The JFK Johnson Rehabilitation Institute (JRI) in central New Jersey offers a range of specialized speech/language services in areas including: 

• Voice disorders
• Stroke
• Dysphagia/swallowing
• Modified barium swallow
• Head and neck cancer
• Adolescent language disorders

Voice Disorders

JRI's Voice Center in Edison, NJ provides evaluation and treatment of patients with hoarseness, vocal cord paralysis and vocal abuse. Adults may have hoarseness or voice changes due to: 

• Vocal cord nodules or polyps
• Voice abuse
• Muscle tension dysphonia
• Smoking
• Vocal cord dysfunction/paralysis
• Cancer
• Stroke
• Neurological disorders (MS, ALS, Parkinson's disease, head injury)
• Open heart surgery

Patients experiencing hoarseness with or without any of the above medical diagnoses, should schedule an appointment with an otolaryngologist (ear, nose and throat doctor). The physician may then refer the patient for a voice evaluation with a speech language pathologist at JRI.

The speech pathologist will evaluate the patient's voice using a Digital Videostroboscopy System to assess vocal quality, pitch and loudness. A detailed case history will be obtained to determine any vocal abuses that may affect the voice. A brief period of voice rest may have already been recommended. An individualized voice treatment program will be designed to improve the patient's vocal quality to its maximum potential. Videostroboscopy is utilized to visualize the vocal cords. A baseline evaluation and periodic reassessments allow each patient to visualize his or her progress.

Lee Silverman Voice Treatment is also offered as a specialized, certified therapy program.

Stroke

Have you or someone you know had a stroke? JRI provides intensive rehabilitation to individuals in the NJ/NY area who have suffered a stroke. If you or someone you know suffers from any of these problems following a stroke, our staff can develop a customized therapy program. 

Common deficit areas that can occur as a result of a stroke include:

Aphasia

• Difficulty understanding verbal and written information
• Difficulty expressing wants, needs, and ideas verbally and/or graphically
• Difficulty finding the words for common items ("It's on the tip of my tongue")

Apraxia

• Difficulty formulating sounds and words in an appropriate sequence

Dysarthia (Slurred Speech)

• Difficulty in pronouncing sounds and words clearly
• May experience weakness in the mouth or have a facial droop

Cognitive Deficits

• Difficulty remembering recent events
• Difficulty organizing thoughts or sequencing ideas and tasks
• Difficulty in processing information
• Difficulty in reasoning out problems or abstract ideas

Dysphagia

• Difficulty swallowing food or liquid
• Coughing or choking during meals
• Difficulty chewing food; food gets stuck inside the mouth
• Frequent bouts of pneumonia or other respiratory problems
• Sudden weight loss
• Poor secretion management or drooling
• Pocketing food in the oral cavity with difficulty dislodging it
• "Globus" or feeling like something is "stuck" in your throat
• If you or someone you know is experiencing any of the above symptoms, inform your physician, who will refer you for a "Dysphagia Evaluation." A speech/language pathologist will take a detailed case history, assess your mouth and throat movements and ask you to swallow a variety of solid foods and liquids

JRI is home to a regional NJ swallowing center with an interdisciplinary approach to assessment and treatment. This approach includes assistance from a variety of specialties, including radiology, nursing, dietary, physical therapy and other services as needed.

Once the evaluation is complete, specific therapeutic intervention may be recommended, including electromyography (EMG) for visual feedback to increase muscle movement and focus on the "feeling" of the correct swallow. EMG therapy involves placing surface electrodes on the throat to measure adequate muscle movement.

Deep pharyngeal neuromuscular stimulation is a systematized therapeutic method for pharyngeal dysphagia, which utilizes nine specific stimulation techniques with the oral/pharyngeal areas. This specialized training is offered at JRI's speech program in NJ.

In addition, following a modified barium swallow procedure, some patients are candidates for Vital Stim. This is a systematic approach for outpatients who meet the criteria to improve swallowing. The electrical stimulation works to increase activity and coordination of the muscles involved in swallowing.

Modified Barium Swallow (MBS)

The MBS procedure is often recommended for individuals with swallowing difficulties. This procedure is performed in conjunction with the radiology department and is often described as an "X-ray of the swallowing mechanism."

During the test, patients are asked to swallow various solids and liquids mixed with barium. The barium acts as an illuminator so that during the X-ray, areas of the swallowing mechanism can be highlighted to determine if they are functioning appropriately.

Results of this test are reviewed by a speech pathologist and radiologist and then forwarded to the patient's physician.

Head/Neck Cancer Rehabilitation Program

JRI's NJ speech pathologists are trained in providing comprehensive laryngectomy evaluation and treatment, including: 

• Preoperative counseling
• Testing to determine prognosis for successful esophageal speech production
• Electro-larynx training and assistance in ordering the appropriate device
• Esophageal speech training
• Tracheoesophageal puncture prosthesis (TEP) fitting and training (a very specialized procedure to experience excellent voice quality)
• Monthly support group
• State-of-the-art diagnostic and treatment protocols for those patients who have undergone surgery of the neck or mouth, including:
  • Total or partial laryngectomy
  • Glossectomy (tongue)
  • Mandibulectomy (jaw)

Patients are referred by their physician for pre-operative counseling or speech/swallowing evaluation post-surgery.

If a dysphagia evaluation is recommended, the speech pathologist will administer various food/liquid consistencies and observe the swallow for overt signs of aspiration (choking or coughing). A modified barium swallow might be recommended to further assess swallow skills.

A complete laryngeal voice evaluation is conducted on patients who have had their voice box removed. Other tests may include a transnasal esophageal insufflation test to determine appropriateness for tracheo esophageal puncture or esophageal speech.

The department offers a monthly laryngectomy support group.

Adolescent Language Disorders

JRI offers evaluation of adolescent language disorders at our NJ facilities. We are prepared to evaluate and treat language disorders, processing disorders, higher level autism and mild retardation. We provide individualized therapy programs as well as group therapy.

Our Social Skills Group involves training adolescents in pragmatic and language skills involved in employment settings in order to help them meet their future goals. We often partner with Vocational Rehabilitation to achieve the common goal of success in the work or academic setting.