Speech therapy, also called speech-language therapy or speech-language pathology, is the evaluation and treatment of problems with speech, language, and swallowing. Experts in this field are usually called speech-language pathologists (SLP’s). They work with children and adults whose speech and language problems interfere with communication, call attention to themselves, and frustrate both speaker and listener. Speech-language pathologists also work with individuals who have problems swallowing. Such problems can make it difficult for the sufferer to get adequate nutrition. Some SLP’s conduct research on the normal development and production of speech and language and on the causes and treatment of speech-language and swallowing disorders. Speech-language pathologists who work with patients are sometimes called speech therapists or speech clinicians.
Types of disorders.
Speech language pathologists treat several types of speech-language impairments. These can include: (1) articulation problems, (the inability to produce certain speech sounds); (2) stuttering, cluttering (rapid, slurred speech), and other fluency problems; (3) voice disorders, including problems of pitch, voice quality, and volume; (4) delayed or disordered speech, characterized by a child’s slow or abnormal language development; (5) aphasia, difficulty in the ability to understand and use language; and (6) apraxia, the inability to voluntarily produce speech sounds in the correct order. In addition, SLP’s treat swallowing disorders, also referred to as dysphagia.
Some speech-language and swallowing disorders result from a physical condition, such as brain damage, cleft palate, damage to the larynx (voice box), or partial or complete deafness. Other speech-language impairments may be related to a person’s environment. For example, a child who receives little encouragement to talk at home may not develop normal speech skills. Severe emotional stresses, such as pressure to succeed or a lack of love, can also lead to speech difficulties.
Diagnosis and referral.
In many schools, SLP’s regularly test students for speech-language impairments. If students have a problem, they may receive therapy at the school, or they may be referred to a speech clinic for treatment. Many physicians, psychologists, and teachers refer people with speech-language problems to such clinics.
Adults may require speech-language therapy following an injury that leads to communication or swallowing problems. They may receive therapy from SLP’s while in a hospital or as outpatients after they are discharged. Elderly adults who live in nursing homes may also receive speech-language and swallowing therapy.
Speech-language pathologists diagnose their patients’ speech-language and swallowing problems and try to learn the causes of these impairments. They take detailed case histories and give their patients special speech, language, and swallowing tests. Swallowing ability may be evaluated using an X-ray machine. The SLP may determine that the patient needs other medical or psychological treatment in addition to speech-language and swallowing therapy.
Treatment.
The SLP begiins treatment by gaining the confidence of the patient. For the best results, the individual should enjoy being with the therapist and want to follow instructions.
To determine the proper course of treatment, the SLP must consider the patient’s age and case history, the type of disorder, and the data gained during therapy. Speech-language pathologists talk to the patient, the patient’s family, teachers, and others who have close contact with the patient, such as teachers or other medical professionals. The success of treatment depends largely on the cooperation of these people.
Methods of treatment vary from case to case. People who have difficulty producing speech sounds must be helped to identify their speech problems and to tell the difference between their speech and normal speech. Then, the SLP teaches the patient new speech skills. If a person is unable to communicate through speech due to a stroke or some other injury or health problem, the therapist will help find alternative ways for the person to communicate.
Speech therapy may be given individually or in groups. Speech-language therapists put patients in groups if they think that contact with people who have similar impairments will lead to improvement. Patients may receive encouragement by listening to others and by hearing the improvement of members of the group. Some patients attend both individual and group sessions.
History.
Little progress in the treatment of speech disorders occurred until the 1700’s and 1800’s. During the 1700’s, speech specialists worked mostly with the deaf. Successful teachers of the deaf included Thomas Braidwood, a Scottish mathematician. Braidwood taught his students to talk by starting with simple sounds and then progressing to syllables and, finally, words.
The 1800’s brought much research into the causes and treatment of stuttering. Physicians known as “speech doctors” had an interest in various communication disorders, especially stuttering. In 1817, Jean Marie Itard, a French physician, declared that stuttering resulted from a weakness of the tongue and larynx nerves. He recommended exercises to cure stutterers. During the late 1800’s, Adolf Kussmaul, a German physician, wrote about the physical and psychological causes of stuttering. In the United States, Alexander Melville Bell and his son Alexander Graham Bell designed a system of visible speech. Visible speech provided a visual code that indicated the position of the tongue, lips, and throat during speech. The code was used as a teaching method for persons who had difficulty producing speech. See Bell, Alexander Graham.
Speech therapy became a profession in the early 1900’s, when therapists were known as “speech correctionists.” Two professional speech therapy organizations formed in the early 1900’s. The National Society for the Study and Correction of Speech Disorders was made up of teachers and was affiliated with the National Education Association. Another group of physicians, scholars, and public school administrators formed the American Academy of Speech Correction, which later became the American Speech and Hearing Association (now the American Speech-Language-Hearing Association).
During World War II (1939-1945), many soldiers and military personnel developed speech defects as a result of war injuries. The need for speech rehabilitation services attracted large numbers of men and women to the profession of speech therapy. Many speech clinics opened, and research increased into speech problems and their causes. Since the end of World War II, the field of speech therapy has expanded rapidly.
Careers.
Many universities offer undergraduate and graduate training in speech-language pathology. People who want to work as SLP’s must obtain a master’s degree. Most people who intend to teach in a college or university or to direct a clinic or research program have a Ph.D. degree.
Undergraduate students interested in speech-language therapy take courses in biology, linguistics, psychology, and physics and introductory courses on communication disorders. Graduate training generally covers the following areas of study: (1) the normal development of speech, language, and hearing; (2) the evaluation of speech and language abilities, auditory skills, and swallowing abilities; (3) the nature of communication and swallowing disorders; (4) treatment procedures; and (5) research techniques.
Many speech-language pathologists work in schools. Others are employed by private institutions, including hospitals, specialized community speech and hearing centers, and university speech clinics. Some speech-language pathologists conduct research and teach in universities. An increasing number of speech-language pathologists are entering private practice. Further information about the profession can be obtained from the American Speech-Language-Hearing Association, which has its headquarters in Rockville, Maryland.
