Speech-language therapy — Waikato

We require all patients with voice difficulties (except those with Parkinson's disease) to first have an assessment by an ear, nose and throat specialist. Ask your healthcare provider for a referral if required.

Caring for your voice

Things that are great for your voice:

• talking gently
• staying hydrated — drink plenty of water
• managing reflux, if this is a problem for you
• relaxation
• keeping the atmosphere moist — e.g. opening the window.

Reduce strain on your voice by avoiding:

• talking against background noise
• shouting
• singing
• whispering
• calling from room to room
• effortful speech.

Things to avoid that can irritate your voice:

• smoking
• coughing and excessive throat clearing
• smoky, dusty, or dry atmospheres
• excess caffeine and alcohol as these can have a drying effect
• foods that cause reflux.

The Stuttering Treatment and Research Trust (START) provide specialist assessment and therapy for stuttering. This a paid service but there are supportive funding options available.

For more information, visit the START website:

Stuttering Treatment and Research Trust (external link)

If you are unable to access START or other specialist providers, you may be eligible for public services. Ask your healthcare provider for a referral and a speech-language therapist will be in touch to discuss your situation.

The National Stuttering Association (USA) website provides useful information about stuttering and the therapy process.

Understanding Stuttering — National Stuttering Association (external link)

Dysarthria is a motor speech disorder. This means that there is a change in how your speech muscles move. It can be caused by stroke as well as other neurological disorders such as Parkinson's disease.

Dysarthria may cause a person's speech to sound:

• slurred or distorted
• too fast or slow
• breathy, hoarse, harsh or strained
• too loud or too quiet
• nasal
• laboured or out of breath.

Dysarthria can be very mild, severe or anywhere in between.

Clear speech strategies

If you are having difficulty being understood, you can try these strategies:

• speak slowly
• speak loudly (project your voice using your breathing — don't strain or shout)
• over-pronounce ('over-articulate') your words
• take pauses between words
• take a breath before speaking — speak as soon as you start to exhale.

You can also try the following tips to help you to communicate more easily with others:

• communicate face-to-face
• make sure there is good lighting
• reduce background noise (for example turn down the TV)
• reduce the distance between you and the listener
• get your listener's attention before speaking to them
• have important conversations when you aren't tired and your speech is at its best
• get feedback from someone — ask a friend to be honest with you about whether they could understand
  tell your listener what they should do if they haven't understood you (e.g. 'raise your hand if you need me to repeat something').

Dysphagia is a swallowing disorder which can occur for many reasons.

Some conditions commonly associated with dysphagia are:

• stroke
• intellectual disability
• brain and spinal injuries
• head and neck cancers
• progressive neurological conditions (such as dementia, Parkinson's disease, and motor neurone disease).

Dysphagia can be very mild, severe, or anywhere in between. If you are losing weight unexpectedly or have recurrent chest infections, see your healthcare provider as soon as possible.

A person with dysphagia may experience:

• a feeling of food or drink being stuck in their mouth or throat
• coughing or choking during or after eating or drinking
• a gurgly, wet-sounding voice after eating or drinking
• drooling or coughing on saliva
• difficulty chewing
• food or drink spilling out of the mouth
• weight loss
• chest infections.

Dysphagia can occur without a person knowing, especially in neurological conditions or with nerve damage. In this case, they may not cough or feel anything when food or drink goes down the wrong way.

If your symptoms are mainly to do with your oesophagus (food pipe), this is usually managed by your healthcare provider and the gastroenterology department.

You should expect from speech-language therapy input:

• a thorough assessment, including history of your swallowing difficulties and trials of different food and drinks
• recommended exercises or strategies to improve the comfort and safety of your swallowing
• recommendations to modify the texture of your food or drink
• recommendation to have a more in-depth assessment of your swallowing, such as flexible endoscopic evaluation of swallowing (FEES) or videofluoroscopic swallowing study (VFSS).

Tips for safe swallowing:

• keep your mouth clean, including before and after meals — this reduces the risk of developing a chest infection
• always sit upright whenever eating or drinking, preferably in a chair at a table
• take extra care when tired
• eat and drink slowly — one mouthful at a time
• take small mouthfuls and sips
• avoid distractions — turn off the TV or radio and limit conversation
• if required, have assistance while eating — this may be help with cutting your food up or with bringing food to your mouth.

We require all patients with chronic cough or airway disorders to first have an assessment by an ear, nose and throat or respiratory specialist. Ask your healthcare provider for a referral if required.

Treating chronic cough

If your specialist recommends speech-language input for your chronic cough, treatment will focus on:

• understanding chronic coughing/throat clearing
• identifying triggers and managing these
• implementing strategies to manage your cough
• looking after your voice.

Your specialist may also recommend medical treatment to target triggers such as reflux, asthma or allergies.

Airway disorders

You may also be referred to speech-language therapy for assistance with airway disorders such as paradoxical vocal fold movement (PVFM) — 'vocal cord dysfunction' — and inducible laryngeal obstruction (ILO) — 'laryngospasm' — etc.

Always seek urgent medical help if you are experiencing severe difficulties breathing.

The therapy process is similar to those who experience chronic cough. You can begin practising 'rescue breaths' while awaiting further speech-language therapy input.

Rescue breaths

Rescue breaths is a technique designed to encourage upper airway relaxation to help you breathe. It is important to practice the technique when you have no symptoms so that you are familiar with it. This can then be used in the event of throat tightness and difficulty breathing.

• Keep calm.
• Sit down either with your palms facing upwards in your lap or lean forwards from your hips, resting your elbows in your lap.
• Sniff in — short gentle sniffs in.
  'Gentle' blow out — short gentle blows out with lips rounded and relaxed like blowing bubbles or blowing out a candle.

Start with fast sniffs/blows and slow down gradually over time as your breathing settles.

With practice, you will be able to use this technique in any position, not just when sitting down. You should find your symptoms settle more readily when you have perfected the technique, so practice it often until it becomes familiar to you.

You may choose to have gender affirming services with a speech-language therapist. This can involve working on your voice and overall communication.

Communication coaching can explore the ways that your voice and communication can represent you and how you express yourself in different settings.

The speech-language therapist will also talk to you about vocal health, which is important for anyone using their voice in new ways.

The following are some of the things you may choose to work on with a speech-language therapist:

• pitch — how high or low your voice sounds
• intonation — the rise and fall of pitch in your speech
• resonance — the quality of the sound of your voice
• the rhythm of your speech
• rate — how fast or slowly you speak
• volume — how loudly you speak
• nonverbal communication — such as your body language and facial expressions
• language — the words you use
• pragmatics — the social rules of communication, such as how to adjust your voice for different situations and to express different emotions.

It can take some time to find a voice that you connect with and you feel expresses who you are. A speech-language therapist can help to give you the tools to communicate in a way that feels authentic.

Useful websites

Professional Association for Transgender Health Aotearoa (PATHA) (external link)

Gender Minorities Aotearoa (external link)

World Professional Association for Transgender Health (WPATH) (external link)

You may be eligible for WINZ funding towards private speech-language therapy services. This will not affect your eligibility for publicly funded services. For further information, visit the Gender Minorities website.

Transgender voice therapy — Gender Minorities Aotearoa (external link)