Parkinson's Speech & Swallowing Program

Frequently Asked Questions About Parkinson's Speech & Swallowing Therapy

About the SPEAK OUT!® Program

Q: What is SPEAK OUT!® and how is it different from other speech therapy programs?

A: SPEAK OUT!® is a specialized speech therapy program developed specifically for people with Parkinson's Disease by the Parkinson Voice Project. Unlike traditional approaches that focus solely on increasing volume, SPEAK OUT! emphasizes "intent"—training you to consciously think about speaking clearly every time you talk. This bypasses the automatic motor control issues caused by Parkinson's. The program combines speech exercises with cognitive engagement, making it uniquely effective for PD patients. You'll work through 12 intensive sessions using specially designed materials, including speech exercises, functional phrases, and cognitive tasks.

Q: How is SPEAK OUT! different from LSVT LOUD?

A: Both are evidence-based programs for Parkinson's voice, but they have different approaches. LSVT LOUD focuses primarily on increasing vocal loudness through intensive effort and includes more repetitive exercises. SPEAK OUT! emphasizes intentional, conscious speech production and combines voice work with cognitive exercises. Some people respond better to one approach than the other. Nina is trained in both and can help determine which program is best suited to your individual needs, learning style, and stage of Parkinson's.

Q: How long does the SPEAK OUT! program take?

A: The intensive phase is 12 sessions, typically scheduled 3 times per week over 4 weeks. Each session lasts 45-60 minutes. After completing the intensive phase, you'll transition to home practice using your workbook, and Nina recommends joining "The LOUD Crowd" maintenance sessions weekly or bi-weekly to maintain your gains long-term.

Q: What if I miss a session during the 4-week intensive period?

A: Consistency is important for best results, but life happens. If you need to miss a session, Nina will work with you to reschedule within the same week when possible. The key is maintaining the intensity and frequency of practice. If you have a planned absence (like a vacation or medical procedure), it's better to delay starting the program until you can commit to the full 4 weeks.

Q: Will I get materials to practice at home?

A: Yes! You'll receive the official SPEAK OUT! workbook, which includes all the exercises, phrases, and cognitive activities you practice during sessions. This workbook is yours to keep for life, and you'll use it for daily home practice (15-20 minutes per day) during and after the intensive program. Nina will also provide you with customized materials based on your specific goals and favorite topics.

Q: What is "The LOUD Crowd" and do I have to participate?

A: The LOUD Crowd is a weekly or bi-weekly group maintenance session where SPEAK OUT! graduates practice together to maintain their voice gains. Research shows that ongoing practice is essential—without it, benefits can fade over time. While it's not mandatory, Nina strongly recommends it. The group format provides motivation, accountability, and social connection with others who understand your journey. Sessions are offered both in-person and via telehealth, so you can join from home.

Q: Can I do SPEAK OUT! if I'm in early-stage Parkinson's with minimal symptoms?

A: Absolutely—and this is actually the ideal time to start! Early intervention can help prevent or delay more severe speech problems from developing. Even if your voice seems "fine" now, starting SPEAK OUT! teaches you the techniques you'll need to maintain your communication abilities as Parkinson's progresses. Think of it as preventive care for your voice.

Q: What if my voice is already very weak? Can I still benefit?

A: Yes. Nina modifies the program to match your current abilities. You don't need to have a certain level of voice strength to start. The program is designed to work with where you are right now. If your voice is very quiet, you'll start with exercises at your current level and gradually build strength over the 12 sessions.

About Swallowing Therapy

Q: How do I know if I have swallowing problems? I don't choke often.

A: Swallowing problems often develop gradually and can be subtle at first. Warning signs include: taking longer to finish meals, coughing or throat-clearing during or after eating/drinking, feeling like food gets stuck, avoiding certain foods you used to enjoy, unexplained weight loss, frequent pneumonia or respiratory infections, drooling, and feeling like you need to swallow multiple times to clear food. Most concerning is "silent aspiration"—when food or liquid enters your airway without causing you to cough. Nina's clinical assessment can detect issues before they become serious.

Q: What is silent aspiration and why is it dangerous?

A: Silent aspiration occurs when food, liquid, or saliva enters your airway (trachea) instead of your esophagus, but doesn't trigger a cough reflex. This means material can reach your lungs without you realizing it, potentially causing aspiration pneumonia—a serious lung infection that's the leading cause of death in people with Parkinson's. It's called "silent" because you don't feel it happening. Up to 40% of people with Parkinson's experience silent aspiration. Nina's swallowing assessment includes techniques to identify this risk.

Q: What happens during a swallowing evaluation?

A: Nina will conduct a comprehensive clinical swallowing evaluation that typically takes 60-90 minutes. She'll review your medical history, current symptoms, and medications. Then she'll assess: your oral motor skills (tongue, lip, and jaw strength and coordination), your voice quality, your ability to protect your airway (cough strength), and your actual swallowing with different food and liquid textures. Nina observes for signs of difficulty like coughing, throat clearing, changes in voice quality after swallowing, or prolonged chewing. Based on findings, she may recommend strategies, exercises, or in some cases, instrumental assessment like a videofluoroscopic swallow study (modified barium swallow).

Q: What is EMST and how does it help with swallowing?

A: EMST stands for Expiratory Muscle Strength Training. It's a handheld device that provides resistance when you blow out, strengthening your expiratory muscles (the muscles you use to breathe out and cough). Strong expiratory muscles are crucial for two things: protecting your airway when you swallow and generating a powerful cough to clear anything that goes down the wrong way. Research shows EMST significantly improves swallow safety in people with Parkinson's. You'll use the device at home for about 5 minutes per day, 5 days per week. Most people see improvements within 4-5 weeks.

Q: Will I have to eat pureed food forever?

A: Not necessarily! The goal is always to keep you eating the most normal diet safely possible. Diet modifications are individualized based on your specific swallowing abilities. Some people only need minor modifications (like avoiding certain textures), while others benefit more from texture changes. Nina uses the IDDSI framework (International Dysphagia Diet Standardisation Initiative) to precisely match food textures to your abilities. As your swallowing improves with therapy, you may be able to advance to more regular textures. Nina also helps you find modified foods that are appealing and nutritious—there are many more options available now than in the past.

Q: Can swallowing therapy really prevent pneumonia?

A: Yes. Research consistently shows that dysphagia therapy reduces the risk of aspiration pneumonia in people with Parkinson's. By strengthening swallowing muscles, teaching compensatory strategies, and ensuring you're eating safely, therapy directly addresses the primary cause of aspiration pneumonia—material entering the lungs. Many of Nina's clients have successfully avoided pneumonia hospitalizations after completing swallowing therapy.

Q: How long does swallowing therapy take?

A: This varies significantly based on the severity of your swallowing problems and your individual goals. Some clients need 8-12 sessions, while others with more complex issues may need ongoing therapy for several months. Nina will discuss expected duration during your evaluation and will reassess your progress regularly. Even after formal therapy ends, you'll continue home exercises to maintain your swallow safety.

Q: My spouse/caregiver is worried about me choking. Can they be involved in therapy?

A: Absolutely—Nina encourages it! Caregiver education is a crucial part of swallowing therapy. Your loved ones will learn: signs that you're having difficulty swallowing, the Heimlich maneuver and when to use it, how to prepare foods safely, mealtime positioning and pacing strategies, when to offer cues vs. when to step back, and how to balance safety with your independence and dignity. Having caregivers present also helps them feel less anxious because they understand what's happening and how to help appropriately.

About Cognitive-Communication Therapy

Q: Is "word-finding" difficulty really part of Parkinson's or is it just normal aging?

A: Both can be true, but Parkinson's does affect cognitive-communication abilities in specific ways. Up to 50% of people with Parkinson's experience some level of cognitive change, including word-finding difficulties (anomia), slower processing speed, attention issues, and executive function challenges. These are different from typical aging—they often appear earlier and progress faster. The good news is that cognitive-communication therapy can teach you strategies to compensate for these changes and maintain your communication effectiveness.

Q: What's the difference between Parkinson's-related cognitive changes and dementia?

A: Not everyone with Parkinson's develops dementia. Many people experience mild cognitive changes that don't significantly interfere with daily life—this is sometimes called "Parkinson's Disease-Mild Cognitive Impairment" (PD-MCI). These changes might include word-finding difficulties, slower thinking, or attention issues, but you can still manage your daily activities independently. Parkinson's Disease Dementia (PDD) is more severe and affects multiple cognitive areas significantly. Nina works with clients across this spectrum, tailoring therapy to your current level. If Nina notices concerning cognitive changes, she'll recommend you discuss them with your neurologist.

Q: Can therapy actually improve my memory and thinking speed?

A: Cognitive therapy can't reverse Parkinson's-related brain changes, but it can teach you highly effective compensatory strategies and may slow cognitive decline. You'll learn: external memory aids (apps, calendars, systems), mental strategies for word retrieval, ways to reduce cognitive load during complex tasks, attention and focus techniques, and methods to organize information more efficiently. Many clients report feeling more confident and capable in daily conversations and activities, even if the underlying condition is progressing.

Q: I feel like I can't keep up with group conversations anymore. Can therapy help?

A: Yes! This is one of the most common concerns Nina addresses. Group conversations are cognitively demanding—you need to follow multiple speakers, process information quickly, remember what was said, formulate your response, and find the right moment to speak. Nina teaches specific strategies: topic maintenance techniques, active listening skills that reduce cognitive load, ways to politely manage turn-taking, methods to re-enter a conversation if you lose track, and self-advocacy skills to ask others to slow down or repeat. You'll practice these strategies in realistic scenarios.

Q: Is cognitive therapy the same as memory games or brain training apps?

A: No—it's much more functional and personalized. While brain training apps focus on decontextualized exercises, Nina's cognitive-communication therapy focuses on real-world communication situations that matter to you. For example, if you're struggling to follow your book club discussions, Nina will work on strategies specifically for that context. If managing your medications is challenging, you'll develop systems that work in your actual home environment. The goal is improved daily function, not just better scores on exercises.

About Therapy Logistics

Q: Do you offer in-home therapy or do I need to come to a clinic?

A: Nina provides both in-home therapy and telehealth—no clinic visits required. In-home therapy means Nina comes to your house, which has several advantages: no travel stress or fatigue, practice in your actual environment, easier for family members to participate, and Nina can assess your home for safety modifications. Many clients find in-home therapy more comfortable and less exhausting than traveling to appointments.

Q: How does telehealth therapy work for speech and swallowing?

A: Telehealth (video sessions) works remarkably well for speech therapy, and research shows it's just as effective as in-person therapy for many Parkinson's interventions. You'll meet with Nina via a secure video platform from your computer, tablet, or smartphone. You can see and hear each other clearly, and Nina can observe your speech, facial movements, and swallowing. For swallowing therapy, Nina will guide you through exercises and may ask you to have certain materials available (like different foods or drinks). The SPEAK OUT! program is designed to be delivered via telehealth, and cognitive therapy is often ideal for telehealth since you can practice in your natural environment.

Q: What technology do I need for telehealth sessions?

A: You need: a device with a camera and microphone (smartphone, tablet, or computer), reliable internet connection, and a quiet space where you can talk freely. Nina will send you simple instructions for joining sessions—you just click a link, no complicated downloads or setup required. If you're not tech-savvy, Nina can walk you through it step-by-step during your first session, or a family member can help you get connected initially.

Q: Can I switch between in-home and telehealth?

A: Yes! Many clients do a combination. For example, you might do your initial evaluation in-home so Nina can assess your environment, complete the intensive SPEAK OUT! program via telehealth for convenience, and then do swallowing therapy in-home where Nina can work with you in your actual kitchen. Nina is flexible and will work with your preferences and needs.

Q: How quickly can I start therapy?

A: Usually within a few days to a week. Once you contact Nina, she'll schedule your evaluation at a time that works for you. After the evaluation, if you want to move forward, you can typically begin treatment within days. Nina understands that with a progressive condition like Parkinson's, waiting weeks for therapy isn't ideal.

Q: What if I need to cancel or reschedule an appointment?

A: Life with Parkinson's can be unpredictable—Nina understands that. She asks for 24-hour notice when possible if you need to cancel or reschedule. If you're having an "off" day where your symptoms are worse than usual, let Nina know—she can often still conduct a productive session by adjusting the activities, or you can reschedule without penalty. Your wellbeing comes first.

Q: How long are therapy sessions?

A: Most sessions are 45-60 minutes. The initial evaluation is typically 60-90 minutes because it's comprehensive. Nina balances the need for intensive practice with the reality of fatigue—if you need shorter sessions due to fatigue or attention issues, she can break them into two shorter visits per week instead.

Q: Do you work with clients at all stages of Parkinson's?

A: Yes. Nina works with clients from newly diagnosed to advanced stages. Therapy goals and approaches vary based on where you are in your journey. For early-stage clients, the focus is on prevention and building skills you'll need later. For middle-stage clients, it's about maintaining function and managing emerging symptoms. For advanced-stage clients, Nina focuses on maximizing quality of life, safety, and helping you communicate your needs effectively, while also supporting caregivers.

About Insurance & Payment

Q: Does Medicare cover speech therapy for Parkinson's?

A: Yes, Nina accepts Medicare Part B, which typically covers speech-language pathology services when they're medically necessary—including speech, voice, swallowing, and cognitive-communication therapy for Parkinson's Disease. You'll need a referral or prescription from your physician (neurologist or primary care doctor). Medicare covers 80% of approved costs after you meet your deductible, and you're responsible for the remaining 20%. Nina handles all Medicare Part B billing directly, so there's no complicated paperwork for you.

Q: Do you accept Medicare Advantage plans?

A: Unfortunately, Nina does not currently accept Medicare Advantage plans (like HMOs and PPOs). However, you can still work with Nina as a private pay client. Many people find that the out-of-pocket cost is worthwhile given the specialized expertise and flexible, personalized care. Some Medicare Advantage plans offer out-of-network benefits that may reimburse you for a portion of the cost—Nina can provide you with detailed receipts (called superbills) that you can submit to your plan for possible reimbursement.

Q: What about private insurance or other insurance plans?

A: Nina currently only accepts Medicare Part B and private pay. She does not bill private insurance companies, Medicare Advantage plans, Medicaid, or other insurance providers. This allows her to focus entirely on providing high-quality care without the administrative burden of dealing with multiple insurance companies, prior authorizations, and claim denials. If you have private insurance, you can pay out-of-pocket and Nina will provide you with detailed documentation (superbills) that you may be able to submit to your insurance for out-of-network reimbursement, depending on your plan's benefits.

Q: How do I know if my insurance will reimburse me?

A: Contact your insurance company and ask about "out-of-network speech therapy benefits" or "out-of-network reimbursement." Specifically ask: Do you cover out-of-network speech-language pathology services? What percentage do you reimburse? Do I need to meet a deductible first? Is there a claim form I need to use? Nina will provide you with detailed superbills containing all the necessary codes and information your insurance company needs to process your claim.

Q: What are your rates?

A: Nina provides transparent pricing and is happy to discuss costs during your initial consultation. Rates vary based on the type and length of service. Contact Nina directly to discuss your specific needs and receive detailed cost information. She can also discuss payment options and help you understand what your out-of-pocket expenses will be with Medicare Part B or as a private pay client.

Q: Do you offer payment plans?

A: Yes. Nina understands that investing in your health is important, and she's willing to work with you on payment arrangements. Whether it's breaking the cost of the SPEAK OUT! program into installments or setting up a monthly payment plan for ongoing therapy, Nina will discuss options that fit your budget. Don't let cost concerns prevent you from getting the care you need—reach out to have a conversation.

Q: Can I use my HSA or FSA for therapy?

A: Yes! Speech therapy is an eligible expense for both Health Savings Accounts (HSA) and Flexible Spending Accounts (FSA). This can significantly reduce your out-of-pocket costs since you're using pre-tax dollars. Keep your receipts and invoices from Nina for your records. Nina can provide any documentation your HSA/FSA administrator needs.

Q: Is private pay really worth it if I have insurance that doesn't cover it?

A: Many clients find that private pay offers significant advantages:

• No session limits: Insurance often caps therapy sessions, but Parkinson's is ongoing. Private pay means you get as much therapy as you need.

• No prior authorization delays: Start therapy immediately instead of waiting weeks for insurance approval.

• Flexibility: Sessions can be scheduled at your convenience and can be longer or shorter based on your needs, not insurance rules.

• Personalized care: Therapy focuses entirely on your goals, not what insurance deems "medically necessary."

• Less paperwork stress: No claim denials, appeals, or justification letters.

• Continuity of care: You can continue therapy as long as it's beneficial, without insurance cutting you off.

Many clients report that the investment in their communication, safety, and quality of life is absolutely worth it—especially considering the potential medical costs of complications like aspiration pneumonia.

Q: Do I need a doctor's referral if I'm paying out-of-pocket?

A: For Medicare Part B billing, yes—you'll need a prescription or referral from your physician. For private pay clients, a referral isn't legally required in Florida, but Nina still strongly recommends coordinating with your medical team. Having your neurologist or primary care doctor aware of your speech therapy ensures integrated care. Nina can provide a simple prescription template that you can take to your doctor's office, or she can communicate with your physician directly with your permission.

Q: What if I start as private pay but then want to switch to Medicare Part B?

A: If you're eligible for Medicare Part B and decide you'd like to switch from private pay to Medicare billing, Nina can make that transition. You'll need to provide your Medicare information and obtain a physician's prescription if you don't already have one. Nina will handle the billing going forward, and you'll pay the standard Medicare Part B coinsurance (20% after your deductible is met).

Q: I have Medicare Part B but haven't met my deductible yet. What does that mean for costs?

A: If you haven't met your annual Medicare Part B deductible, you'll be responsible for 100% of the cost until the deductible is met. After that, Medicare pays 80% and you pay 20%. Nina will keep you informed of where you are with your deductible and what you can expect to pay. If the deductible is a financial concern, you can discuss payment options with Nina.

Q: Can I get a receipt for tax purposes?

A: Yes. Nina provides detailed receipts and invoices for all services. Medical expenses, including speech therapy, may be tax-deductible if they exceed a certain percentage of your adjusted gross income. Consult with your tax advisor about whether your therapy costs qualify as a medical deduction.

Q: What's your cancellation policy?

A: Nina asks for 24-hour notice if you need to cancel or reschedule an appointment. She understands that Parkinson's symptoms can be unpredictable—if you're having an "off" day or not feeling well, just let her know as soon as possible. Late cancellations (less than 24 hours) or no-shows may result in a cancellation fee, but Nina works with clients on a case-by-case basis, especially for medical emergencies or unexpected symptom flare-ups.

Q: What if I can't afford therapy right now?

A: Please don't let cost prevent you from reaching out. Nina is committed to making Parkinson's therapy accessible. During your consultation, she can discuss: modified treatment schedules that spread costs over time, prioritizing the most critical services first (like swallowing safety), payment plans, and community resources that might help with costs. Some clients start with just a one-time evaluation and home exercise program, then return for formal therapy when finances allow. There are options—let's have a conversation about what might work for you.

Q: What forms of payment do you accept?

A: Nina accepts cash, checks, credit cards, debit cards, HSA cards, and FSA cards. Payment is typically due at the time of service. For payment plans, automatic monthly payments can be arranged for your convenience.

About Working with Your Medical Team

Q: Will Nina communicate with my neurologist?

A: Yes! With your permission, Nina regularly coordinates with your neurologist and other healthcare providers. She'll send progress reports, evaluation summaries, and updates on significant changes. This team approach ensures everyone is working toward the same goals and that your Parkinson's care is fully integrated.

Q: What if my doctor hasn't mentioned speech therapy?

A: Many neurologists focus primarily on motor symptoms and medication management during appointments. Speech, swallowing, and cognitive-communication problems may not be discussed unless you bring them up. Don't wait for your doctor to suggest therapy—if you're noticing changes, advocate for yourself. You can ask your doctor for a speech therapy referral, or contact Nina directly and she can coordinate with your physician.

Q: Can therapy help with medication timing issues?

A: While Nina can't adjust your medications, she can teach you strategies to optimize communication during your "on" times and help you track how your speech and swallowing change throughout your medication cycle. This information can be valuable for your neurologist when fine-tuning your medication regimen. Some clients find that therapy is most effective when scheduled during their optimal medication window.

Q: I'm considering DBS surgery. Should I wait until after surgery for speech therapy?

A: Actually, doing speech therapy before DBS (Deep Brain Stimulation) surgery can be beneficial. It establishes a baseline and ensures your communication skills are as strong as possible going into surgery. Some people experience voice changes after DBS, so having therapy skills in place can help you adapt. Nina can also provide therapy after DBS if needed to address any new speech or swallowing issues.

Q: My doctor says my speech and swallowing are "normal for Parkinson's." Does that mean I can't improve?

A: "Normal for Parkinson's" doesn't mean it can't be better! Yes, speech and swallowing changes are common in Parkinson's, but that doesn't mean you have to accept reduced communication or increased aspiration risk. Research clearly shows that therapy improves function even in typical PD progression. You deserve to maintain the best possible quality of life, and therapy can help you do that.

About Results & Expectations

Q: How quickly will I see results?

A: Many clients notice improvements within the first few sessions—they feel more aware of their speech and have better control. Significant, measurable improvements typically appear by the end of the 4-week SPEAK OUT! intensive program. For swallowing therapy, you may notice safer, easier swallowing within 4-6 weeks of consistent exercise. Cognitive strategies often provide immediate benefits in specific situations, though mastering them takes practice over time.

Q: Will therapy cure my speech and swallowing problems?

A: Therapy can't cure Parkinson's or stop its progression, but it can significantly improve your function and slow the decline of communication abilities. Many clients maintain strong, clear voices for years after completing SPEAK OUT!, especially if they continue maintenance practice. Swallowing therapy can prevent aspiration and keep you eating safely for longer. The goal is maximizing your function and quality of life throughout your Parkinson's journey.

Q: What if Parkinson's continues to progress despite therapy?

A: Parkinson's is progressive, so continued changes are expected over time. However, research shows that people who do intensive speech therapy maintain better communication abilities compared to those who don't receive therapy. Even as Parkinson's progresses, the skills and strategies you learn in therapy help you adapt and compensate. Nina can provide refresher sessions or adjust your therapy plan as your needs change over time.

Q: Do I have to practice at home? What if I forget or don't have time?

A: Home practice is essential for maintaining your gains. Nina's sessions teach you the techniques, but daily practice (even just 10-15 minutes) is what makes them stick. Think of it like physical exercise—going to one personal training session per week isn't enough; you need daily activity to see results. Nina helps you build practice into your existing routine and provides strategies if you're struggling with consistency. Many clients practice while having their morning coffee or before bed.

Q: What happens when therapy ends? Will I lose my progress?

A: This is why ongoing practice and maintenance sessions are so important. After intensive therapy, you'll transition to home practice using your materials, and Nina strongly recommends joining The LOUD Crowd or scheduling periodic maintenance sessions (monthly or quarterly). Research shows that continued practice maintains gains long-term. Some clients return for "tune-up" sessions when they notice their voice starting to fade, which is perfectly appropriate.

Q: My spouse says I sound better, but I don't hear a difference. Is therapy working?

A: This is incredibly common! One of the hallmark symptoms of Parkinson's is reduced self-awareness of your voice volume and clarity. Your brain adjusts to your softer voice and perceives it as normal. This is actually why therapy works—by making speech intentional and conscious, you can produce better speech even though it may feel "too loud" or "different" to you. Trust the feedback from your family and Nina's objective measurements. Recording yourself before and after therapy can help you hear the difference.

Special Situations

Q: I have both Parkinson's and another condition (like stroke, hearing loss, etc.). Can you still help?

A: Yes. Nina has experience working with complex medical situations. She'll tailor your therapy to address all relevant factors. For example, if you have hearing loss, she'll incorporate strategies for communicating in that context. If you've had a stroke, she'll address both the Parkinson's-related and stroke-related speech issues. A comprehensive evaluation identifies all factors affecting your communication.

Q: I live alone. Can I still do therapy effectively?

A: Absolutely. While having family involved can be helpful, many of Nina's clients live alone and do very well with therapy. Nina will make sure you have systems in place for safe eating, ways to monitor your own practice, and may connect you with The LOUD Crowd group for social support and accountability.

Q: My spouse/partner has Parkinson's but doesn't think they need therapy. How can I convince them?

A: This is challenging because awareness of speech and swallowing changes is often reduced in Parkinson's. Instead of focusing on what's "wrong," emphasize what therapy can give them: the ability to be heard and understood, confidence in social situations, safety when eating favorite foods, and maintained independence. Offer to sit in on a free consultation with Nina where they can ask questions and learn about the process without commitment. Sometimes hearing from a professional that these changes are treatable makes a difference.

Q: Can therapy help with drooling?

A: Yes! Drooling (sialorrhea) in Parkinson's is usually caused by reduced swallowing frequency and poor lip closure rather than excess saliva production. Nina can teach you: exercises to improve lip closure, strategies to increase automatic swallowing, positioning techniques to reduce drooling, and behavioral strategies like cueing yourself to swallow regularly. Many clients see significant improvement in drooling with therapy.

Q: I'm not ready to start therapy yet, but I think I'll need it eventually. What should I do?

A: Consider doing an evaluation now even if you're not ready for treatment. This establishes a baseline, allows Nina to track changes over time, and gives you information about what therapy would involve when you're ready. You can also ask your doctor for a referral now so it's ready when you decide to start. Additionally, Nina can provide you with some preventive strategies and home exercises to use on your own.

Q: Can Nina provide therapy in a group setting?

A: The intensive SPEAK OUT! program is one-on-one for maximum benefit. However, The LOUD Crowd maintenance sessions are in small groups, which many clients enjoy for the social support and motivation. If you're interested in group therapy for cognitive-communication or conversation skills, let Nina know—she may be able to organize a group if there's sufficient interest.

Have a question that wasn't answered here? Contact Nina directly. She's happy to discuss your specific situation and how therapy might help you.