Foreign Accent Syndrome (FAS)

Recent news outlets have been covering a case where a Texas woman awoke from surgery with a… British accent! If you’re anything like me (and everyone else who’s buzzing about this story), your eyebrows probably raised in a suspicious manner.

Waking up from surgery or a head injury with a foreign accent isn’t impossible, but it’s not too common. A small amount of individuals develop a speech pattern that is different than their own. This occurrence is known as “Foreign Accent Syndrome.” It is considered a rare condition in which patients develop what is perceived as a “foreign accent.”

However, many researchers argue that the new speech pattern is in fact not an accent development, but a change in timing, pitch, and pronunciations due to damage to the brain’s linguistic center.

The earliest studied case of Foreign Accent Syndrome is from 1941 where a woman in Oslo was struck by shrapnel following a German air raid. Following her recovery, her speech evolved to have an altered rhythm and melody.

According to the American Speech-Language Hearing Association, speech therapy has been proven beneficial across case studies. Research suggests that minimal pair techniques with a focus on specific consonant and vowel targets can increase awareness of speech production and improve articulatory accuracy. Additionally, therapists frequently use techniques used in accent modification to benefit these rare cases.

See for yourself! The below links show two cases where individuals have developed “Foreign Accent Syndrome”



Lisamarie Ricigliano M.S. CF-SLP, TSSLD


Turn Taking

Conversation is defined as an informal interchange of thoughts or information by spoken word; it is the oral communication between people (Kelman, 2004). In order for conversation to take place, turn taking skills must be present. During a conversation, two or more people take turns regularly and have the role of a speaker and a listener; this act incorporates turn taking skills. Turn taking skills that develop early in age are essential for later conversational skills. Taking turns, a phrase that typically has a juvenile connotation, is a theme that’s in our communication, work, and play interactions throughout life. Although turn taking is a skill that’s developed with age, however, our ability to take turns is innate in us as infants.

When an adult is speaking to a child, they tend to pause after each spoken word, as if giving the child ample time to respond in gesture, noise, or any way. By doing this, the adult is teaching the child their first turn taking pattern. When the child becomes older, an adult applies the same strategy that they once used towards the infant. The basic equation for turn taking skills consists of listening, responding by completing a turn, then waiting for your turn again after the other person (Kelman, 2004). Whether it’s a conscious act or not, adults set up models that teach children to follow the rules of interaction. By learning from example, the child has a higher rate at being successful in their turn taking skills.

Interestingly enough, evidence of communicative turn taking is seen even before the child begins to use words. Infants show an awareness of communication before they have the ability to speak. However, as the infant moves to toddler from pre-linguistic to linguistic, they develop a turn taking skill that’s more comparable to those of adult conversation (Black & Logan 1995).

In addition to interruptions, a young child may attempt to speak simultaneously with their speaker however, this decreases and a more at ease pattern begins to develop. By two and a half years, the desired conversational turn taking pattern between adult and child is smoother with significantly less interruption. Although understandably, some children at two and half may have difficulty turn taking in a conversation where the topic is either unfamiliar or of something that has happened too far in the past.

A crucial aspect of turn taking includes pause times. Pause time is one of the indications that turns are switching. Pause time is not perfected at age two; this is seen when an adult pauses about one second, the child will proceed to pause much longer. Although, by the age of three, the child begins to recognize the pause length and therefore adjust their timing to maintain a smoother conversational flow (Maroni & Pontecorvo 2008). A child heavily relies on the obvious indication of a longer pause resulting in when a speaker is finished.

By the time the child enters school, their turn taking skills have been significantly developed in the home and play areas. In interaction with adults, children tend to stay involved in conversations and appear to be good turn takers. However, in peer interactions, children are more likely to show a disruption of turn taking and temporarily lose some of their skill.

Since turn taking requires the understanding of a back and forth pattern between people, in can be taught in many activities. By using activities, the pattern becomes learned and makes it easier to be applied in conversation. Some examples of turn taking activities include rolling a ball back and forth, tickling, hugging, and playing peek-a-boo. When doing these activities, it’s important to narrate what’s happening. For example, “It’s my turn, now it’s your turn.” These skills are important to foster from the very beginning and will continue to improve and develop throughout the child’s every day life.

Lisamarie Ricigliano M.S. CF-SLP, TSSLD

Apraxia vs. Dysarthria

A speech-language pathologist is a care provider who assesses, diagnoses, treats, and aids in preventing disorders related to speech, language, cognitive-communication, voice, swallowing, and fluency.

Motor speech disorders are the inability to speak properly when formulating sentences or saying single words. Coordination, timing, and strength needed to verbalize words are affected. When speaking of motor speech disorders, two main disorders are dysarthria and apraxia. When comparing dysarthria and apraxia, patients who present with dysarthria show consistent errors in speech while patients who present with apraxia demonstrate inconsistent and unpredictable errors.

Childhood apraxia of speech, also commonly seen in literature as CAS, is a motor speech disorder that is characterized by the child demonstrating difficulty of producing sounds, syllables, and words. This is not because of muscle weakness or paralysis but rather the child’s brain has problems planning to move the articulators needed for speech, such as lips, the mandible, and tongue. An individual with apraixa is aware or what they want to say but the brain is unable to plan muscle movements necessary to verbally communicate the individual’s ideas in a fluid manner.

Depending on age, there are different symptoms of a child with apraxia however, not all children diagnosed with CAS show the same signs. In a very young child, a child may not coo or babble as an infant, have late production of first words, demonstrate the inability to combine sounds, and have difficulty in eating. In an older child, there is a pattern of inconsistent sound errors, difficulty imitating speech, difficulty saying longer words, difficulty speaking while anxious, and may be seen groping while attempting to produce sounds to coordinate articulators such as lips, tongue, and the mandible. The child may be hard to understand or have choppy, monotonous speech (Caruso & Strand, 1999). Other issues noticed are delayed language development, difficulties with fine motor movement, coordination, hypersensitivity or hyposensitivity in the child’s mouth. An example of hypersensitivity or hyposensitivity in the mouth is the dislike of brushing teeth or eating crunchy foods. As with most speech problems, the child diagnosed may have trouble learning to read, spell, or write.

There are numerous methods and techniques used to diagnose CAS. The different assessments serve the purpose of assessing the child’s oral-motor abilities, melody of speech, and sound development (Forrest, 2003). Prior to motor assessments, an audiologist should perform a hearing evaluation to rule out hearing loss as a possible cause of the speech difficulties. During an oral motor assessment, the speech-language pathologist will assess for signs of weakness or low muscle tone in the lips, jaw, and tongue; in order to differentially diagnose dysarthria. Typical children with CAS do not exhibit signs of weakness, however, assessing for this helps limit the possibility of other disorders. During this exam, it’s assessed how well the child can coordinate mouth movement by performing prompted tasks such as smiling, puckering of the lips, or frowning. In addition to movements, the child’s rote ability is also tested by comparing the individual’s function to actually performing a real life situation versus pretending (Forrest, 2003). An example of a rote ability assessment would be asking the child to lick a lollipop versus pretending to lick a lollipop.  Intonation, or melody of speech assessment, determines whether or not the child can use pauses and pitch changes to mark different types of sentences such as interrogatives or declaratives. In a speech sound assessment, the clinician evaluates vowel and consonant sounds, as well.

For children diagnosed with CAS, there are different treatments available. Research has shown that children who receive intense, frequent, one on one treatment have much more success than those children who receive inconsistent treatment or participate in a group session. The treatment focuses on improving the planning, sequencing, and coordination of muscle movements for speech production (Forrest, 2003). As with a large majority of treatment plans, time and commitment is stressed to the patient and in this case, to the child’s care-provider.

Childhood dysarthria is a motor speech disorder that affects speech by weakened muscles. It’s caused by neurological damage prenatally, perinatally, or postnatally. It’s characterized by the strength, steadiness, tone, accuracy, and speed or range of movement. An individual with dysarthia can have all speech systems affected such as, respiration, phonation, articulation, resonance, and prosody.  There are numerous types of dysarthria such as flaccid, spastic, ataxic, hypokinetic, hyperkinetic, and mixed (Walshe & Miller, 2011). Dysarthria can either be congenital or developmental. In the case of congenital dysarthria, a child experiences development of dysarthria at birth and developmental dysarthria takes place prior to the development of speech and language. There are also instances where dysarthria is acquired from an injury.  Dysarthria has various combinations of weakness and hypertonicity in the muscles that control phonation, respiration, resonation, and articulation. Characteristics of childhood dysarthria manifests in each of the speech systems. Respiration is at a low intensity and speech is typically limited to short phrases because of the low intensity respiration. Breathy phonation is common because of unilateral or bilateral vocal fold paralysis. Hypernasality during resonation is because of weak movement of the soft palate which causes velopharyngeal incompetence. Articulation is distorted therefore imprecise consonants are produced. Imprecision in articulation is due to weakness and the in-coordination of the mandible, lips, and tongue. “Hot potato speech” is a way to describe dysarthric speech because it sounds like someone is trying to talk with something hot in his or her mouth (Fogle, 2008). Children diagnosed with dysarthria also display non-speech characteristics such as having difficulty with sucking, chewing, or swallowing. As a result of these difficulties, drooling, gagging, or choking may be seen. Childhood dysarthria, there are often other associated syndromes or disorders such as Down’s Syndrome or Spina Bifida (Walshe & Miller, 2011).

Dysarthria tends to affect all speech systems, therefore, each system needs to be individually evaluated. Since having any in-coordination of the soft palate or articulators can cause distorted speech sounds, clinicians evaluate the symmetry and structure of each articulator. The articulators evaluated include the mandible, tongue, and lips. Their functioning is also evaluated such as the range of motion, strength, coordination, and rate of movement (Fogle, 2008).

Due to brain plasticity, children generally have a better outcome from treatment. The main goal for children diagnosed with dysarthria is to help them maximize their speech intelligibility. Other goals of treatment include slowing the rate of speech, improving respiratory support, strengthening muscles, increasing mouth, tongue, and lip movements, improving articulation, and family teaching (Caruso & Strand, 1999). Sometimes, in severe cases, the use of an augmented communication device may be used. Treatment for dysarthria is based on severity; the level of severity and type of dysarthria forms the type of intervention used. As seen in mild to moderate cases, compensatory strategies are used to assist in the child’s function. In severe dysarthria, alternate forms of communication tends to be necessary. It’s important for treatment to also incorporate the development of literacy and self-esteem (Walshe & Miller, 2011).

According to Pennington (2007), speech and language therapy for young children who have motor disorders targets both the children and parents. Therapy for parents often involves training about communication and how to foster children’s development. From an early age, interaction patterns between the children and their parents may differ from those involving non-disabled children, therefore, children are then at risk of failing to develop a full range of communication skills. Speech and language therapy for children with motor speech disorders aim to maximize their communication skills and help them to take a full and active role in conversation. Therapy can focus directly on the children, teaching them individual conversation skills, introducing augmentation communication systems, or working on maximizing their intelligibility of their speech production.

Learning the steps involved in a clinical practice ensure successful implementation of diagnostic and intervention procedures. There’s a need for speech-language pathologists to problem solve in an organized way in addition to logically analyzing the components of the speech processes. In doing so, impairments will be isolated and specific goals can be targeted. Understanding the basic anatomical and physiological foundations of human communication is an essential skill for every clinician. Once clinicians understand the basic anatomical and physiological components of human speech and language, with experiences, diagnosing, and treating specific speech language impairment becomes easier (Pena & Kiran, 2008).

In order to be a successful speech-language pathologist, one must be capable of expressing clear views about training programs and their outcomes for both the child being treated in addition to the parent or family unit. In order to concisely express this, the speech pathologist must be thoroughly familiar with the pathology of specific disorders, diagnostic tests, and rehabilitation procedures (Janet, 2010). Speech-language pathologists develop a specific plan which is individually created to target the patient’s needs. Clinicians should communicate diagnostic test results, diagnose, and propose treatment in a way that is understood by patients and families. Compassion is a necessary characteristic to hold; according to Janet (2010), speech pathologists often grow to profoundly know their client through their struggles. Often the case with children, progress may be slow so patience, compassion, understanding, and good listening skills are necessary throughout treatment.

Lisamarie Ricigliano M.S. CF-SLP, TSSLD

Deaf Culture

Although deafness has and continues to be viewed as a medical diagnosis or disability, there are people in the United States whom are members of a minority group that takes pride in being Deaf, with a capital ‘D’.  Of 35 million people who are considered deaf or hearing impaired, 500,000 of these people view deafness as a culture (Williams & Abeles, 2004). Deaf people still continue to face discrimination in housing, employment, and education. Movies, documentaries, literature, and television have highlighted these difficulties, growth, triumph, and overall culture.

According to Gallaudet University, Deaf culture revolves around the use of American Sign Language and the unity between others who are Deaf. Dr. Barbara Kannapel, a Deaf sociolinguist defined Deaf culture as a set of learned behaviors of a group of deaf people who have their own language, values, rules, and tradition (Williams & Abeles, 2004). Deaf culture promotes vision as the primary sense, encourages American Sign Language above all other modalities of communication, and focus on film and literature that preserves their culture.

In an age where there is significant research regarding the benefits of being an oral deaf individual or receiving amplification technology, it’s easy to point fingers and shame those who disregard the aforementioned. As a budding Speech-Language Pathologist, I understand “language”. Language is a system of communication used by individuals to send and receive messages; both spoken and sign language fit this criteria. However, the benefits of oral language are not to be over-looked given research in this area. Ibertsson et al. (2009) findings agree with most researchers in this area: speech recognition and spoken language contribute to efficient communication. When working with children who are hearing impaired, we as Speech-Language Pathologists should be aware of the importance of language acquisition for social scenarios and academic instances while challenging the children to encounter different conversational settings in a less structured way.

However, some members of the Deaf population feel so strongly about becoming oral or even receiving amplification. Cochlear implants and additional amplification technology are looked upon as instruments to “cure” deafness (Sparrow, 2005). They’re offered as treatment options of both children and adults who were either born deaf or became deaf. A portion of the deaf community poorly reacts to these devices. There has been numerous protests against the use of amplification devices specifically against the use of young children. Protestors

It’s difficult to argue the benefits of receiving amplification and gaining oral language given the adversity that the Deaf have faced in the past; various voices in Deaf Culture have stated in “Through Deaf Eyes” that the Deaf is often treated as an ethnic group that needs to be assimilated (Avon, 2006). These issues present the question; If a deaf person is completely fine with their current way of life, why is it necessary for them to change? Some may view that hearing people encourage this assimilation to make it easier on themselves so that there is no need to accommodate the hearing impaired.

As literature and popular culture allows us to see, deaf individuals have been denied the rights to own property, have children, drive cars, be educated, or even communicate through sign. Deaf people have rarely been treated with simply human dignity. Humphries, a Deaf scholar, created a word in 1975 that properly defines the discrimination that hearing impaired individuals have and continue to face. “Audism” is when people judge deaf individuals’ intelligence and success based on their ability in the language of the hearing culture; additionally, an assumption is made about the deaf persons’ happiness based on them acquiring fluency in the hearing culture’s language (Hamil & Stein, 2011). Audism, although a fairly recent word, stands for something that has been occurring for a long time.

Although the Deaf have clearly been discriminated against, there are informative and delightful resources that continue to advocate for the Deaf and keep Deaf Culture alive. The American Society for Deaf Children, National Association of the Deaf, and the World Federation of the Deaf (Golos & M, 2012) all provide an outlet for those who are hearing impaired. But arguably more importantly, these organization serve as a source of information for hearing individuals who aren’t educated enough to fully understand the Deaf, their culture, and the importance of preserving it. Additionally, in an age where we gain exposure from movies and social media, prominent deaf athletes, scholars, actors, and even musicians shine a light on the narrow difference between deaf and hearing individuals. Often times, these people teach a lesson that a typically hearing person can follow: the importance of focusing on what you can do, rather than what you cannot do.

Lisamarie Ricigliano M.S. CF-SLP, TSSLD