Speech and Language Therapy

What is speech and language therapy?

Speech and language therapy is an intervention service for children and adults with communication difficulties, (and also eating and drinking difficulties). The aim of therapy is to enable children and adults to reach their fullest potential in terms of their speech, language and communication development, which in turn will enable them to function and participate more fully in all aspects of daily life.
It is sometimes mistakenly thought that speech and language therapy is only for children with articulation difficulties or conditions such as a stammer. In fact, speech and language therapy can benefit children and adults with all types of speech, language or communication impairment, including difficulties with understanding language or maintaining conversations.

Speech and Language development:

It Is Important To Keep In Mind That Children Develop Their Speech And Language Skills At Their Own Unique Rate.
As children mature, their speech and language skills mature aswell. Their vocabulary increases, sentences become larger andmore complex and they are able to converse at a fairly adultlevel.

Age

Language Level

Birth

Cries

2-3 months

Cries differently in different circumstances; coos in response to you

3-4 months

Babbles randomly

5-6 months

Babbles rhythmically

6-11 months

Babbles in imitation of real speech, with expression

12 months

Says 1-2 words; recognizes name; imitates familiar sounds; understands simple instructions

18 months

Uses 5-20 words, including names

Between 1 and 2 years

Says 2-word sentences; vocabulary is growing; waves goodbye; makes “sounds” of familiar animals; uses words (like “more”) to make wants known; understands “no”

Between 2 and 3 years

Identifies body parts; calls self “me” instead of name; combines nouns and verbs; has a 450 word vocabulary; uses short sentences; matches 3-4 colors, knows big and little; likes to hear same story repeated; forms some plurals

Between 3 and 4 years

Can tell a story; sentence length of 4-5 words; vocabulary of about 1000 words; knows last name, name of street, several nursery rhymes

Between 4 and 5 years

Sentence length of 4-5 words; uses past tense; vocabulary of about 1500 words; identifies colors, shapes; asks many questions like “why?” and “who?”

Between 5 and 6 years

Sentence length of 5-6 words; vocabulary of about 2000 words; can tell you what objects are made of; knows spatial relations (like “on top” and “far”); knows address; understands same and different; identifies a penny, nickel and dime; counts ten things; knows right and left hand; uses all types of sentences

As for any skills, the age that specific sounds shouldemerge have a wide range. Young children often do not and arenot expected to pronounce all speech sounds correctly. Soundsare learned in a developmental sequence and come with time aswell as talking experience. Age of acquisition may vary accordingto the various research available.

Various areas of Speech and Language defined:

ARTICULATION & PHONOLOGY:

The mechanical production of sounds is articulation, whereas, the science of speech sounds and soundpatterns. Articulation errors usually take the form of leaving out a sound, substituting one sound for another and or distorting a sound. While, a phonological process disorder involves patterns of sound errors. For example: an individual may drop all endings of words, or turn all back sounds such as /k/ and /g/ into sounds produced in the front of the mouth such as /t/ and /d/, eg. Saying “tar” instead of “car” or “dum” instead of “gum”.
Adults can also have speech sound disorders. Some adults continue to have problems from childhood, while others may develop speech problems after a stroke or head injury.

TONGUE-TIE:

Normally the free tip of the tongue is mobile. However if the lingual frenulum, which is a small fold of mucous membrane extending from the floor of the mouth to the underside of the tongue., is too short, tongue tip mobility is reduced. Research has shown that tongue-tie may or may not cause articulation errors. If articulation is impacted, clipping the frenulum is a common surgical procedure.

TONGUE THRUST / OROFACIAL MYOFUNCTIONAL DISORDER (OMD):

Usually an individual with tongue thrust has a deviant swallow. In a normal swallow the tongue pushes backwards. In a deviant swallow the tongue tip pushes against the front teeth. The tongue may exert force during speech production against the front teeth. Even at rest the tongue may be carried more forward in the mouth. This may contribute to an open bite and other dental issues.

FLUENCY:

A fluency disorder refers to a break in smooth speech. Everyone has disfluencies from time to time. Stuttering is speech that is more disfluent than average. The flow of speech is disrupted by involuntary repetitions and prolongations of sounds, syllables, words or phrases as well as involuntary silent pauses or blocks in which the person who stutters is unable to produce sounds.The term "stuttering" covers a wide range of severity, encompassing barely perceptible impediments to severe symptoms that effectively prevent oral communication.

VOICE:

Individuals who display noticeable hoarseness, loss of voice, inappropriate volume, ora nasal/denasal quality may have a medical condition being the underlying cause of the disorder. They must be seen by an EarNose and Throat Doctor before receivingvoice therapy.

LANGUAGE:

Includes semantics, syntax and pragmatics. Semantics refers to word meanings, syntaxrefers to grammar and pragmatics refers to actual use of language. Expressive language refers to use of words and construction ofthoughts while speaking. Receptive language refers to the understanding or comprehension of what was said or written.
When a person has trouble understanding others (receptive language), or sharing thoughts, ideas, and feelings completely (expressive language), then he or she has a language disorder. A stroke can result in aphasia, or a language disorder in adults. In children, delayed speech and language development is the most common developmental problem, where, either the child’s language is developing in the right sequence, but at a slower rate or there is an abnormal language development pattern.
Both children and adults can have speech and language disorders. They can occur as a result of a medical problem or have no known cause.

AUDITORY PROCESSING:

Is the natural process of taking in sound through the ear and having it travel to thelanguage area of the brain to be interpreted. To have a breakdown in this process is calledan auditory processing disorder. This deficitis present despite having normal hearing.Auditory processing is "What our brain does with what the ear hears." When one is faced with an auditory processing deficit, his or her ears can pick up the sounds, words, etc., but his or her brain is not able to process the sounds properly. The auditory information becomes jumbled up or confused and therefore misunderstood.


Intervention:
In speech-language therapy, a speech language specialist will work with a child one on one or in a small group to overcome difficulties involved with a specific disorder. therapy should be individualized to meet each child's needs.

LANGUAGE INTERVENTION:

The Speech Language Specialist’s job is tomodel the language rules in the areas oflanguage function, syntax, semantics, andpragmatics that the individual has deficit in.The target of intervention will varywith the age, functional level of the individualand his/ her needs. Some examples ofteaching methods include: modeling,cueing and responding. Speech LanguageSpecialists should be collaborating withteachers and parents (in case of kids)and family and caregivers (in case of adults) to providemaximum carryover of treatment targets.
Language difficulties put children at greater risk of poor literacy, mental health issues and poorer employment outcomes in adulthood. Speech and language therapy is a vital service that improves children’s language and communication skills, and aids their personal development. Speech and language therapy also plays an important role in the rehabilitation of stroke survivors by assessing their needs and providing appropriate strategies to support their speech, language, communication and swallowing needs. 

AUDITORY PROCESSING TREATMENT:

Treatment generally focuses on threeprimary areas: changing the learning orcommunication environment, recruitinghigher-order skills to help compensate forthe disorder, and remediation of theauditory deficit itself. The primary purposeof environmental modifications is toimprove access to auditorily presented information.Suggestions may include use ofelectronic devices that assist listening,teacher-oriented suggestions to improvedelivery of information, and other methodsof altering the learning environment so thatthe child with APD can focus his/ her attentionon the message. Compensatory strategiesusually consist of suggestions for assistinglisteners in strengthening centralresources (language, problem-solving,memory, attention, cognitive skills) so thatthey can be used to help overcome theauditory disorder. In addition, many compensatorystrategy approaches teachindividuals with APD to take responsibility fortheir own listening success or failure and tobe an active participant in daily listeningactivities through a variety of active listeningand problem-solving techniques. Finally,direct treatment of APD seeks to remediatethe disorder, itself. There exists a widevariety of treatment activities to addressspecific auditory deficits. Some may becomputer assisted; others may include one-on-one training with a therapist.

ARTICULATION THERAPY:

Speech Language Specialists teachindividualswith articulation disorders how toproduce sounds correctly in their mouths.This can be difficult becausethey may have to change the way theyspeak. The SLS will physically show theindividual how to make specific sounds. Inessence, traditional articulation therapyinvolves behavioral techniques, focused onteaching new sounds in place oferror sounds or omitted sounds. Often thisis done one sound at a time, and then theSpeech Language Specialist gradually introducesthe new sound into longer and longerutterances, and eventually into everydayconversational speech. This sequence thattakes the individualsfrom single sounds up toincreasingly complex utterances is oftenreferred to as a treatment hierarchy.

PHONOLOGICAL THERAPY:

Goals in phonological therapy differ fromarticulation therapy in that phonologicalprocesses or rules are treated rather thanthe individual sounds themselves. Contrastsbetween phonemes are emphasized. Goalof therapy is eliminating broad patternsrather than training specific sounds.

ORAL-MOTOR THERAPY:

The SLS will use a variety of oral exercisesoften in conjunction with articulationtherapy — various tongue, lip, and jawexercises — to strengthen the muscles ofthe mouth ultimately improving articulatoryaccuracy.

VOICE THERAPY:

Voice therapy begins only after the individual was seen by an ENT. The overall aim ofvoice therapy is to teach a healthy, non-abusivevoice production pattern. The treatmentof nodules and vocal strain begins by educating the individual and his or herfamily about the nature of the problem,including its signs and symptoms, causesand risk factors. The individual is taught aboutvoice production: phonation (how thesound is produced by the vocal cords);respiration (breathing); and, resonance. Theidea of adequate breathing patterns isexplained, and the individual is helped to “feel”the sensations of appropriate breathsupport while sitting, standing and lyingdown.

STUTTERING:

There are several approaches to stutteringtreatment. Stuttering modification therapy,also known as traditional stuttering therapyfocuses on reducing the severity of stutteringby changing only the portions of speechin which a person stutters, to make themsmoother, shorter, less tense and hard. Thisapproach attempts to reduce the severityand fear of stuttering, and strives to teachstutterers to stutter with control, and not tomake the stutterer fluent. Therapy usingthis approach tends to recognize the fearand avoidance of stuttering, and consequentlyspend a great deal of time helpingstutterers through those emotions. Stutteringtherapy usually translates intohim/her learning to talk in an easier manner,and building positive emotions andattitudes about talking.

OROMYFUNCTIONAL THERAPY:

Will treat the effects of a tongue thrust onswallowing, rest postures, and speech whenarticulation of sounds is impacted.

SPEECH LANGUAGE THERAPY FOR CHILDREN WITH HEARING IMPAIREMENT

Adults who gradually lose their hearing over time already understand language and have speech. Infants and young children have not yet learned these skills. In young children with hearing loss, speech and language development can be delayed. Speech-language pathologists work with families to help their children with hearing loss develop language understanding (reception) and language use (expression).
Children with hearing loss need training to learn to listen well while using a hearing aid or hearing assistive device. One of the first things they learn is to be aware of the sound of their parent’s voice and other interesting things in their home environment. Very quickly, they learn that sounds have meaning. Parents can help by naming different sounds for them. For example, “Listen, I hear the dog. He is barking, woof.” As they get older, they will be taught to “discriminate” between different sounds of speech (e.g., “b” sounds different than “th”).
Young children and infants will need help with their hearing aids or cochlear implants. For this reason, family members and/or caregivers must be trained in the care and consistent use of this equipment. This training includes proper daily care and adjustments of the device to maximize performance. As children get older, it is important for them to gradually become responsible for caring for their own devices and communication needs.