid textures.
• FEES – Fiberoptic Endoscopic Evaluation of Swallowing
  is an exam using a flexible endoscope and camera to evaluate the swallow function as food passes through the pharynx.

Both examinations are sensitive to identifying aspiration and pharyngeal residue, as well as identifying the safest food and liquid consistency for oral feedings. Both exams can be completed on an inpatient and outpatient basis.

What are the treatment options for dysphagia?

The Speech Pathologists at Mercy Medical Center are certified in the latest and most successful methods for the treatment of dysphagia:

• Vitalstim
  This treatment modality uses neuromuscular electrical stimulation for swallowing. This includes electrodes placed on the neck to stimulate strength and range of motion of the muscles used for swallowing. Vitalstim involved treatment of the swallow, while swallowing foods and liquids. A clinician must be trained and certified in order to use Vitalstim. Mercy Medical Center employs five therapists certified in the Vitalstim treatment protocol. To learn more abut Vitalstim, visit their website at www.vitalstimtherapy.com
• DPNS (Deep Pharyngeal Neuromuscular Stimulation)
  DPNS uses thermal (cold) and tactile (touch) stimulation to improve strength, speed and sensation of swallowing reflexes. DPNS involves direct contact with the swallowing muscles (tongue, palate, throat/pharynx) using frozen lemon glycerin swabs in a repeated pattern. DPNS also required a certification/training course, which five of our clinicians have completed.
• Traditional Laryngeal Strengthening/Exercise Programs
  Exercises for the improvement of strength and range of motion for swallowing are also employed. Patients are trained to complete oral – motor exercises, voice exercises and swallowing exercises that will improve and maintain strength of the swallowing musculature. Home exercise programs are also given.

For additional products, services and information related to dysphagia please visit the following websites:

• www.nidcd.nih.gov/health/voice/dysph.asp
• www.AliMed.com
• http://www.asha.org/Publications/leader/2003/031104/f031104c.htm
• www.vitalstimtherapy.com
• www.reliantmp.com

What is aphasia?

Aphasia is the name for a language problem caused by injury to the brain. Aphasia can affect a person’s ability to comprehend or use language to communicate. It can be mild (trouble finding words), or severe (unable to speak at all). Aphasia can also affect other areas of language such as reading, writing and numerical processing skills.

The most common cause for aphasia is stroke, although any disease or injury that affects the brain can cause aphasia.

How is it treated?

A person with aphasia undergoes a complete assessment of all areas of language comprehension and expression:

• Auditory comprehension (understanding language)
• Reading comprehension
• Verbal expression/communication
• Speech production (sound production, voice, intelligibility)
• Written language
• Basic cognition

Therapy will revolve around those skills that are diminished, while focusing on residual skills to facilitate independence with communication of basic needs. Advanced communication skills needed in the community or at work are also facilitated. Therapy tasks will be specific to each person.

What if my family member can’t talk at all?

Traditional therapy would continue, however, the ability to use an alternative communication device (machine that is programmed to talk) can be tested. There are a variety of devices that can be programmed to help the patient communicate using their residual language and motor skills.

To read more about aphasia please visit the following websites:

• www.aphasia.org
• www.aphasiahope.org
• www.asha.org/public/speech/disorders/Aphasia
• www.stroke.org
• www.StrokeAssociation.org
• www.alimed.com

What is voice therapy?

Voice therapy is a treatment used to improve the quality, strength and endurance of the voice. The voice can be affected by overuse or abuse, injury to the throat or vocal cords or a neurological problem such as Parksinson’s Disease. Having a voice disorder can also affect the intelligibility of speech.

The clinicians in Mercy’s Speech–Language Therapy Department are qualified to complete voice evaluations, in conjunction with anatomical assessments that should be completed by an otolaryngologist (E.N.T.).

There are four therapists certified in the Lee Silverman Voice Treatment (LSVT), which is a specific therapy regimen used to improve the intensity of the voice and intelligibility of speech. It was specifically designed for use with patients with Parkinsons Disease. This regimen involves a high frequency of therapy sessions with strict home programs and carry-over techniques.

For additional information about the LSVT program, please visit the following website:

www.lsvt.org

What is cognition?

Cognition refers to the act of thinking. It involves the tasks of paying attention, initiating, problem solving, planning and executing activities. Being able to evaluate one’s work, have awareness of errors and show good judgment are also acts of cognition. Cognitive deficits can be caused by any injury or disease that affects the brain. The most common cause for cognitive deficits is traumatic brain injuries.

The Speech Pathologists at Mercy Medical Center provide specialized treatment for cognitive deficits that may affect a person’s activities of daily living, education or employment. An individual treatment plan is developed following a complete assessment of the following:

• Problem solving 
• Memory
• Judgment
• Orientation
• Attention
• Reasoning
• Insight
• Convergent thought
• Functional cognition
• Categorization skills
• Numerical processing

Family, friends and other caregivers are often involved in the treatment plan to facilitate the best outcomes. Home activities such as memory notebooks or organizational planners are often used to help patients organize and complete tasks.

For more information regarding traumatic brain injury and cognitive deficits, visit the following websites:

• www.ninds.nih.gov/disorders/tbi/tbi.htm
• www.traumaticbraininjury.com
• www.asha.org/public/speech/disorders/TBI.htm
• www.TBIRecovery.org

Staff Credentials

• Abby Milano, M.A., CCC-SLP
  Master’s Degree from The University of Akron, 2005
  Employed by Mercy since April, 2007
  Special areas of certification: Vitalstim Certified Provider

• Joann Ovnic, M.A., CCC-SLP
  Master’s Degree from Case Western University, 1987
  Employed by Mercy since 2006
  Special areas of certification: Lee Silverman Voice Treatment
  Special interest in Cognitive Rehabilitation and Community Re-entry

• Debbie Adams-Schumaker, M.A., CCC-SLP
  Master’s Degree from The University of Akron, 1982
  Employed by Mercy since 1986
  Special areas of certification: Deep Pharyngeal Neuromuscular Stimulation (DPNS), Facial Stimulation, Vitalstim Certified Provider, Lee Silverman Voice treatment

• Joelle Reese, M.A., CCC –SLP
  Master’s Degree from The University of Akron, 1994
  Employed by Mercy since 1994
  Special areas of certification: Deep Pharyngeal Neuromuscular Stimulation (DPNS), Facial Stimulation, Vitalstim Certified Provider, Lee Silverman Voice Treatment, Myofascial Release for Dysphagia Management, Clinical Specialist of Neonatal Feeding and Acute Stroke Management
  Special interest/training in Neonatal and Pediatric Feeding/Swallowing Disorders)

• Elizabeth Roesink, M.A., CCC-SLP
  Master’s Degree from Kent State University, 2005
  Employed by Mercy since 2005
  Special areas of certification: Deep Pharyngeal Neuromuscular Stimulation (DPNS), Facial Stimulation, Vitalstim Certified Provider, Fiberoptic Endoscopic Evaluation of Swallowing (FEES)

• Chris Kramer, M.A., CCC-SLP
  Master’s Degree from Kent State University, 1998
  Employed at Mercy since 1999
  Special areas of certification: Deep Pharyngeal Neuromuscular Stimulation (DPNS), Facial Stimulation
  Special areas of interest: autism, brain injury, developmental delays, dysfluency
   
• Sarah Kakoules, MA, CCC-SLP
  Master’s Degree from Kent State university, 2007
  Employed by Mercy since 2010
  Special areas of certification: Vitalstim Certified Provider, Fiberoptic Endoscopic Evaluation of Swallowing (FEES)
  Special interest/training in Traumatic Brain Injury, Cognitive Rehabilitation and Stroke Rehabilitation
  

• Laurie Neal, MA, CCC-SLP
  Master’s Degree from University of Akron
  Employed by Mercy since 2010
  Special area of certification:  Vitalstim Certified Provider 22 years of long-term care experience
  Special interest/training in Dysphasia, Cognitive Rehabilitation and Modified Barium Swallow Studies
  
  

Cancellation/No Show Policy

Patients, parents and/or caretakers will be notified during their initial assessment of the following policy:

1. Patients need to attend scheduled therapy sessions in order to progress toward goals. Regular attendance is vital to the patient’s progress.
2. If the patient does not attend 75 percent of their scheduled therapy sessions over a two-month period of time, the following will occur:
   1. If the patient does not notify the therapist prior to the patient’s appointment three consecutive appointment times, the patient will be discharged from therapy and will require a new prescription to re-initiate therapy services.
      1. A letter will be sent to the patient and physician notifying them of the patient’s discharge from therapy due to non-compliance and that a new script will be required to resume therapy services.
   2. If the patient cancels but misses 25 percent or more of their scheduled therapy sessions, the therapist will discuss again with the patient, parent and/or caretaker the importance of regular therapy attendance and discuss  if changing of treatment times, assistance with transportation, etc, would help improve attendance. The therapist will also inform the patient, parent and/or caregiver that if the patient does not attend 75 percent of scheduled therapy sessions over the next two-month period of time, the patient will be discharged from therapy and will require a new prescription to resume therapy services.
      1. If the patient is discharged, a letter will be sent to the patient and physician notifying them of the patient’s discharge from therapy due to non-compliance and that a new script will be required to resume therapy services.
   3. If the patient notifies the therapist prior to missed scheduled treatment sessions due to a vacation, hospitalization/medical procedure and/or medical insurance authorization these missed sessions will not count in the percentages  for missed sessions.
      1. If the vacation, hospitalization/medical procedure and/or medical insurance authorization is going to require more than four weeks, then the patient will be placed on hold and removed from the schedule. A new schedule will be initiated when the patient is able to return. The patient/parent/caregiver should be notified that the same treatment times will not be guaranteed upon the return of the patient, but the therapists will work to accommodate their scheduling requests as best as possible.
      2. Missed sessions due to illness or illness of other family members, will be included in the missed percentages.

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