Accent Modification


  • An accent is the unique way that speech is pronounced by a group of people speaking the same language.
  • Accents are a natural part of spoken language and reflects distinct characteristics and background of a person
  • Accents are not a disorder! However, some individuals with accents have difficulty communicating with others
    • People not understanding
    • Avoiding social interaction
    • Frustration from having to repeat yourself
    • People focusing on your accent


  • Accent modification focuses on learning how to reduce the influence of your native language in order to sound more like a native English speaker
  • Changing the way one speaks is a difficult task, as speaking style is a well-engrained motor habit (Ojakangas, 2013).
  • Accent modification takes 3-4 months with optimal motivation and effort.
  • Innate ability + motivation + intensity of practice + amount of socialization with native speakers contribute to changes in accent


Rose Costanzo MA CF-SLP, TSSLD


Hearing Loss and Aural Rehabilitation


Hearing loss can have a negative impact on the quality of life of individuals. Hearing loss alters the certainty of everyday life causes social insecurity, fear, and anxiety in individuals who suffer from it (Preminger & Yoo, 2010). Often people with hearing loss are fitted with hearing aids, however hearing aid fittings should not be the final step for individuals with hearing loss. Hearing aids do not restore hearing to normal, therefore additional counseling should follow a hearing aid fitting in order to aid in the coping of hearing loss.

Jessen (2014) referred to communication as a puzzle and to hearing aids as only one piece of the puzzle. Aural rehabilitation can assist in completing the communication puzzle. According to Hawkins (2002), the primary purpose of aural rehabilitation is to guide an individual with hearing loss to a better understanding of their hearing loss and develop strategies to cope with the situations where problems continue even with hearing aid use A speech-language pathologist can provide individuals with aural rehabilitation.

Abrams and colleagues (1992) conducted a study aimed in determining whether participation in aural rehabilitation program resulted in greater reduction of self-perceived hearing handicap than hearing aid use alone. The researchers found that hearing aid use was correlated to reduced hearing handicap self-perception. However, the researchers found significant evidence that participating in an aural rehabilitation program in addition to hearing aid use resulted in a greater reduction of self-perceived hearing handicap than did hearing aid use alone.

Hearing Loss and Families

The impact that hearing loss has on family members is often referred to as a third-party disability (Scarinci et. al., 2013). However, it is important to realize that successful communication begins with the speaker. The speaker’s responsibility is to create a clear message that can be easily received by the listener (Jessen, 2014).  As speakers, family members should be cognizant of their facial positions before beginning the message. The speaker is close enough when they can reach out and touch their loved one. When trying to get the attention of a family member with a hearing loss, the speaker should reach out and touch them, rather than yelling.  Family members should also speak clearly without over-exaggerating words.   The speaker should make the family member with hearing loss aware of changes in topics and make sure that the message is being understood throughout communication (Jessen, 2014).


Rose Costanzo MA CF-SLP, TSSLD

Cerebral Vascular Accidents


            Blood supplies brain cells with essential nutrition, such as glucose and oxygen. Oxygen supply by the bloodstream is vital to normal brain function. A cerebral vascular accident (CVA) occurs when there is an interruption in the supply of oxygenated and bloodPrintto the brain. This can be caused by an artery that has ruptured or an obstruction of an artery (Isaksen et. al,. 2008). CVA’s are classified as either hemorrhagic or ischemic. Hemorrhagic type strokes are the result of a blood vessel rupturing, such as an aneurysm. An aneurysm is a ballooning area of an artery. The ballooning causes the walls of the aneurysm to become stretched and thinned. An aneurysm ruptures when wall tension exceeds the strength of the wall tissue (Isaksen et. al,. 2008). The rupturing of an aneurysm results in spilling of blood into the subarachnoid space, thus resulting in a hemorrhagic stroke (Cebral et. al., 2005).

            An ischemic type of stroke is the result of a blood clot or sclerotic material obstructing blood flow to the brain. An ischemic stroke can be the result of a thrombosis or an embolism. A thrombosis is a clot that forms inside of the brain. An embolism is a clot that forms elsewhere in the body and travels through the bloodstream towards the brain. An embolus blood clot is often caused by atrial fibrillation (Jespersen & Ostergaard 2012).

            Obstruction of oxygen and glucose supply to the brain can result in impairments in speech and in voice (Jespersen & Ostergaard 2012). For example, a CVA may result in vocal fold paresis or paralysis, dysarthria, aphasia, or apraxia. The changes in speech and voice are dependent on the location and the extent of the cerebral event.Circle_of_Willis_en.svg

            Although CVA’s may result in speech impairments, initial severity of symptoms often become less severe. This is due to a reduction in swelling in the areas of the brain that were impacted. Additionally, when one area of the brain is impacted by a CVA blood supply is often still supplied by way of the circle of Willis. The circle of Willis is the ultimate form of collateral circulation and plays an important role preserving blood supply to brain tissue following an obstruction (Romero et. al. 2009).

            The circle of Willis works to secure blood supply to each side of the brain. Therefore, if a person experiences a CVA in one area of the brain, blood supply to that portion may still
be delivered. The presence of collateral circulation is a favorable prognostic factor in cases of CVA (Romero et. al. 2009).

Rose Costanzo MA CF-SLP, TSSLD




Developmental apraxia of speech is characterized by the inability to plan and execute motor-speech tasks. More specifically, it is the inability to coordinate oral movements that are necessary to form syllables and words in the absence of oral paresis or paralysis. The speech of children with developmental apraxia of speech is filled with inconsistent articulation errors. The errors in this population increase with word length. These children exhibit more errors in consonants than in vowels, especially in the initial consonants of words and in consonant clusters (Wertz, LaPointe, and Rosenbek, 1991).

Children who are able to produce many sounds in isolation, yet exhibit difficulty maintaining sound combinations, reduce the number of syllables in simple words, or inconsistently substitute sounds are appropriate candidates for a speech-language evaluation. A speech-language evaluation should also be complemented with a detailed case history, as certain answers may assist in the diagnosis of developmental apraxia.

The American Speech-Language-Hearing Association (2007) identified the features consistent with the developmental apraxia diagnosis. These features include inconsistent errors on consonants and vowels in repeated syllables or words, lengthened and disrupted co-articulatory transitions between sounds and syllables, and inappropriate prosody (ASHA, 2007).


Rose Costanzo MA CF-SLP, TSSLD