Social Enough?

When you listen to the term “Speech Therapy/Speech-Language Pathology”, a few things instantly strike you such as getting clear speech, better voice or fluency or for those who start talking late. However, an aspect that may slip off our mind is the ability to use language socially (known as pragmatics).

There is a chance that even though children may appear to be very talkative and have good knowledge about the world and are intelligent, if their thoughts are not organised then what is the use or they simply do not understand the application, i.e., use of the vocabulary and sentence knowledge they have. This difficulty can also appear in adults after a brain injury or a stroke.

There are a lot of aspects that are considered as a part of Pragmatic Language Skills. Following are some of the skills that are listed below –

  • Understanding and use of greetings – hello, goodbye)
  • Changing the tone of the sentence in terms of a request, demand, passing on information or making a promise.
  • Changing language rules according to the setting and age – We cannot speak everything to everyone. There is a way we speak at school with our teachers, our parents at home, and our friends. We cannot speak to an adult like a five year old kid or vice-versa.
  • At times,  we have to give some additional information depending on the listener so that he/she understands the context of the conversation.
  • When we meet a person for the first time, we do not give out all our information to them or anyone. You cannot simply talk because you have to talk. It is essential that we keep these aspects in mind.
  • To initiate a conversation depending on the environment (people and location).
  • To maintain the ongoing topic of conversation.
  • To take turns and speak in an on-going conversation.
  • To understand the facial and body language (non-verbal cues) of the listener (the person listening to the story/conversation). An example would be, if the speaker is speaking at an extremely fast or it is boring for the listener, the listener may just not maintain eye contact with the speaker. He may look here and there and one must be able to grasp this.
  • To maintain basic emotions while speaking. Example – to laugh when someone has died would be considered inappropriate.
  • How loud and soft should the voice of the speaker be while talking.
  • To be able to make oneself understood to the speaker.
  • To ask for clarifications when speaker is not understood.
  • To narrate a story in a coherent manner.

These are a few basic listed. These minute details have a significant impact in how we conduct ourselves. Think about it! 🙂

Until next time!


The 5 Strokes of Communication!

Hello Reader,

It has been a while since I’ve shared some information from my end and my sincere apologies for not staying in touch. For January, I have chosen the topic – stroke and its relation with Speech-Language Pathology.

Often people get confused between a heart attack and a stroke. Well, before we go into the depth, let’s filter out the two terminologies.

A heart attack is caused due to a blockage in the blood flow to the heart and a stroke is caused when the blood vessels in the brain burst and cut off the blood supply and oxygen in that part of the brain and can have an impact on speech, language and swallowing.

A thought that could follow the above terms – how are stroke and Speech-Language Pathology related? The human brain is extremely organized. It is divided into parts called hemispheres (right and left) and each area of the brain has a set of functions that it carries out. It sends signals to the organ to carry out a movement (motor signals) and also receives a signal (sensory signals). For example, when a pin is pricked on one’s arm, the prick is the sensory signal that travels to the brain. The brain helps us determine the location, that is, the pin was pricked on the arm in this case. An example of a motor signal would be – when one wants to lick an ice-cream, a signal is generated in the brain and carried to the tongue, then the tongue will initiate the movement of licking.

Similarly, the brain has areas designated for understanding spoken language, written language and for expressing language either verbally or non verbally. The left side of the brain is said to be more dominant for verbal language.

A stroke can occur in either side of the brain.  Following are some basics of the disorders and common effects of stroke in adults:

Aphasia – affects the person’s ability to comprehend and/or express verbal and written language. Aphasia has various sub-types – some people have more difficulty in understanding language, some in speaking and some in both formats. The type of aphasia depends on the location of stroke in the language areas of the brain. Auditory understanding, naming, repetition of sentences, spontaneous speech, math, visuospatial skills are affected. Degree varies from person to person. Aphasia can also be caused by tumors, head injuries, etc.

Dysarthria – affects the person’s speech clarity, i.e., speech intelligibility. The speech can be slurred, nasal, fast rate of speech, and not have a varied pattern of tone (monotonous). This is mainly due to weakness in the speech muscles.Along with stroke, tumors, any degenerative neurological disease (Parkinsonism, Alzheimer’s, ALS), brain injuries are a few causes of dysarthria.

Right Hemisphere Damage – if a stroke causes damage to this area of the brain, language skills like understanding humor and metaphors, attention, memory, orientation (self or place), problem solving skills, reasoning, emotions, neglecting anything written or on the left side, speaking out of context and reacting inappropriately in situations (laughing in a serious matter).

Apraxia – This is a type of speech disorder in which the person cannot say something he/she wishes to, in spite of no weakness in the speech muscles. The message programmed in the brain cannot be executed by the articulators (mouth). It can occur along with aphasia and dysarthria. Inability to repeat sentences and words, and better use of automatic speech (days of the week, months of the year, greetings, etc.) are few of the common speech difficulties observed.

Dysphagia – The difficulty, incoordination and/or deficits of the structures and the movements of the mouth and throat essential for swallowing food.

Besides stroke, there are other causes of the above mentioned disorders. If you know anyone around you who has speech-swallowing-language impediments,  do not hesitate to consult a Speech-Language Pathologist. In stroke patients, recovery depends on when was the damage done and the onset of therapy. Like said, the first 6 months post stroke with therapy often leads to better outcomes than later.

Stay tuned. 🙂


We do come across children who have difficulty in saying particular speech sounds or “totla” as we say in India. Some may show difficulty in blends (two consonants that come together, example: Straw), some show difficulty in sounds like “p” in “Parrot” and others may have more difficulties.

When a child is growing, he/she is discovering the movements of the speech musculature for articulation (known as articulators). Over a period of time the articulators are able to articulate speech sounds that are easy (p, b, m, n) and gradually moving on to tougher sounds (r, l, s). Studies have shown that speech sounds are usually developing and a child acquires all of the speech sounds around the age of 5 to 6 years. Some studies have also shown that some children acquire these sounds in the form of blends by the age of 8.

The term ‘misarticulations’ means that a person cannot say speech sound(s) correctly. These errors can be noticed in various levels of speech. (Single Word, phrases, while reading, conversation, etc.) and at different position of the sound (for example: parrot, compulsory and top. The highlighted ‘p’ refers to the initial, medial and final position of the sounds). Each sound has a typical character.

There are 8 reasons as to why a child may be facing a difficulty in articulation:

1. Rate of Speech:

The faster you speak; the clarity of speech deteriorates. This is simply because we give less time for our articulators to complete their movements in order for a sound to be said correctly. This leads to reduced mouth opening for speech and it constraints the movements of the articulators. Some children, or even adults have a fast rate of speech. This is one of the reasons why the person tends to misarticulate. This can also be seen in children who have Attention Deficit Hyperactivity Disorders. Even adults, who wish to have better speech while giving lectures, conducting a meeting, or speaking in general should keep this in mind.

2. Ankyloglossia:

Commonly known as “Tongue-tie”. Many people assume that because the child has a tongue tie or the tongue is stuck to the floor of the month, he or she cannot speak. This does not hold true. Not everyone who has limited tongue movements cannot speak. There are people with tongue ties who can articulate perfectly without the need of an operation. Only if the person has difficulty in swallowing or speech is affected at a severe level, a consideration can be made to release the tie.

3. Hearing Loss:

Yes, you read that correctly. The speech sounds that are used in speaking spread across a frequency. Frequency refers to the number of cycles per second. Each sound is made up of different frequencies, thereby spreading across from rambling sounds (low frequency) to sizzling sounds (high frequency). If a child has an ear infection right from an early age, it can affect the sounds in the low frequency (m, n, v, g). Sometimes, a minimal to mild loss in the high frequency can also go unnoticed resulting in misarticulations for sounds in the high frequency (s, f, th). A golden rule to be remembered, if he cannot hear the sound, how do we expect him to say it with ease?

4. Sensory Issues:

There are cases when the child has no hearing loss, no tongue tie, no weakness in the articulators, nothing evident. These children simply have difficulty in understanding the difference between a letter and the sound corresponding to them (for example the alphabet B has the sound of ब). In such cases, intensive therapy will be required for the child to understand the difference between letters and sounds, to distinguish among speech sounds, understand the correct placement of the articulator for a sound and to then articulate them correctly


5. Dentition:

As a child is growing up, his/her milk teeth start to get replaced by permanent teeth. This sometimes leads to misarticulations which is simply caused due to the lack of teeth present for saying a particular sound. The child will be knowing the exact placement of the articulator and has an idea that he is saying it incorrectly. The absence of the tooth/teeth in a particular area leads to less pressure required for the articulators to articulate.

6. Weak Musculature:

Children who have weak movements of the tongue, soft palate, cannot puff their cheeks, etc., have difficulty in articulation. Those with Cleft-Lip and Palate, Cerebral Palsy, or sometimes have no known cause need exercises to develop strength in the muscles. Increased range of movements lead to more flexibility of the sounds.

7. By Imitation:

Yes, some children pick up speech from persons who are misarticulating themselves. The child could probably not be knowing the difference between what is correct and what is incorrect. These errors can be easily rectified.

8. Delayed Development:

It does not always happen that child is delayed in his language development will have a difficulty in articulating. But there are instances that with a delay in language leads to a delay in his clarity of speech. With appropriate training, the misarticulations can be resolved.

Some errors disappear with time; however, some stay and do not fade with time. If they persist, then consult a speech-language pathologist at the earliest. With correct guidance, you will be able to overcome your difficulty and have a CLEAR SPEECH!

Until next time.:)


10 Steps to Good Vocals

Here come the concerts and the festive season and brings with it joy and what is the most obvious way of expressing ecstasy? Yes, you want to scream and shout and let it all out! Following which, waking up, you might feel a slight change in your voice or pain in your throat. Misuse and/or abuse of voice does not only arise during festivals and concerts, but also during various other situations (Talking constantly, Screaming and Shouting, Singing Incorrectly). I recently attended a concert. With one of my favorite artists around, it was hard to not sing out his songs at the top of my voice. This culminated in slight hoarseness in my voice.

There are certain basic techniques with which we can feel better about our voice and experience lesser pain. A lot of professionals like teachers, journalists, singers, politicians, sales executives rely majorly on their voice for their income. Sometimes, it can occur in persons who are garrulous, people who use their voice incorrectly and also not take care of their vocal hygiene.

So how should we maintain Good Vocals? Here’s a few tips to take care of your voice!


  1. Avoid speaking in loud environments:

The environment around us can get really noisy at times. While communicating with persons next to us or even at a foot’s distance in such scenarios, we tend to elevate the loudness of our voice in order to make ourselves audible. This leads to adding more pressure on our vocal cords (voice box), by straining them.

  1. Avoid speaking to huge crowds without aids:

While addressing larger crowds or in a situation where we have to be heard by a huge group of persons, we should use an aid that’ll help us speak with less strain. Use of mics is one good solution. If a teacher is teaching in a class and the class is widespread, he/she can get the class closer to her, thereby, reducing the distance that has to be covered.

  1. Avoid Excessive Coughing & Throat Clearing.

Your Vocal Cords are muscles, after all. Throat clearing and coughing are both nonspeaking activities. When we clear our throats, our vocal cords rub against each other. It can result in traumatic injury to the cords. This frequent rubbing of the vocal cords can lead to a lesion making it tougher for maintaining a good vocal hygiene. Some patients have developed the habit of frequent coughing and throat clearing, despite the fact that they don’t have a need to.

  1. Avoid Polluted Environments:

When we breathe polluted air very frequently, it acts as an irritant to the throat and is harmful to the vocal folds. Extensive combined effects of the pollutants with other behavior can change the tissues of the larynx. This can lead to a difference to our voice by worsening the quality.

  1. Avoid eating Oily foods and Spicy Foods:

Oily and spicy foods can result in an acid reflux. Acid reflux is the backward flow of acid and digestive enzymes from the stomach to the food passage, throat and voice box. The throat and voice box are not well protected from these digestive enzymes. This can harm the larynx

  1. Alcohol, Smoking and Tobacco Consumption:

Even though it is a nonspeaking activity, Cigarette Smoking and Chronic Alcohol Abuse are harmful for our vocal cords. They act as irritants Extensive changes can be seen in the tissue of our voice folds that leads to a poor voice quality. If one continues smoking for very long, it can also lead to cancer. Alcohol has a drying effect on the larynx.

  1. Avoid Picking up Heavy Objects:

When we go to lift a heavy object, one normally tends to add pressure on our voice box as well. This is because the vocal cords close and they’re made extremely tight and one also makes a grunting sound or simply screams out an “aa”. This rubs the vocal cords and worsens it, thereby.

  1. Voice Rest:

Voice Rest is absolutely essential when you’re experiencing pain, lethargy in your voice. The simple aspects of voice rest help one recover tremendously. Avoid screaming, shouting, laughing out loud, whispering, talking for long periods, humming, and singing songs. Speak for short durations and have long intervals.

  1. Consume Lots of Water:

If you feel that your throat becomes dry very frequently, then have a few sips of water on regular intervals. This will have a lubricating effect. If you have to speak for long durations like giving a lecture, then have small sips of water frequently. Consume at least 1.5-2 liters of water daily.

  1. Balanced use of Voice:

If you’re feeling ill and tired, make sure that you rest your voice along with a full body rest. If you have an occasion coming up where you have to maximize your voice and speak, then minimalize the use of your voice before the occasion. Vocal cords are reddened and swollen due to an infection like common cold, tonsillitis, etc., avoid speaking for longer durations or harming them further by indulging in any abusive activities. The cords get sensitive and any minute damage can have extensive effects on it.


Like how we break our legs and our doctor’s address us to take some bed rest. Similarly, for our voices, we need to rest them out so that we can recover and step back into our game.



Breaking Barriers


Imagine yourself, waking up not knowing what to do next, or having no idea with respect to your daily routine. Going to the same place repeatedly without knowing why you went there. Losing track of time, day, month, people, seasons and, situations. Living a fragmented life where someone or you, feel aimless or directionless. Having tough time in performing activities of daily living as simple as bathing. Finding it difficult to take part in conversing with friends and family or carrying out an array of tasks!  Unable to make simple decisions or finding it difficult to get back home without any cues, every single time. Forgetting your near and dear ones, forgetting important things related to them. Forgetting their birthday. Forgetting your own birthday.

Well put together, we cannot even imagine what a person with Alzheimer’s Disease goes through.


So what is Alzheimers Disease?

Alzheimer’s Disease is one where the condition of the individual deteriorates over time, destroying the memory and overall mental functions.

Dementia is referred to as a group of conditions characterized by of at least two brain functions. Various psychological, behavioral, cognitive, muscular, mood differences, difficulty in self-care, loss of motivation, etc. Alzheimer’s Disease is the most common cause of Dementia (approximately 70%).

It is a progressive neurological disorder, i.e., the condition worsens over time affecting the brain cells.  Over a period of time, the brain shrinks and appears much smaller than the normal human brain. This can be viewed on MRI, PET and CT Scans. Adults over 60-65 years of age are affected with this.



Often seen signs are:

  • Difficulty in memory and recalling recent events that have happened
  • Difficulty in concentrating and planning a task
  • Unable to make decisions
  • Difficulty in recollecting the correct word
  • Difficulty in making a judgement where one needs to use Visuo-Spatial skills. Example: Activities like the distance between two steps or climbing up and down the stairs
  • Not knowing where they are.
  • Losing track of the day, time, month, year.
  • Difficulty in holding conversations.
  • Forgetting a familiar travel path.



Speech-Language Pathologist and Alzheimers Disease

Populations that suffer from Alzheimer’s often face language, speech, and swallowing difficulties.

Communication difficulties like trouble in recalling a word, beating around the bush as one cannot remember the word (known as circumlocution), difficulty in understanding complex ideas, humor, sarcasm, asking for repetitions, subtle memory difficulty, etc., are seen in the early stages. As the condition worsens, the person may have difficulty in maintaining his conversational topic, forgetting the topic, repeating the same idea over and over again, reduced vocabulary, making grammatical errors in sentences, not realizing one’s mistakes are. In the final scenarios, the language is very guarded, difficulty in maintaining eye contact, reduced understanding of language, absence of speech, fragmented sentences can be seen.

Eventually the person’s mobility is restricted, severe behavioural changes ranging from extreme anger or violence are also seen. These patients also require constant care from the caretakers in the simplest of tasks. They can also be sent to Day-care centers, or in different homes available for these persons as the care takers also have a difficult time in managing persons with Alzheimer’s.

Various tests and examinations are done to know the status of the degree of difficulty in communication.

There is no curable treatment for Alzheimer’s disease. As a professional of communication disorders, we work towards providing as effective communication as possible for the longest period. Balance of mental, spiritual, physical, cognitive health, social relations, financial and legal management is essential.  Quality of life and health care is an important key in helping these people cope with day to day activities better.

Giving them simple tasks, involving them in conversations, keeping a fixed routine for the person, outlining a schedule for them, labeling things, making sure that there is enough nutritional intake, giving a list of important contacts with photographs of the person , exercising various word and memory games, etc., can provide a good stimulation.

These exercises can help a person cope better with the disease. Exercising on the Speech, Language, and Swallowing aspects can also sometimes help in slowing down the progression of the disease. However, it does not stop the progression of the disease. Motivation of the care takers, family members and the person themselves also plays an important role in the overall management. Family and Care takers are equally important team members of persons suffering with Alzheimer’s Disease.

The Alzheimer’s and Related Disorders Society of India (ARSDI) is one of the main resources for dementia caregivers in India and is located in many metros in the country. Dignity Foundation also provides with Dementia Day Care Centers in Mumbai and Chennai.  For further details, visit

You may fret as to what is wrong with the person, spouse, parent, grandparent or  friend. You may also find it difficult to cope up with the individual.Sometimes you may not be able to share a difficulty you’re going through. There is degeneration of the neurons (brain cells) which affects the ability to comprehend emotions, making prudent judgements, etc, making it difficult to follow or fail to understand the emotion behind it. You can hold their hand and make them go through the tough times with more ease.

Results vary from person to person but we could use a little hope and turn the skies a bit blue for them.



Signing off for now.:)



References for images:





One Word At A Time.

Everyone strives for perfection. What does one do when we need to take a few steps extra to achieve our goal? We live in a society  where having any kind of difficulty is till date, taken as a burden by the parents and caretakers. From not being able to tie shoe laces, to facing difficulties in communication. Several assumptions like- The child will talk eventually and learn everything by him/herself or, pressurising the child to excel when the he/she may have difficulty in keeping up to expectations. Worried about how the society will react to it, take it as a in-built problem in the family gene(s). The child may have no difficulty as such but not being talked to as a kid and left by him/herself may lead to speaking late and less. He/She can simply pick up a method of talking from a person who has a difficulty. Not only children, even adults and elderly who sometimes have trouble hearing do not accept the problem and difficulties they face. They’re often scared to go and ask for help. An adult may start to sound hoarse and ignore the same, thinking that it is no big deal or someone who starts coughing often when he or she swallows food/liquids.  Often thought by people is that if it physically does not appear to be a problem, then why to go for a consultation or then they may get scared for the commitment that will be required.

Who is an “Audiologist and Speech-Language Pathologist” ? Many individuals around me would answer this question by saying “Arey jo gunga behera hota hai, unka doctor” or “The one who sells hearing aids.”  Probably some people would answer it by saying, ” Arey who jo hakla ke bolta hai, bacho ke liye”.

Is this the only job of an Audiologist and Speech-Language Pathologist?

No, this is neither a misnomer nor completely correct. It is incomplete information that is perceived by many people. An ASLP not only diagnoses and provides therapy required but also plays an important role in terms of preventing and educating persons with Speech, Language, Hearing and Swallowing disorders. Next part would be, what are these Speech, language, hearing and swallowing disorders? Following them would be about the population involved and the different lines of disorders that the professional deals with.

In terms of populations, the ASLP deals with all populations, right from newborns to infants, school going children and adolescents, adults and elderly.That’s quite a huge population, isn’t it? In terms of disorders for diagnosis and therapy, there are many that are covered by the professional, as listed below:

  • Identification of Hearing Loss and providing appropriate management for improved hearing.
  • Detection of hearing loss in newborns, i.e., screening.
  • Integrating listening skills in infants and children who have been fitted with an appropriate aid for hearing, facilitating Aural-Oral Speech (Listen and Speak).
  • To reinstate hearing and listening skills for children and adults who have acquired a hearing loss.
  • Delayed Speech and Language Development.
  • Articulation Disorders.
  • Voice Disorders
  • Fluency Disorders (Stuttering and Cluttering)
  • Pragmatic Language Disorders
  • Speech and Language Disorders as a result of brain damage.
  • Swallowing Disorders

A commonly used idiom “Ignorance is a bliss”, is not always a bliss. A sign or symptom that instigates the probability of a difficulty coming up in terms of speech, language, hearing and swallowing should be marked upon immediately.

We wouldn’t label the person as one who has a disease; probably a person who has a difficulty which can be over-comed or maximised in the most effective way possible. A Professional dealing with communication disorders is not a teacher, but someone who can help you communicate better.

Like Yehuda Berg said, ” Words are singularly the most powerful force available to humanity. We can use to choose this force constructively with words of encouragement, or destructively using words of despair. Words have energy and power with the ability to help, to heal, to hinder, to hurt, to harm, to humiliate and to humble.”


Stay tuned for the next post. 🙂