Speech And Language Therapy

7.12.05

What does a speech therapist do?
• Work with children and adults who have communication difficulties, and/or problems with eating/drinking/swallowing.
• Work in partnership with range of professionals from variety of agencies.

Knowledge and skills
• 4-year degree course.
• Anatomy and physiology (particular emphasis on head and neck).
• Phonetics and linguistics.
• Psychology.
• Child development.
• Speech pathology and therapeutics.

Where can you find speech and language therapists?
• Community health centres.
• Hospitals - wards and outpatients.
• Mainstream and special schools.
• Day centres and homes.
• Courtrooms, prisons and young offenders' institutes.

Assessing communication impairment.
• Have well-established knowledge of process required to communicate effectively.
• Ability to identify whether impairment at language or speech level.
• Separate problems of understanding and expression.

Communication framework.
• Language.
-Phonology (sounds).
-Syntax (grammar).
-Semantics (meaning).
-Pragmatics (social rules).
• Speech.
-Articulation.
-Voice.
-Fluency.
-Resonance.

Client groups.
Children…
• Feeding and swallowing difficulties.
• Learning difficulties (mild, moderate, severe).
• Language delay.
• Specific language impairment.
• Specific difficulties in producing sounds.
• Hearing impairment.
• Cleft palate and other structural abnormalities.
• Stammering 9stuttering).
• Autism.
• Dyslexia.

Adults…
• Eating, swallowing and communication problems following stroke, head injury.
• Neurological impairment and degenerative conditions.
• Cancer of head, neck and throat, including laryngectomy.
• Voice problems.
• Mental health issues.
• Learning difficulties.
• Physical difficulties.
• Stammering.
• Hearing impairment.

How many have these problems in the UK? 2.5 million or more?
• Improved mortality rates in premature and very sick infants.
• Complex surgery available.
• Health care for long-term disabled improved.
• Improved trauma care for head injury.
• Better recognition.
• Still missing some - youth offenders.

Stroke
• Around 30% stroke patients will experience significant communication difficulties.
• 45% stroke patients admitted into hospital will experience swallowing problems, either transient or long-term.

GLOSSARY
Dysphasia
• Loss of ability to formulate, express or understand meaning of spoken needs.
• May also be difficulty in reading, writing, understanding and using gesture.

Dysarthria
• Occurs at speech level.
• Can be slurred, weak articulation with poor coordination of breathing and voicing.

Dyspraxia
• Inability to perform sequence of movements, despite having normal power, sensation, coordination and understanding.

Broca's dysphasia
• Motor/expressive dysphasia.
• Comprehension good, handwriting poor.
• Speech may be limited to a few repeated words.
• 'Shorthand' speech - conjunctions/articles missing.

Wernicke's dysphasia
• Sensory dysphasia.
• Comprehension and handwriting poor.
• Speech nonsensical, but fluent with seemingly accurate grammar and social phrases.
• Nonsense words/wrong words.
• Patient unaware.
• Sometimes confused with speech of someone with dementia.

Global dysphasia
• Mixed motor and sensory dysphasia.
• Impaired understanding.
• Non-fluent speech.
• If severe, poor prognosis.

Core programmes
• Direct one-to-one/group programmes.
• Training carers both professional and non-professional.
• Dysphasic support (voluntary sector).

NB. Different expectations for communication than for mobility.

Dysphagia (eating, drinking, swallowing)
• 33% in acute care.
• 66% in long-term care.
• 30% of stroke patients.
• Only one-third of sufferes get professional help.
• UK has poor European record.

Loss of communication may result in:
• Affected self-esteem.
• Affected retirement plans.
• Changed relationships with partner, family members - living with stranger.
• Bring about sense of isolation, boredom, depression.