Adult Services : Speech

Motor Speech Disorders

Motor speech disorders can result from stroke, traumatic brain injury, and neurological or neuromuscular disease. A motor speech disorder is characterized by a weakness, slowness and/or incoordination of the oral speech mechanism and can affect a person’s speech, voice, and breath support for communication and swallowing.

The terms dysarthria and apraxia are terms that describe the type of motor speech disorder. The nature and extent of the motor speech disorder will vary depending on the cause. Proper assessment and diagnosis will facilitate effective and efficient treatment.

The Swain Center protocol has been established to provide assessment treatment to patients with motor speech disorders. Following an initial evaluation, treatment recommendations will be discussed and a comprehensive report will be sent to the referring physician. Insurance companies may cover treatment.

Our Treatment Program Includes:

  • An initial evaluation assessing speech, voice, respiratory support and swallowing
  • Intensive therapy program based on evidenced based research
  • Clinically supervised structured supplemental home program
  • Group maintenance program following therapy
  • Collaboration with medical professionals as needed


Accent Reduction

A foreign accent is not considered to be a communication disorder but it can result in being misunderstood and being misunderstood can be frustrating. Every day, many competent and fluent English speakers frustration or misunderstanding because of their accents in spoken English. No matter what the native accent is one’s speech must be understood to be effective! Many professionals who are required to use English on a daily basis benefit from accent modification programs. These professionals may include: physicians, engineers, teachers, computer program specialists, sales professionals and techniology engineers and professionals.

Communication differerences resulting from accented speech can affect one’s personal and professional success. Those with accents, both native and non-native, may experience common communication difficulties related to sound and word pronounciation, grammar, word blending and intonation and stress that is carried over from their native language or dialect.

The Swain Center offers accent modification services by licensed and certified spedch-language pathologists. The accent modification program is designed to reduce the effects of the accent by increasing speech intelligibility up to 90-95%. Very few individuals can completely eliminate their native accent. Success of the accent modificatio program is highly variable and very dependent on home practice.

Our Treatment Program includes:

  • An initial evaluation using Proficiency in Oral English Communication: An Assessment Battery of Accented Oral English
  • Individualized therapy program based on specific needs
  • Services offered in office or webcam
  • Clinically supervised structured supplemental home program
  • Presentation skills improvement


Aphasia is a general term used to describe difficulties often seen after a stroke. It refers to the loss or reduction of communication skills. Generally aphasia is specified as being receptive or receptive aphasia. Receptive aphasia refers to a person’s ability to understand what is being said as well as one’s ability to understand what is read. Expressive aphasia refers to a person’s ability to use language to communicate by speaking or by writing. This is a very general and simplified explanation, and following a stroke or related brain injury, one or more symptoms may be present.

A stroke can affect one or both sides of the brain. The brain is divided into the right and left hemispheres (sides) each of which controls the opposite side of the body. Each hemisphere has specific functions but they also work together. The left hemisphere controls the speech and language areas including understanding, reading, writing, using numbers and recalling words. The right hemisphere controls visual, spatial and perceptual areas reasoning and judgment, behavioral and emotional areas. Behavioral and emotional issues may include impulsiveness or initiation, recognizing one’s limitations, or overall memory.

Our treatment program includes:

  • Evaluation, interpretation, and recommendations by a certified speech-language pathologist
  • Customized treatment programs based on individual concerns
  • Specialized materials, activities and suggestions to improve communication skills
  • Patient/family support groups for coping with communication loss
  • Special rehabilitation software and workbooks for added stimulation and treatment


Parkinson’s Disease

Parkinson Disease is a progressive neurological disease affecting 1.5 million Americans and 8 million individuals worldwide. PD results in motor, sensory and/or neuropsychological disorders that occur in varying degrees with different associated symptoms.

Eighty nine percent of patients with Parkinson Disease will have problems with communication skills affecting speech and voice.. Communication is our most important skills and problems with communication can result in social isolation, low self-esteem, depression and diminished quality of life.

The Swain Center sponsors the Northern California Voice Project for Parkinson Disease to provide treatment for individuals with Parkinson Disease.

The therapy offered by The Swain Center is the only documented efficacious treatment for individuals with Parkinson Disease scientifically documented to restore oral communication beyond what current pharmacological and surgical interventions offer. Evidenced-based statistics indicate that 90% of patients improve vocal loudness from pre to post treatments and approximately 80% maintain treatment improvements for 12-24 months. To view pre and post treatment videos please click here: [videos coming soon]

Our treatment program includes:

  • An initial evaluation assessing speech, voice, and candidacy for therapy
  • Intensive therapy program based on principles of neuroplasticity
  • Computer based support for data analysis and treatment outcomes
  • Clinically supervised structured supplemental home program
  • Group maintenance program following therapy
  • Collaboration with medical professionals as needed


According to the American Speech-Language and Hearing Association (ASHA) (2011) stuttering affects the fluency of speech. It begins during childhood and, in some cases, lasts throughout life. The disorder is characterized by disruptions in the production of speech sounds, also called “disfluencies.” Most people produce brief disfluencies from time to time. For instance, some words are repeated and others are preceded by “um” or “uh.” Disfluencies are not necessarily a problem; however, they can impede communication when a person produces too many of them.

In most cases, stuttering has an impact on at least some daily activities. The specific activities that a person finds challenging to perform vary across individuals. For some people, communication difficulties only happen during specific activities, for example, talking on the telephone or talking before large groups. For most others, however, communication difficulties occur across a number of activities at home, school, or work. Some people may limit their participation in certain activities. Such “participation restrictions” often occur because the person is concerned about how others might react to disfluent speech. Other people may try to hide their disfluent speech from others by rearranging the words in their sentence (circumlocution), pretending to forget what they wanted to say, or declining to speak. Other people may find that they are excluded from participating in certain activities because of stuttering. Clearly, the impact of stuttering on daily life can be affected by how the person and others react to the disorder.

Some ask if stuttering can be hereditary. There is growing evidence that stuttering tends to occur in families who have a history of stuttering in previous generations. Many children demonstrate characteristics of stuttering during early childhood speech and language development. This period of dysfluency can be considered to be “normal” in most children. A large portion of children (75 percent) who begin to stutter at three to five years of age stop stuttering without treatment. The decision to seek treatment for children is based on many factors but if one is observed to have muscle tremors, spasms or anxiety about speech treatment should be considered.

Our treatment program includes:

  • An initial evaluation assessing speech, voice, and candidacy for therapy
  • Intensive therapy program based on evidenced based research
  • Clinically supervised structured supplemental home program
  • Group maintenance program following therapy
  • Collaboration with medical professionals as needed

There are several treatment strategies that have proved very successful. They include stuttering modification and fluency initiating programs.


Swallowing Disorders

Swallowing difficulty, or dysphagia, presents itself in a variety of ways and occurs for a number of reasons. Swallowing disorders are usually related to neurologic disorders or dysfunctions. They may occur after a stroke, traumatic brain injury, neurological diseases, surgery or serious illness.

Swallowing disorders can pose safety and health risks and must be identified and treated. Sometimes a problem with swallowing can go unrecognized or undiagnosed and result in aspiration. Aspiration can occur when food or liquid enters a patient’s airway. This type of event is commonly referred to as food or liquid “going down the wrong pipe.” When this happens pneumonia may result. Additional problems can include choking which can be life threatening. In order to minimize health and safety risks changes in a person’s diet may be recommended.

Our Treatment Program:

  • Evaluation, interpretation and recommendations by a speech-language pathologist
  • Collaboration with physicians and radiology professionals regarding imaging studies
  • Development of an individualized therapy plan to improve swallowing function
  • Implementation of specific swallowing techniques to improve skills (e.g. Masako, Mendelsohn, etc)
  • Use of oral-motor exercises to improve muscle strength to support swallowing rehabilitation
  • Consultation with a dietician for development of an appropriate diet and meal planning

Very often patients with post-surgical dysphagia or swallowing problems after stroke do recover their swallowing ability and return to a normal diet.



“His words are scarcely intelligible…”

James Parkinson, 1817

At least 89% of people with Parkinson’s are at risk of losing their ability to speak and swallow.

Lee Silverman Voice Training (LSVT)— A scientifically documented efficacious program for treating voice and speech disorders in patients with Parkinson’s Disease and other neurological disorders.

Lee Silverman Voice Treatment is the only speech treatment clinically proven to effectively treat the speech and swallowing deficits associated with Parkinson disease. In sixteen individual treatment sessions over four weeks, patients learn to use increased effort when communicating. LSVT improves overall strength, endurance, and coordination of the speech and swallowing mechanism. All treatment is provided by a master’s level speech-language pathologists who are LSVT certified.

Following completion of the four week program each patient enters the maintenance phase of the program and becomes a member of the “LOUD Crowd.” Parkinson’s is a progressive disease and it is necessary to meet the challenge of maintaining the speech and swallowing gains attained from the intensive therapy program. The Loud Crowd provides support, encouragement, and continued care from a certified speech pathologist. Patients who participate in continued voice maintenance have been shown to maintain their improved voices for more than five years.

Speech and Swallowing Screening

  • Do people ask you to repeat?
  • Does your voice sound hoarse, scratchy, or breathy?
  • Does your family say you speak too softly?
  • Does your voice fatigue easily?
  • Does your voice sound strong on some days and weak on others?
  • Do you cough when you eat or drink?
  • Do you experience drooling?

*If you answered “yes” to any of these questions, call to schedule a voice evaluation with The Swain Center 707-575-1468

My Experience With LSVT LOUD —by Anne

Today I completed my 4th week of LSVT LOUD therapy sessions (1 hour a day, 4 days a week) with Michelle Chastain, Speech-Language Pathologist, at The Swain Center in Santa Rosa, CA. Looking back over the journal Michelle had me keep I remember my feelings and concerns during this time.

In the beginning I was given a baseline evaluation. At that time my voice was quite raspy, strained and weak. It was not steady and would fade in and out. Michelle said I have nice, high pitches, but my lower register sounds were much more unsteady and difficult. I had an ‘ah-ha’ moment about the importance of taking a deep breath before speaking, making it easier to project so much better. With each session I have become more aware of how I am sounding and how my throat is feeling. I have been trying to control my breath so that it can help me to project. THINK LOUD is a constant reminder—whether it is from Michelle, the sign on the wall, my own thoughts or the red button that says those words! Since Parkinson’s came into my life (my diagnosis was a year and a half ago) I have felt my speech was not only weak, but also slow and hesitant. Often it was difficult for me to formulate what I was wanting to say. I also felt I had lost some of the expression and animation in my voice. Since being involved with the LSVT therapy I have become much more aware of the concentration it takes to overcome these weak areas. It takes work—and homework!—but it has definitely been worth the effort. I feel so much better about the way I sound and this has boosted my confidence.

I was videotaped at the beginning of the course and again on the last day. The improvement shown is remarkable! My plan is to keep practicing all the things I have learned these past 4 weeks so that my voice will sound strong and confident for a long, long time!


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