Speech Therapy is More Than Just Speech
A lot of people think of speech therapy as just for children with a lisp or stutter. Slurred speech, delayed speech, and stuttering are common reasons you might seek out a speech-language pathologist. But these specially trained therapists can help restore your ability to swallow, improve a hoarse or raspy voice, and remediate short-term memory and thinking skills. Ivy Rehab partner clinic, Generation Care Speech Language Pathologist (SLP), Michelle Davis, MA, CCC-SLP, first became interested in the profession while in high school. She job shadowed a speech-language pathologist who was working with a patient with memory loss after a car accident.
“She had no problem speaking; the problem was with her thinking,” Davis said. “I saw how life can change so quickly, and how I wanted to be a part of helping.” Speech-language therapy can give people the right tools and exercises to improve memory and speech patterns after an accident, brain injury, or stroke. Davis also works with a lot of patients who have difficulty swallowing, known as dysphagia, so they can get off a feeding tube. “I think 90 percent of the general public think that is all we do, work to help people talk, and that is just a small part of what we do,” she said.
Who Needs Speech Therapy?
May is Better Hearing and Speech Awareness Month and a great time to clear up some of the misconceptions about what speech therapy actually encompasses. Speech-language pathologists are highly trained to evaluate and treat acute and chronic conditions from birth to death. “I have treated babies, and I have treated a 104-year-old in hospice care,” Davis said. “That is what makes the profession so exciting and unique.” Speech therapy really runs the gamut and spectrum of ages. While early intervention helps with speech delays, SLP is definitely not just for children.
Common diagnoses where a referral for speech therapy can help include:
- Developmental delays
- Genetic disorders
- Stroke, brain injury, concussion, and other neurological conditions
- Parkinson’s disease
- Dementia and Alzheimer’s disease
- Brain/throat/mouth cancers
- COPD, recurrent aspiration pneumonia, GERD/reflux, and seizures
Speech-language pathologists work with a wide variety of disorders that involve speech, language, reading, writing, comprehension, cognition, memory, attention, voice, swallowing, and other behaviors. Davis, the Dysphagia Specialty Team Leader, has extensive experience treating patients with a variety of SLP-related difficulties. Most of the patients she treats are adults, but Ivy Rehab also has clinicians who specialize in pediatric speech therapy. While most seek treatment after a life-changing event, such as a stroke, fall or car accident, speech therapy can improve voice clarity, rate of speech, misarticulation, enunciation or correct a strong accent.
“It’s such a broad field I don’t think a lot of people understand all of the skills we can provide,” Davis said.
Signs of speech and language disorders in children include:
- Does not babble (4-7 months)
- Does not understand what others say (7 months-2 years)
- Says only a few words (12-18 months)
- Words are not easily understood (18 months-2 years)
- Does not put words together to make sentences (1.5-3 years)
- Has trouble with early reading and writing skills (2.5-3 years)
- Says p, b, m, h, and w incorrectly in words (1-2 years)
- Says k, g, f, t, d, and n incorrectly in words (2-3 years)
- Produces speech that is unclear, even to familiar people (2-3 years)
- Struggles to say sounds or words (stuttering)
Speech therapists can help detect and correct early developmental delays. For children, early intervention and therapy can resolve improper speech patterns, improve reading, spelling, and writing, and help them keep pace with their peers. Many SLPs work in schools and with autistic children in clinical settings. Parental involvement is another key to success. Speech therapists teach parents how to encourage a child to use language and social cues. In therapy, they use playing and talking, games and books, and reward systems to stimulate language development.
“Parents will say ‘oh they will outgrow it, let’s wait and see,'” Davis said. “It’s best to get the evaluation, to at least get some guidance and tips and tricks so they can be followed by a speech therapist, as well to make sure they are hitting those milestones.”
Signs of speech and language disorders in adults include:
- Speaks in short, fragmented phrases (expressive aphasia)
- Says words in the wrong order (expressive aphasia)
- Struggles with using words and understanding others (global aphasia)
- Difficulty imitating speech sounds (apraxia)
- Inconsistent errors (apraxia)
- Slow rate of speech
- Slurred speech (dysarthria)
- Hoarse or raspy voice (dysphonia)
- Difficulty swallowing or frequent coughing during eating (dysphagia)
- Difficulty with attention, “thinking,” memory (cognition)
With adults, most recognize when they have a speech impediment or impairment. It can range from slurring or speaking softly to the tip-of-the-tongue syndrome. They notice “I can’t think of the words I want to say or I get lost in my train of thought,” Davis said.
“A lot of this can happen after a stroke or a brain injury or a fall or a concussion,” she said. “Brain injuries can bring on all of those types of issues.”
Even normal aging can cause memory impairment or moments of blanking out. Speech therapy can provide activities and exercises that help keep the brain sharp and improve the quality of life for elderly patients. SLPs can help identify signs of dementia or Alzheimer’s or refer patients for additional testing and specialists. Speech therapists also assist family members and caregivers of Alzheimer’s and dementia patients with how to manage and respond to certain behaviors and keep their loved one safe at home. Difficulty swallowing, or coughing or choking during meals, is another common problem Davis treats in all ages. She shows patients different swallowing exercises and strengthening exercises for the muscles of the throat, along with recommendations for changing a person’s diet. It’s life-changing for a person to be able to eat out in public or attend family gatherings.
“The most gratifying work that I do is helping people get off of feeding tubes,” she said. “Such a big part of our social lives is eating and going out to restaurants and family dinners. Depression can sink in.”
More than Speech Issues
Language therapy involves working with children who have difficulty formulating sentences or have decreased vocabulary. It also includes re-acquisition of vocabulary and assists with word-finding/blocking issues that are common following a stroke or traumatic brain injury.
Cognition therapy involves working with individuals who have difficulty with concentration, memory, and high-level organization following a concussion, traumatic brain injury or dementia.
Voice therapy involves two routes. SLPs work with patients who have a hoarse, harsh or raspy voice secondary to overuse, nodules, polyps, and reflux, Davis said. Others need therapy to strengthen their voices associated with conditions such as Parkinson’s Disease, stroke, and degenerative diseases.
Swallowing therapy involves assessing swallow, either in the clinic or at the hospital with an x-ray, and working with the patient to treat and decrease the risk of coughing, choking, or aspiration during eating and swallowing.
Where and How to Seek Out Speech Therapy
Speech therapy is provided in a variety of settings: acute care hospitals, outpatient clinics, skilled nursing facilities, home care, and schools. The requirements for accessing treatment can vary from state to state and insurance providers. In most cases, speech therapy requires a referral. This is why it is important for patients and caregivers to express their concerns and talk to their doctor, Davis said. People need to know that help is out there.
“We are here to help; we just need to be guided to that person to help them,” she said. “They need to be educated to say ‘I am having this problem.'”
A plan of care, including the number and frequency of visits, is based on the severity of the impairment or how near you are to the initial injury date. In most cases, it’s better to start rehabilitation soon after the injury/onset. Gains can still be made as time passes, Davis said, but it becomes more strategy and compensation at that point. Sessions typically last 30-45 minutes and the SLP plans the session prior to the patient’s arrival with tasks that are considered “just right,” meaning not too challenging to frustrate the patient, and not too easy so that positive changes and new skill development can occur. Davis also emphasizes that any plan of care continues outside of therapy. It requires the patient’s and caregiver’s buy-in to practice exercises on a regular basis and work to change behaviors and speech patterns.
“The key takeaway is really about how the span of your lifetime could involve speech therapy in some capacity,” she said. “Every person in the world has to communicate, has to eat and swallow safely to survive, has to have the ability to think, and speech therapy works with all of those things. It’s such a key part of every person’s life at any age.”
We’re Here to Help
If you are struggling with your speech in any way, there is no need to feel ashamed, embarrassed, or suffer in silence. Don’t let a speech delay, memory problems, or a hoarse voice interfere with your job, work, or hobbies. Let Ivy Rehab’s dedicated and highly trained speech-language pathologists help you speak with clarity and confidence! Talk to your doctor or contact a clinic near you to learn more about how we can help.
Article Reviewed by Holly Lookabaugh-Deur, PT, DSc, GCS, CEEAA
Holly Lookabaugh-Deur, PT, DSc, GCS, CEEAA is a practicing physical therapist and a partner and Director of Clinical Services at Ivy Rehab Network. Deur is board certified as a geriatric clinical specialist and certified exercise expert for aging adults with more than 35 years of clinical experience. She is certified as an aquatic and oncology rehabilitation specialist and serves as adjunct faculty at Central Michigan University and Grand Valley State University.