Speech Language Pathology:
Voice & Swallowing Rehabilitation

Our speech language pathology services diagnose, treat and manage problems with swallowing, speech and cognition that can come from cancer and/or treatment.
 
Led by certified speech language pathologists, services are available for patients who are having difficulty communicating verbally, concentrating and expressing thoughts, or swallowing.

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Speech Language Pathology

Community Cancer Institute
785 Medical Center Drive West
Clovis, California 93611

Monday-Friday
8:30 a.m.-5:00 p.m.


Services and Treatments

Evaluates and provides a plan for addressing cognitive changes caused by a brain tumor or cancer treatments like chemotherapy, hormone therapy and radiation therapy. Treatments can include training to restore attention, memory and executive function.
 

Swallow therapy includes conducting a thorough evaluation and making an individualized rehabilitation plan. We use state-of-the art tools for swallowing analyses including Video Fluroscopic Swallow Study (VFSS) and Fiber-Optic Endoscopic Evaluation of Swallowing (FEES). Rehabilitation plans usually include finding new approaches based on your specific challenges or exercises to stretch and strengthen the muscles used for swallowing.​
 

Videofluroscopic Swallow Study (VFSS)


Your Speech Language Pathologist (SLP) uses this procedure as a baseline measurement for your swallowing prior to starting your cancer treatment. It’s also used about 3 to 4 weeks after treatment, and yearly for maintenance. It provides a direct, dynamic view of your oral, pharyngeal (throat), and upper esophageal (the tube that runs from your throat to your stomach) function during swallowing.
 
This procedure uses food and liquids mixed with Barium to assess your oral prepatory (when food is chewed and mixed with saliva to form a soft consistency), oral transit (when food is moved back through the mouth with a front- to-back squeezing action), pharyngeal, and/or esophageal phases of swallowing. It will also help determine treatment and management strategies to minimize the risk of sucking food into your airway and increasing swallowing efficiency.
 
Radiation safety is important for everyone in the room throughout this procedure. Acceptable levels of radiation exposure are controlled by the radiologist and radiology department.
 

Fiber-Optic Endoscopic Evaluation (FEES) Procedure 


This procedure takes about 15 to 20 minutes and assesses how well you swallow. Preparing for this includes following any special diet you’ve been placed on prior to your visit. Please arrive about 15 minutes before your scheduled appointment. The FEES procedure takes place on the first floor of Community Cancer Institute in the Radiation department.
 
There are two basic parts to this exam. Part one views the way you swallow and manage your own saliva, and part two views the way you swallow different textures of foods and liquids. The FEES procedure uses a thin, flexible instrument called an endoscope. During the procedure you’ll be seated and awake. Your SLP lubricates the endoscope with jelly so it comfortably passes through your nose and down your throat. You may feel some discomfort.
 
The endocscope lets your Speech Language Pathologist (SLP) see parts of your Larynx (voice box), Pharynx (throat), and Trachea (windpipe) on a video screen as you swallow. Once the endoscope is in the correct position, your SLP will have you complete a few verbal tasks and movements.
 
Next, food and liquid will be introduced. Food coloring is used to contrast the food and liquids from the rest of your throat. Your SLP may also ask you to try different positions or textures to fully evaluate your throat and swallowing function. This procedure can also be used as a therapy to provide feedback to you while you try to eat different foods.
 
Once the procedure is complete, the scope will be quickly removed. Risks of this procedure include nosebleed, discomfort, gagging, vomiting, brief closure of airway, and aspiration (usually only a small amount). Your SLP will work to minimize these risks.
 
After your procedure, your SLP will review the results with you and place you on an appropriate diet.
 
For patients with head and neck cancer, we offer head and neck rehabilitation services like Swallowing Preservation and Rehabilitation Exercises (SPARE) – an exercise program unique to our program – and an intensive swallowing rehabilitation program called Swallow Boot Camp.
 
We also team up with physical therapy and nutrition services to treat radiation-induced difficulties such as head and neck lymphedema (swelling that occurs in an arm or leg), Trismus (lockjaw), Dysgeusia (a distortion of the sense of taste), Xerostomia (dry mouth from reduced or absent saliva flow) and restoration of oral nutrition.
  • IDDSI Handouts
  • Oral Care
  • Swallowing Examinations
Vocal restoration for Laryngectomy (surgical removal of the part of your throat that houses your vocal cords) includes rehabilitation before and after surgery, counseling, and communication including using an Electrolarynx (small medical device used to produce clearer speech), esophageal speech, and trancheoesophageal speech.

We also provide services to those who need voice prosthesis (an artificial device used with voice therapy to help patients speak) changes.
Evaluates and restores function lost due to disorders like Dysarthria (speech disorder caused by muscle weakness) and Aphasia (loss of ability to understand or express speech) which can be caused by brain tumors.

Some patients may also get a language assessment before surgery that can be used to minimize language disruption during brain surgery. Services also include speech assessment and therapy for those who have received oromaxillaryfacial surgery (surgery of the face, mouth, and jaws) or reconstruction.
We analyze your vocal cord function and voice production using exercises, biofeedback (technique to learn to control body functions) techniques and devices to strengthen your vocal cords and support your breathing. We also use Laryngeal Videostroboscopy, a technology that provides a slow motion view of the vocal cords to assess your vocal cord function.
 
Treating voice disorders includes both direct and indirect approaches. Direct approaches include manipulating the voice-producing mechanism, such as phonation (the production of speech), respiration, and musculoskeletal (affecting the muscles, bones, and joints) function to establish healthy voice production. Indirect approaches include both patient education and counseling to modify cognitive, behavioral, psychological and physical environments in which voicing occurs.