Karen Levin, Ph.D Speech Therapist, Johannesburg

Traumatic brain injury is defined as damage to the brain due to a traumatic blow to the head. Sometimes the skull is penetrated and sometimes the injury is a closed head injury. On this page you will find detailed notes about the different injuries to the brain and the different effects of these injuries, as well as information about the patterns of recovery from brain injury. I also describe some of the approaches that we take in speech therapy with people who have sustained a traumatic brain injury.

Cerebral palsy is caused by damage to an immature brain, and so the neurological control of movement and posture is impaired. Children and adults with cerebral palsy experience a wide range of communication as well as feeding and swallowing problems.  On this page you will read about the nature of CP, the different classifications of CP, and the communication impairments related to CP.

Many children do not learn language like their peers. Language delays may or may not be associated with other problems such as learning problems, intellectual disability, ASD, hearing loss and so on. This page describes what a language impairment is, and how to recognize it. 

Speech therapists work with children who are risk of communication  impairments from the day that they are born. It is never too early to consult a speech therapist. On this page, I describe very early development and signs that indicate that a speech therapy assessment may be called for.

Some children talk later than others. But when should one be concerned? This page describes late talkers and provides guidance about when one should seek the assistance of a speech therapist.

All children learn to say the sounds of their language over time. On this page, you will read about when it is expected for children to learn their sounds, and how to identify lisps, and sound errors such as "tat" for "cat", "doze" for "those" and "lellow" for "yellow". I provide guidelines on when to consult a speech therapist about a child's speech development.

Auditory processing disorders involve the reduced ability to manage to listen to, process, and use information that is heard.  There are many approaches to assessing and managing these difficulties. They include, but are not the same as, phonological processing disorders. 

Phonological processing is what the brain does with various sounds to make sense of what we are hearing. It involves phonological awareness, phonological memory, and rapid naming mainly. How do you know that cat=c+a+t? How do you know that sister = sis+ter? Your brain works it out. The ability to process phonology is crucial for learning language and also for learning to read and spell. 

Alternative and/or Augmentative Communication (AAC) is the term that we use to describe ways in which we supplement ('augment') or replace ('alternative') the ways in which a person conveys meaning if he or she has difficulty with transferring ideas in typical oral speech and/or language. We also use AAC to help children to learn language and literacy.

 This page provides a description of communication through the lifespan. Speech therapists work with newborns, babies, toddlers, very young children, children, adolescents, young adults, adults, senior adults, and ageing adults whenever communication with others is impaired. 

Ear infections can lead to a hearing loss. The hearing loss can be mild or it can be more severe. It is also inconsistent, and it affects different frequencies differently. Children who have many ear infections are at risk of problems with their speech and language development. On this page, I provide information about ear infections and the importance of intervening when speech and/or language are not developing as they should.

Hearing impairments result in communication difficulties. Some people have difficulties with speech and/or language development or conservation. Some have difficulties participating in the communicative world. This page describes what the role of speech therapists is with people with hearing impairments, and offers suggestions to individuals and their families.

Many clients require a diagnosis... a word that describes "what is wrong"; other clients avoid diagnosis. Some clients have been given conflicting diagnoses. Diagnoses can be heartbreaking.  My philosophy to diagnosis is described here.

Speech therapists work as part of a multi disciplinary team to identify, assess, treat and prevent dysphagia. We use a variety of strategies to help individuals (new born babies, babies, toddlers, children, adolescents and adults) to eat and swallow safely and efficiently. On this page, I discuss the causes of dysphagia, signs and symptoms of dysphagia, the various procedures used to evaluate dysphagia, and the role of the speech therapist in dysphagia management.

Speech involves the flow of air from the lungs, creating voice with that air, directing it to the mouth or nose, creating consonants and vowels, and providing it with rhythm, coordination and speed.

Speech therapists deal with the speech, language and feeding issues that arise from head and neck cancer and complications of surgery, chemo and radiation. This page provides some relevant information as well as links to other pages, to better inform our clients and answer some of their questions.

CAS is a complex speech disorder. We think that the problem lies in the programming and planning of speech movements. There are a number of characteristics of CAS such as inconsistent errors, all kinds of problems with the production of vowels, unusual and sometimes idiosyncratic production of sounds, intelligibility, and sometimes groping for sounds. CAS is often associated with other issues such as language impairments and motor problems.  This page provides  information about this complex problem.

Blind children sometimes have difficulty developing speech and language skills. In addition, blind people negotiate the world using their communication skills and so it is thought that young blind children benefit from precocious language development. In addition, many blind children also experience speech and language difficulties as well as auditory impairments. Very little has been published on how speech therapists can work with blind children. This page describes what we do to enhance the communication skills of blind children.

Oral motor therapy is a most controversial aspect of speech therapy. The published literature to date shows very little evidence that this type of therapy is effective, but clinically we have evidence that it works. However, it has to be done (1) well and (2) to suit each individual (3) to match the type of difficulty the client has and (4)  be directly linked to speech production. This page describes what it is, and warnings about when it is the wrong thing to do.

Voice is produced by the larynx, otherwise known as the voice box. The larynx is a complex structure that sits at the top of the trachea. Air flows through it , and muscles create a tight space in which the air is made to vibrate which makes the sound audible. On this page, I describe some of the things that can lead to voice problems such as vocal nodules, voice abuse, laryngeal cancer, and puberty changes. Some people with sexual orientation issues are able to change their voices to better match their self perceptions and gender preferences.

A diagnosis of autism spectrum disorder is made when individuals have social communication difficulties as well as repetitive, stereotypical behaviours. Speech therapists play a very important role in the lives of people with ASD. 

Many speech therapists work in schools in South Africa. They can be employed by a school, or can run an independent private practice in the school. This page informs the public about what the obligations are with regard to attending speech therapy with the speech therapist/s who work at your school.