Clinical Practicum

Laryngectomy Clinic

Once a laryngeal carcinoma has been diagnosed and surgical removal (laryngectomy) has been scheduled, the ENT physician for pre-operative counseling refers the Veteran to the Laryngectomy Clinic.  During pre-operative counseling every aspect of the surgical procedure, post-operative care, voice restoration, and the physiological changes that will occur are discussed.  Spouse and other family members are involved in this counseling process whenever possible.  These patients are provided with a variety of patient education materials to facilitate the rehabilitation process.  Following the laryngectomy procedure, the patient is seen daily beginning in the SICU to provide post-operative counseling until medical clearance to initiate voice rehabilitation is received from the ENT physician.  The Laryngectomy Clinic is dedicated to provide the most advanced voice restoration treatment available.  Training in the use of artificial larynx devices, esophageal speech and the "Blom-Singer" tracheo-esophageal voice prosthesis is provided.  Significant attention is also provided to the psycho-social aspects associated with laryngectomy surgery.

The Laryngectomy Clinic also provides follow-up treatment upon successful completion of voice rehabilitation for the maintenance and support of emotional, physical, and the prosthetic equipment needs of the veteran.  The replacement and repair of both artificial larynges and the tracheo-esophageal voice prosthesis is provided on an as needed basis.  The Laryngectomy Clinic is under the direction of Dennis R. Lutz, M.S.  

Dysphagia Clinic

Inpatients and outpatients with a swallowing problem due to a disorder in the mouth, larynx and/or throat are seen in the Dysphagia Clinic for evaluation and treatment.  An evaluation includes a video fluoroscopic swallowing study or modified barium swallow.  This procedure is recorded on videotape for analysis of the anatomy and the physiological functions of the oropharyngeal area during swallowing.  Frequently compensatory strategies such a tilting the head forward, thickening liquids, small food bites, and alternating food and liquid swallows is all that is needed to avoid or significantly reduce penetration of material into the larynx.  Patients with a severe swallowing problem generally need a feeding tube.  Physicians rely heavily on the swallowing evaluation to help them decide whether or not a feeding tube is needed.  Often, management of these patients involves other services including dental, dietetics, occupational therapy, and/or otolaryngology to better help the patient.  The Dysphagia Clinic services include screening, family counseling and observation of inpatients during meals.  The Dysphagia Clinic is under the direction of Robert S. King, M.A.

Nursing Home Care Unit

A clinical supervisor provided by the Department of Communicative Disorders at ETSU, who serves as a WOC consultant, directs the speech-language pathology program in the Nursing Home Care Unit.  This individual provides supervision to the rotation students assigned to the NHCU and provides the complete range of speech-language pathology and dysphagia (swallowing) services to 120 resident patients.  ETSU graduate students provide services as a part of their clinical practicum program.  Services provided are on a consultation basis upon admission, with a comprehensive diagnostic evaluation administered.  Patients found to have a communicative and or swallowing impairment are placed in a therapeutic/rehabilitative program.

Maxillofacial Prosthetics Clinic

In cooperation with Dr. Robert Hunter, Chief of Dental Service, the Maxillofacial Prosthetics Clinic was created to serve patients with a wide variety of problems, such as cleft palate, velopharyngeal insufficiency and head and neck cancers.  The clinic team, which is the only such team in the immediate geographic area, is composed of Gird A. McCarty, DDS  (Prosthodontist), Nancy J. Scherer, Ph.D. (ETSU Faculty), Dennis R. Lutz, M.S. and Robert S. King, M.A. (VA speech-language pathologists), and Arthur Harris, M.D. (consulting VA otolaryngologist).  The team focuses on services to the veteran population and to the patient population served by the ETSU, Quillen College of Medicine and the Washington County Department of Health.

Neurogenic Speech-Language Disorders Clinic

The purpose of the Neurogenic Speech-Language Disorders Clinic is to identify, screen, evaluate and rehabilitate any patient treated with neurogenic communication impairment such as aphasia, oral/verbal apraxia, and dysarthria related to cerebral vascular accident (CVA) or any and all neurogenic diseases.  Following identification of a neurogenic communication disorder, the patient is scheduled in the Neurogenic Speech-Language Clinic for an initial assessment.  After completion of the Initial assessment, the patient is enrolled in an aggressive acute care rehabilitation program.  Should the patient's treatment program extend beyond the length of stay guidelines established by medical center policy, the patient may be transferred to our long-term care facility (NHCU) for additional treatment, or be seen as an outpatient.  The Neurogenic Speech-Language Disorders Clinic is under the direction of Dennis R. Lutz, M.S.

Voice Clinic

Inpatients and outpatients who have a voice problem such as hoarseness, insufficient loudness, inappropriate pitch, a strained vocal quality, intermittent loss of voice and/or vocal fatigue are evaluated and treated in the Voice Clinic.  The voice problem may be attributed to a nodule, polyp, cyst or injury to one or both vocal cords.  Patients with laryngeal cancer resulting in hoarseness and requiring eventual removal of the larynx are seen in the Laryngectomy Clinic.  Before coming to the Voice Clinic, patients are first seen by an ear, nose and throat (ENT) physician to examine the throat, larynx and the vocal cords.  The Speech Pathologist and the ENT physician usually conduct a videostroboscopic examination of the vocal cords using a rigid endoscope.  Insertion of a flexible endoscope through the nose may, at times, be necessary.  Other instrumental approaches include the use of an analog pitch analyzer known as a Visi-Pitch and electroglottography, a noninvasive procedure used to examine specific aspects of vocal cord function.  The Speech Pathologist looks for possible voice misuse and/or abuse such as frequent shouting, excessive loud talking, frequent coughing, and hard throat clearing.  Frequently, a period of voice rest, eliminating abuses, establishing a new average conversational pitch level, and/or changing loudness is all that is needed to correct a voice problem.  The Voice Clinic is under the direction of Christopher R. McCrea, PhD and Robert S. King, M.A.

Stuttering Clinic

Patients who have stuttered since childhood or who have acquired stuttering behaviors after a brain injury are referred to the Stuttering Clinic.  Emphasis is given to changing the patient's attitude about his/her stuttering and focusing on the positive aspects of his/her communication.  Approaches such as relaxation, visualization, behavior modification and fluency shaping are used.  Treatment approaches are highly individualized.  What works for one person may not work for another.  The Stuttering Clinic is under the direction of Robert S. King, M.A.

Specialized Clinics

Infant-Toddler Language Clinic  (Ms. Teresa Boggs)

The TLC clinic is an assessment and intervention program for infants and toddlers birth
to three with communication delays or disorders. Children receive both one-on-one and
peer interventions within a setting that is arranged for natural communication exchanges. The TLC sessions last 60 minutes, twice each week at the on campus facility. Parents are actively engaged in the intervention during the semester through observation, and planned parent-child activities. Parents receive specific training as they view educational videotapes, watch demonstration of strategies and techniques for facilitating language development and assist with developing home programs.

Crumley House  

The primary purpose of the Crumley House, an adult day treatment center, is community
re-entry and integration of individuals who have experienced traumatic brain injury (TBI).  Rehabilitation at Crumley House includes behavior management and recreation and vocational programs. This off-campus center provides an opportunity for evaluation and treatment of adults who have cognitive and communicative disorders resulting from TBI and/or other neurological impairments. These disorders include deficits in perception and discrimination and memory, orientation, organization, reasoning and speech and language.

School Age Language Clinic 

The School Age Language Clinic is located on the campus of the East Tennessee State
University. It is an after-school program that provides both evaluation and intervention
services to children between the ages of 5 and 12 years. This program serves a diverse
client base that includes children with language and/or reading disorders, children with
phonological disorders, and children with developmental delays.

Child Phonology-Language Clinic 

The Child Phonology-Language Clinic provides assessment and intervention of speech and language impairments in children who are in the preschool to early elementary ages. Children are seen for twice weekly 50-minute individual sessions at the ETSU Speech and Hearing Clinic. In-depth speech, language, and phonological awareness testing is completed prior to designing individual intervention programs for children who exhibit moderate to profound speech and language impairments of a functional nature.

Resonance Clinic 

This program is an assessment and intervention clinic for both children and adults with nasal speech quality resulting from cleft palate or other causes. The services are provided 2 to 3 times per week for 60 minutes sessions depending on the individual needs of the client.

Speech-Language and Hearing Screening Program 

The Speech-Language and Hearing Screening Program is a community-based service that
provides screenings to preschool children. The screening includes brief assessment and
observation of the child’s speech, language, fluency, voice and hearing. Referrals and
recommendations are made as appropriate.