Speech therapy

Various individuals can require speech and language therapy. While some may be born with defects that produce physical or learning deficits, others may lose their speech and language ability at a later stage in life due to illness or disease. Following are some people who may seek and benefit from speech therapy:

• Babies with:
  • Feeding problems (Read more: Feeding your newborn in the first 24 hours) 
  • Swallowing problems
• Infants and older children with: 
  • General learning disability
  • Physical disability
  • Language delay
  • Difficulties in sound production
  • Hearing problems
  • Cleft palate
  • Stammering
  • Autistic spectrum disorders
  • Dyslexia
  • Voice disorders
  • Selective mutism
• Adults with: 
  • Stroke: Motor disability following a stroke results in eating, swallowing and/or communication problems
  • Neurological impairment and degenerative disorders like head injury, Parkinson's disease, motor neurone disease and dementia.
  • Cancer of the head, neck or throat 
  • Voice problems
  • Mental health problems
  • Learning difficulty
  • Physical disability
  • Stammering
  • Hearing problems
  • After laryngectomy surgery for cancer

Following are some speech and language disorders that can be treated or better managed with speech therapy:

• Articulation disorders: An inability to properly form certain word sounds is referred to as an articulation disorder. The patient might drop, swap, distort or add word sounds. An example of distorting a word would be speaking with a lisp and replacing “this” with “thith”.
• Fluency disorders: Fluency disorders of speech affect the flow, speed and rhythm of what is being spoken by the individual. Examples of fluency problems include stuttering and cluttering. A person with a stutter is unable to speak out loud without experiencing interruptions or blocks in their flow. They might even repeat a part of or the whole word repeatedly. Cluttering, on the other hand, refers to an individual’s tendency to merge words and speak rapidly.
• Resonance disorders: Due to an obstruction in the airflow through the nasal and oral cavities, sound vibrations travelling from the vocal cords are altered and a nasal quality is imparted to the voice. If an opening called the velopharyngeal valve does not close properly, resonance disorders can arise. Resonance disorders are often associated with cleft palate, neurological disorders and swollen tonsils. (Read more: Tonsillitis)
• Receptive disorders: Receptive language disorders refer to the trouble an individual may have processing and understanding what others say. This can result in the person falsely appearing disinterested in what others have to say, having a hard time following instructions and possessing a very limited vocabulary. Autism, hearing impairment and head injuries can cause receptive language disorders.
• Expressive disorders: When an individual has trouble conveying or expressing their thoughts or other information, they are said to have an expressive language disorder. There may be some difficulty in forming sentences and often wrong conjugations or tenses of the verbs are used. Usually, expressive language disorder stems from developmental impairments, including Down’s syndrome and loss of hearing. Trauma to the head or other medical conditions can also cause it.
• Cognitive communication disorders: Cognition refers to the ability of the brain to have thoughts. Communication difficulties that are resultant of injury to or disease in the part of the brain that regulates one’s ability to think leads to a cognitive-communication disorder. Other associated problems with cognitive impairment can be lapses in memory and difficulty with problem-solving, listening and speaking. Causes of cognitive-communication disorders can be abnormal brain development, certain neurological conditions, brain injury or stroke. (Read more: First aid for head injury)
• Aphasia: Aphasia is an acquired communication disorder that arises due to disturbances in a person’s ability to speak. The individual also experiences difficulty understanding others and has trouble reading and writing. Stroke is the most common cause of aphasia; however, other brain disorders can also cause it.
• Dysarthria: Acquired loss of control of muscles required for speech causes a characteristic slow and slurred speech to be produced. Neurological disorders that affect the nervous system, particularly conditions that cause paralysis of the facial nerves (responsible for innervating most facial muscles) and weakness of the tongue and throat are usually culpable for dysarthria. Examples include multiple sclerosis (MS), amyotrophic lateral sclerosis (ALS) and stroke.

The therapeutic journey begins by a consultation with the speech and language pathologist (SLP). The speech and language therapist begins by evaluating the individual’s current ability and assessing their deficits in order to diagnose the exact communication disorder plaguing the patient. Although patients are generally referred by doctors, the SLP also takes a medical, past and family history to ascertain the cause and expected type of communication disorder. The duration of speech and language therapy required varies depending on the individual’s age, type and severity of the speech disorder they are suffering from, frequency of therapy, underlying medical condition and the expected outcome of its treatment.

Speech and language therapy in children: Depending on the child’s communication (speech and language) disorder, the SLP will conduct the therapy session one-on-one, in a small group or in a classroom. The SLP conducts speech exercises depending on the child’s communication disorder, age and needs. Along with speech exercises, the SLP will demonstrate the correct sounds and vowel pronunciation to the child in a playful game-like manner. Use of other colourful visual aids like books, pictures and objects can stimulate language development in the child. Homework is regularly given to the parents or other caregivers to do speech exercises with the children.

Speech and language therapy in adults: Speech and language therapy in adults also begins by assessment of the type of communication disorder and the underlying diseases and other factors. Usually, adult patients have an acquired type of speech or language impairment, secondary to stroke, trauma, cancer, surgery, neurological diseases or degenerative disorders. This means that they may have had normally-functioning speech and language abilities but have lost them. They need to adjust with the help of rehabilitation, speech exercises and adopting strategies (including the use of assistive devices) to effectively communicate in spite of the acquired disability. Speech and language therapy in adult patients focuses on – speech, language, cognitive-communication and retraining of swallowing (in neurodegenerative diseases like Parkinson’s disease or oral cancers).

Speech exercises that are used with adult patients can include:

• Activities and exercises geared at improving cognitive-communication functioning: These include problem-solving activities, memory improvement and organisation tactics.
• Improving social communication skills: By building and learning conversation tactics, social communication can be improved.
• Rehabilitation exercises for facial muscle strength building: After suffering from a stroke, or a neurological or degenerative disorder that affects the nerves supplying the facial muscles responsible for creating the correct shape of the mouth to enunciate clearly, speech can become slurred, strange and tiresome for the patient. Exercises that focus on rebuilding lost strength in these muscles, and prevent their atrophy, can help normalise speech to a certain extent.
• In resonance disorders of speech, such as those in which a nasal twang inevitably sneaks in, breathing exercises can be practised to improve the vocal resonance quality.
• After total laryngectomy or the complete removal of the sound-producing voice box (larynx) in laryngeal cancer, patients are re-trained to produce sound by swallowing air and their breath in the upper esophagus in order to slowly eject it into the pharynx. The voice is rough and loud but understandable. Six to eight words can be spoken by the patient at a time by esophageal speech.
• Another method that can be used after total laryngectomy is aphonic lip speech, which is carried out by trapping air in the buccal cavity of the mouth.

In adult patients, other aids, applications and devices can also be used depending on the patient’s speech and language deficit baseline status and needs. Some examples of such tools are:

• Assistive listening devices (ALDs) help amplify the sounds you want to hear, especially where there’s a lot of background noise. They can be used with a hearing aid or cochlear implant to help the wearer hear certain sounds better.
• Augmentative and alternative communication (AAC) devices help people with communication disorders express themselves. These devices can range from a simple picture board to a computer program that synthesizes speech from text.
• Alerting devices connect to a doorbell, telephone or alarm that emits a loud sound or blinking light to let someone with hearing loss know that an event is taking place.
• After total laryngectomy (as in case of laryngeal cancer), speech can be produced by an artificial prosthesis implant that carries the air from the trachea (windpipe) to the esophagus (food pipe) to produce sound.
• Electrolarynx is a device that is held to the throat in post total-laryngectomy patients and produces sound to help with speech.
• Speech therapy mobile phone applications can be a huge help while being easily accessible.

The overall outcome of speech and language therapy depends on the type of communication disorder and the underlying cause. Some speech and language disorders arise in childhood, and with adequate and appropriate therapy, are resolved by adulthood. However, other disorders could persist lifelong and the individual would have to adapt their lifestyle to accommodate the disability. Furthermore, some seemingly healthy adults who have never experienced communication disorders may acquire it following the development of neurological diseases, like multiple sclerosis (MS) or after a stroke. Timely initiation of speech and language therapy along with treatment for the underlying cause can effectively help manage communication disorders. Although it may not be possible to cure the underlying disease or disability in all cases, effective management strategies can be adopted to lead a meaningful life.