Adult Therapy Services
Provided throughout Gainesville, Lake City, and Northeast Florida
• Evaluation and treatment of oropharyngeal swallowing disorders
• Evaluation and treatment of voicing disorders
• Evaluation and treatment of receptive and expressive language disorders
• Patient and family counseling on progressive decline across speech language and swallowing disorders associated with neurological diagnosis and disease
• Tracheostomy management and assessment as correlate to voice and swallow with passy muir valve indications
• Pre-laryngectomy counseling and management of tracheo-esophageal prosthesis
• Evaluation and treatment of lymphedema of head and neck
• Treatment with patient and caregiver training related to cognitive-linguistic disorders
• End of life swallow management and diet modifications • Transgender Voice Therapy-Voice Feminization Therapy •Accent Modification Therapy
Have questions about Speech Therapy, Swallow Therapy, and Evaluations?
- LARYNGEAL COMPLEX
- MUSCLE TENSION DYSPHONIA
- SPEECH THERAPY FOR CANCER PATIENTS
- ACCENT MODIFICATION THERAPY
- TRANSGENDER VOICE THERAPY
The laryngeal complex refers to a variety of structures located in the throat just above the trachea including the epiglottis and vocal cords. The structures in this region are responsible for speech and for preventing food and liquids from entering the lungs when eating. Air must also pass through the laryngeal complex during breathing.
What is dysphagia?
People with dysphagia have difficulty swallowing and may even experience pain while swallowing (odynophagia). Some people may be completely unable to swallow or may have trouble safely swallowing liquids, foods, or saliva. When that happens, eating becomes a challenge. Often, dysphagia makes it difficult to take in enough calories and fluids to nourish the body and can lead to additional serious medical problems.
How do we swallow?
Swallowing is a complex process. Some 50 pairs of muscles and many nerves work to receive food into the mouth, prepare it, and move it from the mouth to the stomach. This happens in three stages. During the first stage, called the oral phase, the tongue collects the food or liquid, making it ready for swallowing.
The tongue and jaw move solid food around in the mouth so it can be chewed. Chewing makes solid food the right size and texture to swallow by mixing the food with saliva. Saliva softens and moistens the food to make swallowing easier. Normally, the only solid we swallow without chewing is in the form of a pill or caplet. Everything else that we swallow is in the form of a liquid, a puree, or a chewed solid.
The second stage begins when the tongue pushes the food or liquid to the back of the mouth. This triggers a swallowing response that passes the food through the pharynx, or throat (see figure). During this phase, called the pharyngeal phase, the larynx (voice box) closes tightly and breathing stops to prevent food or liquid from entering the airway and lungs.
The third stage begins when food or liquid enters the esophagus, the tube that carries food and liquid to the stomach. The passage through the esophagus, called the esophageal phase, usually occurs in about three seconds, depending on the texture or consistency of the food, but can take slightly longer in some cases, such as when swallowing a pill.
How does dysphagia occur?
Dysphagia occurs when there is a problem with the neural control or the structures involved in any part of the swallowing process. Weak tongue or cheek muscles may make it hard to move food around in the mouth for chewing.
A stroke or other nervous system disorder may make it difficult to start the swallowing response, a stimulus that allows food and liquids to move safely through the throat. Another difficulty can occur when weak throat muscles, during or following cancer and surgery, cannot move all of the food toward the stomach. Dysphagia may also result from disorders of the esophagus.
What are some problems caused by dysphagia?
Dysphagia can be serious. Someone who cannot swallow safely may not be able to eat enough of the right foods to stay healthy or maintain an ideal weight.Changes to the muscles controlling the lips, tongue, jaw or within the neck can alter the way food flows through the throat.
Food pieces that are too large for swallowing may enter the throat and block the passage of air. In addition, when foods or liquids enter the airway (also known as aspiration of food), coughing or throat clearing sometimes cannot remove it. Food or liquid that stays in the airway may enter the lungs and allow harmful bacteria to grow, resulting in a lung infection called aspiration pneumonia. Therapy can target respiratory muscle strength training to improve the strength of the cough and decrease the risk of aspiration. Lauren will work to teach and train the patient and family members on the benefits of a home exercise program aimed to improve respiratory drive.
Swallowing disorders may also include the development of a pocket outside the esophagus caused by weakness in the esophageal wall. This abnormal pocket traps some food being swallowed. The esophagus may also be too narrow, causing food to stick. This food may prevent other food or even liquids from entering the stomach. Together, Lauren and the patient may complete an objective swallow evaluation to identify the swallowing disorder and refer to appropriate specialties.
What causes dysphagia?
Dysphagia has many possible causes and happens most frequently in older adults. Any condition that weakens or damages the muscles and nerves used for swallowing may cause dysphagia. For example, people with diseases of the nervous system, such as cerebral palsy or Parkinson’s disease, often have problems swallowing. Additionally, stroke or head injury may weaken or affect the coordination of the swallowing muscles or limit sensation in the mouth and throat.
People born with abnormalities of the swallowing mechanism may not be able to swallow normally. Infants who are born with an opening in the roof of the mouth (cleft palate) are unable to suck properly, which complicates nursing and drinking from a regular baby bottle.
In addition, cancer of the head, neck, or esophagus may cause swallowing problems. Finally, for people with dementia, memory loss and cognitive decline may make it difficult to chew and swallow. There are several strategies and diet modifications that can be utilized to minimize the effects of dysphagia through swallow therapy.
How is dysphagia treated?
There are different treatments for various types of dysphagia. Medical doctors and speech-language pathologists who evaluate and treat swallowing disorders use a variety of tests that allow them to look at the stages of the swallowing process. One test, the Flexible Endoscopic Evaluation of Swallowing with Sensory Testing (FEESST), uses a lighted fiberoptic tube, or endoscope, to view the mouth and throat while examining how the swallowing mechanism responds to such stimuli as a puff of air, food, or liquids.
A videofluoroscopic swallow study (VFSS) or modified barium swallow study is a test in which a clinician takes a videotaped X-ray of the entire swallowing process by having you consume several foods or liquids along with the mineral barium to improve visibility of the digestive tract. Such images help identify where in the swallowing process you are experiencing problems. Speech-language pathologists use this method to explore what changes can be made to offer a safe strategy when swallowing. The changes may be in food texture, size, head and neck posture, or compensatory maneuvers, such as “chin tuck” or head turn, strategies in which you change your postures so that food and other substances do not enter the trachea when swallowing. If you are unable to swallow safely despite rehabilitation strategies, then medical or surgical intervention may be necessary for the short-term as you recover. In progressive conditions such as amyotrophic lateral sclerosis (ALS, or Lou Gehrig’s disease), diet modifications or a feeding tube in the stomach may be necessary for the long-term. Therapy with Lauren will work to train and counsel the patient and family member each step of the way.
For some people, treatment may involve muscle exercises to strengthen weak facial muscles or to improve coordination. For others, treatment may involve learning to eat using strategies. For example, some people may have to eat with their head turned to one side or looking straight ahead. Preparing food in a certain way or avoiding certain foods may help in some situations. For instance, people who cannot swallow thin liquids may need to add special thickeners to their drinks.
For some, however, consuming enough foods and liquids by mouth may be very difficult. These individuals must use other methods to nourish their bodies. Usually this involves a feeding system, such as a feeding tube, that bypasses or supplements the part of the swallowing mechanism that is not working normally. A feeding tube can be removed, it is not a permanent measure. Feeding tubes are a valuable tool to help gain the nutrition/hydration and support when needed. A person can also eat and drink with a feeding tube in place.
What research is being done on dysphagia?
Scientists are conducting research that will improve the ability of physicians and speech-language pathologists to evaluate and treat swallowing disorders. Every aspect of the swallowing process is being studied in people of all ages, including those who do not have dysphagia, to give researchers a better understanding of how normal and disordered processes compare.
Research has also led to new, safe ways to study tongue and throat movements during the swallowing process. These methods will help physicians and speech-language pathologists safely evaluate a patient’s progress during treatment.
Studies of treatment methods are helping scientists discover why some forms of treatment work with some people and not with others. This knowledge will help some people avoid serious lung infections and help others avoid tube feedings. When working with Lauren the therapy is evidence based and supported by research.
Where can I get help?
If you have a sudden or gradual change in your ability to swallow, you should consult with your physician. He or she may refer you to an otolaryngologist—a doctor who specializes in diseases of the ear, nose, throat, head, and neck—and a speech-language pathologist. You may be referred to a neurologist if a stroke or other neurologic disorder is the cause of the swallowing problem.
What is dysarthria?
Dysarthria is a motor speech disorder. It results from impaired movement of the muscles used for speech production, including the lips, tongue, vocal folds, and/or diaphragm. The type and severity of dysarthria depend on which area of the nervous system is affected.
What are some signs or symptoms of dysarthria?
A person with dysarthria may demonstrate the following speech characteristics:
• "Slurred," "choppy," or "mumbled" speech that may be difficult to understand
• Slow rate of speech
• Rapid rate of speech with a "mumbling" quality
• Limited tongue, lip, and jaw movement
• Abnormal pitch and rhythm when speaking
• Changes in voice quality, such as hoarse or breathy voice or speech that sounds "nasal" or "stuffy"
What causes dysarthria?
Dysarthria is caused by damage to the brain. This may occur at birth, as in cerebral palsy or muscular dystrophy, or may occur later in life due to one of many different conditions that involve the nervous system, including
• stroke • brain injury • tumors • Parkinson's disease • Lou Gehrig's disease/amyotrophic lateral sclerosis (ALS) • Huntington's disease • multiple sclerosis
How common is dysarthria?
There are no known data about the incidence of dysarthria in the general population, because of the broad variety of possible causes.
How is dysarthria diagnosed?
A speech-language pathologist (SLP) can evaluate a person with speech difficulties and determine the nature and severity of the problem. The SLP will look at movement of the lips, tongue, and face, as well as breath support for speech and voice quality. The assessment will also include an examination of speech production in a variety of contexts.
What treatment is available for people with dysarthria?
Treatment depends on the cause, type, and severity of the symptoms. An SLP works with the individual to improve communication abilities. Some possible goals of treatment include:
• Slowing the rate of speech
• Improving the breath support so the person can speak more loudly
• Strengthening muscles
• Increasing tongue and lip movement
• Improving speech sound production so that speech is more clear
• Teaching caregivers, family members, and teachers strategies to better communicate with the person with dysarthria
• In severe cases, learning to use alternative means of communication (e.g., simple gestures, alphabet boards, or electronic or computer-based equipment)
How effective are speech-language pathology treatments for dysarthria?
ASHA produced a treatment efficacy summary on dysarthria [PDF] that describes evidence about how well treatment works. This summary is useful not only to individuals with dysarthria and their caregivers but also to insurance companies considering payment for much needed services for dysarthria.
A dysphonia (diss-PHONE-nee-ah) is the medical term for a voice disorder.
Muscle tension dysphonia (MTD) is one of the most common voice disorders. It occurs when the muscles around the larynx (voice box) are so tight during speaking that the voice box does not work efficiently.
MTD is more prevalent among people in the 40- to 50-year-old age group, especially women.
There are two types of MTD:
• Primary MTD — In this type, the muscles in your neck are tense when you use your voice but there is no abnormality in the larynx (voice box)
• Secondary MTD — In this type, there is an abnormality in the voice box that causes you to over-use other muscles to help produce your voice
Muscle tension dysphonia is also referred to as muscle misuse dysphonia.
Causes or Contributing Factors
No one fully understands what causes MTD. It usually begins without warning or explanation. It may be caused by irritants such as an upper respiratory infection, passive smoking, acid reflux or excessive demand placed on your voice. Sometimes, more than one of these factors are present when MTD begins.
Speech therapy services are vital for patients going through chemotherapy and radiation treatment. Lauren Meffen devotes a large part of her practice to working on swallowing, voice restoration, and cognitive rehabilitation of swallowing and voice rehabilitation for cancer patients. From loss of range of motion from radiation, to reconstructive surgery complications, Lauren addresses each patients’ needs skillfully and with dignity.
Many cancer patients notice mental "fogginess" before, during, and after treatment. While the cause of this cloudiness isn’t known, it can happen at any time when you have cancer.It is often referred to as "chemo brain".
These sometimes distressing mental changes are real, not imagined. They might be brief spells, or they might go on for years. "Chemo Brain" sometimes prevents patients from carrying on with their school, work, or social activities, or make it very difficult to do so.
Speech Therapy with Wildflower Voice & Swallow Therapy includes the treatment of “chemo brain" symptoms, including word recall and memory issues that often develop as a result of chemotherapy treatments.
Lauren has had great success with her patient's swallowing rehabilitation outcomes. Call today for your consultation, 352-283-0595.
Accent Modification Therapy: Per American Speech and Hearing Association Guidelines:
Accent modification is an elective service sought by individuals who want to change or modify their speech patterns. Accents are variations in the execution of speech characterized by differences in phonological and/or prosodic features that are perceived as different from any native, standard, regional, or dialectal form of speech (Valles, 2015). Accents are marked by variations in speech-sound production, prosody, rate, and fluency (Celce-Murcia, Brinton, & Goodwin, 1996). These linguistic variations may affect intelligibility; however, one can have a noticeable accent and still be clearly intelligible.
Through diligence and home practice working with a speech language pathologist, there can be changes to the sound of your words and intelligibility of your speech.
Services are often sought by:
Goals of Your SLP (Speech Language Pathologist)
What Can I Expect From Therapy?
Your SLP will work with auditory feedback, recording your voice and teaching strategies to improve the rate, rhythm and sound of syllables, vowels and words. You will be asked to complete weekly home exercises incorporating reading sounds, words and sentences aloud.
It is essential you share with the SLP what are your goals specifically, based on what is the most useful therapy for you.
Insurance companies will not pay for services to change an accent because an accent is not a speech or language disorder. Services are considered a non-medically necessary elective option. Please contact me for a fee schedule of services.
The SLP will treat clients 1-2x per week depending on the patient preference and goals with giving a weekly home exercise program at the end of each session. Home exercises include visual mirror feedback, recording and reading aloud.
Accent modification therapy is an elective service, typically patients are highly motivated and driven to meet specific goals. My mission is to help you meet your articulation goals.
If you have a medical diagnosis related to a language, speech or articulation disorder please share that information with your SLP.
I thank you for the opportunity to work with you.
Voice and Communication Therapy for Transgender People
The goal of voice therapy will be to establish an authentic voice that matches each client’s perception of self. Through dedication, teaching vocal hygiene and working together goals of gender congruent voicing can be reached.
What Can I Expect From Voice Therapy?
The current recommended treatment plan is 1-2x week sessions ranging from 30-45 minutes in length with review and training of home exercises. The role of home exercise program and daily practice is essential in reaching goals. In clinic, you will be given handouts, exercises and education to meet your goals.
Your speech language pathologist will work with pitch, rate, resonance, intonation and pragmatics to obtain an authentic gender congruent voice.
Important to know: current American Speech Hearing and Association guidelines
Most services at this time are not covered by insurance and considered elective. You can investigate if your insurance covers services, I am happy to help guide with procedure codes for you to ask the insurance company. If considering the telepractice option: Please confirm with your insurance this is a covered service (many insurance companies do not cover telepractice).
Offering services in Gainesville, Lake City and Jacksonville.
Partnering with Dr. Noelle Pomeroy
12443 San Jose Blvd #202
Jacksonville, FL 32223
Jacksonville Center for Sexual Health
• John Hopkins Medicine: Patients Guide to Head and Neck Cancer - Christine G. Gourin
• Meeting the Challenges of Oral and Head and Neck Cancer: A Guide for Surivors and Caregivers, Second Edition - Nancy E Leupold
• We have Walked in Your Shoes: A Guide to Living with Oral, Head and Neck Cancer
- Support for People with Oral and Head and Neck Cancer
Support Group Meets:
American Cancer Society
1st & 3rd Tuesday, 5:00-6:00pm
Ackerman Cancer Center
3rd Tuesday, 6:00pm-7:30pm
• Dysphagia Cookbook
• Elaine Achilles
• Easy to Swallow: Easy to Chew Cookbook
• Magic Bullet/Blender
• Use Biotene products (mouthwash + spray)
• Keep with brushing toothpaste/toothbrush x2 daily
• Sage 5210 Advance Oral Moisturizer Spray 27-1/2mL, Spearmint Flavor (online product)
If pain/discomfort: Discuss options with physician
For the Person About to Undergo Chemoradiation (NonOperative) Treatment for Head and Neck Cancer
Can Chemoradiation Affect My Swallowing?
Yes. Swallowing difficulties during treatment and long term are very common following treatments for head and neck cancer. The muscles used during chewing and swallowing often become weak and restricted in movement due to reduced use and development of fibrosis/muscle hardening.
Swallowing/speech evaluation and therapy is very important to limit the severity and prevent permanent swallowing problem. Ongoing therapy and follow-up will focus on improving strength and movement of the muscles of swallowing and normalizing your diet.
How Often Will I See the Speech-Language Pathologist?
You will need ongoing Speech evaluation for the next 3-5 years. We will try to visit in conjunction with other appointments. The protocol is as following:
• First Year - Before treatment for baseline assessment, education and discussion of swallowing plan of care
• Week 2 - Review or modify your exercise program/regimen
• Halfway-through your treatment (approximately week 3 or 4) - Telephone or clinic follow-up as needed during the remainder of your treatment
• Swallowing assessment and development of post-treatment rehabilitation plan approximately 4-6 weeks following completion of chemoradiation
• Return therapy every 6 months or PRN
• Year 2-5: Visits yearly or as needed
Damage to the lymphatic system can result in chronic swelling or lymphedema. During cancer diagnosis and treatment lymph nodes may need to be biopsied or removed. Also, the lymph nodes and lymphatic vessels within the radiation field during radiation therapy may be damaged. If the lymphatic flow in the head and neck is disrupted a buildup of lymphatic fluid may occur and result in swelling within areas of the head, face and neck. Lymphedema can result in limitations in function and impact quality of life. Evaluation and management of head and neck lymphedema is evidence based and combines an in clinic and at home approach.
Language & Respiratory Muscle Resources
• Swallow Exercise 2 - Mendelsohn-Maneuver
• Swallow Exercise 3-Strengthen Tongue and Pharynx
• Swallow Exercise 4-Tongue Base Strengthening
Advanced Training or Certifications and Clinical Expertise
• Head and Neck Lymphedema Evaluation and Management
• Neuromuscular Electrical Stimulation of Swallowing Therapy (AMPcare certified) -comparable to VitalStim
• Myofascial Release of Voice and Swallowing Disorders
• EMST150 (Expiratory Muscle Strength Training)
• ARKJ (Disorders of Trismus) and Jaw related evaluations
• FEES: Fiberendoscopic Swallowing Evaluation
• Stroboscopy Voicing Evaluations
• LIPS: Lindamood Phoneme Sequencing