Speech and language therapy !!!!!

The people who find it difficult to verbally communicate with others can resolve their problems by undergoing a certain kind of therapy

Hassan was first evaluated for speech and language difficulties at the age of three years and one month. His parents at the time reported that he uttered only a few words. His most frequent communicative attempts involved gesturing, producing certain favourite syllables (such as ba) and whining. According to his parents, it looks as if he understood much of what is said to him. Hassan’s motor development seemed within normal limits.

Azra, age 46, suffered a stroke. One month after her stroke, her verbal output was limited in quantity and had difficulty finding the appropriate words to complete a sentence. Characteristically, she spoke in short phrases, and some grammatical problems were evident. Her comprehension was considerably better than her speech although she had problems comprehending complex instructions and messages.

Language is our most human characteristic. It is essential to learning, working and enjoying family life and friendship. Think of a person who cannot communicate verbally; who has difficulty in telling others his needs and thoughts; and sho cannot enjoy a conversation with others because he cannot participate in it. Or think of a child who is facing learning difficulties because he has problems in speech and language. Some of these individuals need the speech and language therapy.

What is speech and language therapy?

Speech and language therapy is a treatment programme designed to regain and increase/improve the person’s ability to communicate with others.

How does speech and language therapy work?

We correspond by encoding our thought into language and conveying to others using speech, language and gestures.

• Speech

• Language

• Body gestures and facial expressions.

Let’s examine them one by one

Speech is a very coordinated process. During which we use our breath to produce sound (voice). This is then shaped by movements of our lips, tongue, teeth etc., (articulation) into meaningful words. These words come out of our mouth fluently in a form of a sentence. Thus speech consists of three parts: voice, articulation and fluency.

Language gives us rules to make words and also rules to put them together to form meaningful sentences.

We also use our facial expressions, hand gestures and body movement to communicate.

The speech and language therapy encompass all these areas and it is the job of a speech and language therapist to assess, diagnose and then design a treatment programme to correct or rehabilitate the person so that he/she can communicate efficiently.

Who is a speech and language therapist?

The speech and language therapist is a person who specializes in this type of treatment. Such therapists either have a master’s degree or a diploma in speech and language therapy with ample clinical experience. A speech and language therapist may specialize in certain kind of problems; so it is important to choose a speech and language therapist carefully.

Who needs speech and language therapist?

Any person who has difficulty with verbal communication or swallowing due to any reason physical or cognitive should consider the speech and language therapy.

What kind of problems does the therapy treat?

There are four kinds of problems that the speech and language therapy can treat. They are:

• Speech

• Language

• Cognition or thinking skills

• Swallowing problems

The person with speech problem may have difficulty in producing voice, articulation or fluency. These problems make such persons’ speech less clear and harder to understand. Examples include stuttering, a lisp and garbled speech after stroke, loss or impairment of the voice.

Language is the use of symbols, such as words, numbers or gestures that have meaning. The person with language problems may have trouble understanding or accurately choosing words, numbers or gestures. Such people may lack the necessary vocabulary needed to understand or have difficulty putting the words together to make a grammatically correct sentence. In order to communicate accurately with others, they must be able to pay attention, concentrate and use various thinking skills. For treatment of certain language problems the speech and language therapist may need to work on these thinking skills.

We depend on swallowing in order to get the nutrients we need to live. Swallowing difficulties is a general term used to describe the inability to move food from the mouth to the stomach. By and large swallowing can be divided into three phases:

• Oral phase — sucking, chewing, and moving food or liquid into the throat

• Pharyngeal phase — triggering the swallowing reflex, squeezing food down the throat, and closing off the airway to prevent food or liquid from entering the airway ( aspiration ) or to prevent choking

• Esophageal phase — relaxing and tightening the openings at the top and bottom of the feeding tube in the throat (esophagus) and squeezing food through the esophagus into the stomach.

Difficulty may occur in any of these phases. A person may have swallowing problems if there is an injury or illness that affects the nerves or muscles in the tongue, mouth or throat such as cerebral palsy, stroke, cleft palate or cleft lip. Swallowing problems can also happen if there has been surgery to remove parts of the mouth or throat.

Illnesses for which the therapist is usually consulted

• Congenital problems like cleft palate or cleft lip

• Cerebral palsy children, if there is impairment in their speech and language

• Stuttering

• Articulation errors

• Delayed speech in children

• Language difficulties

• Children with learning difficulties specially learning language

• Psychological problems like autism, ADHD, mental retardation and conversion disorders

• Hearing impairment

• Abnormal childhood languages.

• Voice problems like harsh voice may have physical or functional reasons.

• After trauma which result in loss of language or speech

• After stroke which result in loss of speech & language (aphasia, dysarthria)

• Apraxia (disorder of impaired voluntary movements)

• After cancer surgery involving mouth or throat.

• Swallowing problems

When someone goes to a speech and language therapist he/she will listen to your problem and assess you by giving you certain tests. These are not the usual tests as in school or in laboratory. The therapist may physically examine the areas involved. You may be required to answer certain questions. Repeat certain words or sentences. The therapist will record your responses on paper or may use a tape recorder.

Usually the physician has referred you to a speech therapist but if there is need to refer back or a further investigation is a necessity you may be referred to the appropriate physician by the speech therapist.

The speech and language therapist will design a treatment programme which is best for the patient. This will be based on many factors. Some of them are:

• The type and the extent of illness

• Disability

• Type and extent of handicap (if present)

• Motivation of the person

• Home situation

• Extent of the speech impairment

Depending on the above mention factors the range of treatment includes:

• Counseling.

• Physical strengthening exercises.

• Training and repetitive exercises.

• Exercises to build language skills.

• Use of devices that can make it easier for some people to speak and communicate.

The speech and language therapist also works closely with family members or significant others.

How long does the treatment last?

Every patient will see a speech and language therapist for his/her individual reason/problems. Each will receive a specific treatment programme to suit his/ her needs. The number of times you see a speech and language therapist depends on your specific reason for seeing one. Just like some diseases take longer to treat than others. Some speech problems take longer to correct than others. You may see your therapist once a week or a few times a week and your treatment can take any where from a few weeks to a few months to a few years.

The best thing patients can do for themselves is practise, practise and practise. Repeat the same exercises at home that have been taught in the therapy session. Don’t just rely on work you do during your sessions with the speech and language therapist. The more you practise, the shorter your therapy will be and the sooner you will be speaking comfortably and confidently.

Where does one find such a therapist?

Speech and language therapists work in a number of environments that include:

• Hospitals

• Special schools

• Health care centers

• Some times they visit patient’s home