Adults
Aphasia
Typically seen in patients that have experienced a Cerebral Vascular Accident (CVA- Stroke) , Traumatic Brain Injury (TBI), Brain Tumours or Infections, or progressive neurological conditions like Alzheimer’s and Dementia.
Aphasia is a neurological condition that acts as a barrier between a person’s thoughts and their ability to communicate. Whether it appears suddenly following a stroke or head injury, or develops over time due to a brain tumour or disease, it disrupts the “translation” of ideas into language. This challenge extends beyond speaking; it can also make it difficult to understand conversations, read, or write. In some cases, a person might struggle to find a specific word, while in more severe instances, they may become completely non-verbal. However, it is essential to remember that aphasia affects language, not intelligence.
Dysarthria
Typically seen in patients with Parkinson’s Disease, Amyotrophic Lateral Sclerosis (ALS), Multiple Sclerosis (MS), or following a stroke or Traumatic Brain Injury (TBI).
Dysarthria is a motor speech disorder that occurs when the muscles used for speaking are weak, damaged, or difficult to control. Unlike aphasia, which is a struggle with language itself, dysarthria is a physical challenge with the “mechanics” of speech. It is caused by damage to the nervous system that governs the movement of the lips, tongue, vocal cords, or diaphragm. As a result, a person’s speech may sound slurred, breathy, or excessively slow, making it difficult for others to understand them. It is crucial to understand that dysarthria affects speech execution, not intelligence or language comprehension. While the voice may sound different or strained, the individual’s ability to process ideas, understand others, and form complex thoughts remains entirely unaffected.
Apraxia of Speech (AOS)
Typically seen in patients that have experienced a Cerebral Vascular Accident (CVA- Stroke), Traumatic Brain Injury (TBI), or in conjunction with neurodegenerative diseases and certain brain tumours.
Apraxia of Speech is a neurological disorder that affects the brain’s ability to plan and coordinate the complex muscle movements required for speaking. While the muscles themselves are strong (unlike in dysarthria) and the person knows exactly what they want to say (unlike in aphasia), the “message” from the brain to the mouth gets scrambled. This results in “groping” for the right mouth position or inconsistent speech errors where a person can say a word correctly one moment but not the next. It is essential to recognize that apraxia is a coordination disorder, not a loss of intelligence. The individual still possesses their full cognitive abilities and language skills, but they face a significant physical hurdle in “programming” their speech to come out smoothly and accurately.
Cognitive-Communication Disorder
Typically seen in patients with Traumatic Brain Injury (TBI), Right Hemisphere Stroke, Alzheimer’s Disease, or other forms of Dementia.
A cognitive-communication disorder is a condition where language remains functional, but underlying thinking skills disrupt a person’s ability to communicate effectively. While the individual may be able to form perfect sentences and speak clearly, they struggle with the “higher-level” cognitive processes—such as memory, attention, organization, and social awareness—that make successful conversation possible. This can manifest as difficulty staying on topic, trouble understanding jokes or sarcasm, or a lack of awareness regarding social boundaries. It is important to distinguish this from aphasia: while aphasia is a breakdown of the language system itself, a cognitive-communication disorder is a breakdown of the thinking skills that support how we use that language.
Dysphagia (Feeding and Swallowing) Difficulties)
Typically seen in patients following a Cerebral Vascular Accident (CVA – Stroke), Traumatic Brain Injury (TBI), or those living with progressive conditions such as Parkinson’s Disease, ALS, or advanced Dementia. It is also frequently seen in Head and Neck Cancer patients due to tumours or the side effects of radiation, as well as those with a Total Laryngectomy or Tracheostomy who have had surgical changes to their airway.
Dysphagia is a medical term for difficulty swallowing, involving a disruption in the complex coordination of muscles and nerves required to move food or liquid from the mouth to the stomach. While often discussed alongside speech disorders, dysphagia is a physical safety concern that can lead to choking or “aspiration,” where food or drink enters the lungs instead of the oesophagus. This is a particular risk for Tracheostomy and Laryngectomy patients, as their surgical alterations can change the pressure and movement needed to swallow safely. Patients may experience a sensation of food being stuck, coughing during meals, or a “wet” sounding voice. It is important to note that dysphagia is a physical impairment of the swallowing mechanism, not a sign of decreased intelligence. Because the same muscles and nerves are often used for both speaking and swallowing, it is common for these physical challenges to occur alongside communication changes.
Fluency (Adult Stuttering)
Typically seen in patients with developmental stuttering, but also in adults following a Cerebral Vascular Accident (CVA – Stroke), Traumatic Brain Injury (TBI), or as a result of progressive neurological conditions like Parkinson’s Disease. In some cases, fluency disruptions can also be psychogenic, appearing as a physical response to severe anxiety or emotional trauma.
Fluency disorders, commonly known as stuttering or cluttering, involve disruptions in the rhythmic flow and timing of speech. While many associate this with childhood, “acquired” stuttering can occur in adulthood when the brain’s timing for speech production is damaged or when intense psychological stress impacts the motor system. This may present as repetitions of sounds, prolongations, or “blocks” where sound is temporarily trapped. It is important to emphasize that fluency disorders are not a sign of decreased intelligence. Whether the cause is neurological or psychogenic, the individual knows exactly what they want to say, but their brain or body has difficulty maintaining the smooth, continuous movements required to produce words.
Voice Disorders
Typically seen in patients with Head and Neck Cancer, Vocal Fold Paralysis, Parkinson’s Disease, or those who have undergone a Total Laryngectomy or Tracheostomy. Voice changes are also frequently related to anxiety or psychogenic factors, such as Muscle Tension Dysphonia.
A voice disorder occurs when the quality, pitch, or loudness of the voice is affected by changes to the vocal folds or the muscles surrounding them. For patients with Parkinson’s, this often manifests as a quiet, breathy voice, while those with Cancer may experience a total loss of sound. Additionally, severe stress or anxiety can cause Psychogenic Aphonia, where the voice may “whisper” or disappear entirely despite the vocal folds being physically healthy. It is vital to remember that a change in voice is a physical or emotional loss of sound, not a loss of mind. Whether the cause is a surgical bypass like a Tracheostomy or an involuntary response to trauma, the individual’s internal voice remains unchanged; they simply require support and the right tools to be heard again.