AN INTRODUCTION TO SPEECH THERAPY

Dr. Ghulam SaqulainHead Of Department of ENT

Capital Hospital

Who is a ‘Speech Therapist’?

A person who specializes in the diagnostic procedures, evaluation techniques, assessment tools and various therapeutic techniques related to different communicative disorders.

What is Speech Therapy?

“Speech Therapy is a rehabilitative procedure undertaken in order to help the people having any kind of Communication Disorders or Problems and some swallowing problems”

AIMSThe problems these people face have many sources, some stem from the Physical cause, Psychologically based, some have roots in the Childhood environment, and some may result from an un measurable combinations of these factors/ causes.Regardless of the cause or causes Speech Language Therapist tries to help the whole person who is experiencing the communicative difficulty.In some instances the problem is “CURED”, In other cases no cure is found but the person is helped to COMPENSATE and to REACH MAXIMUM COMMUNICATIVE POTENTIAL.

Speech &Language Rehabilitation A TeamWork

The specialities involved are:Psychiatry & Psychology, Neurology, Pediatrics, Medical Specialist, an Audiologist, a Rehab. specialist and above all a Otolaryngologists and a Speech Language Pathologist.

Speech Therapist Role

A Speech Therapist may assist relevant specialists by providing their patients with diagnostic and therapeutic techniques related to speech therapy for the following types of speech language disorders :

COMMUNICATIONAL DISORDERSTypes

Stammering Voice Disorders Language Disorders Aphasia Articulation Disorders Neurogenic Speech & Swallowing Disorders

Dysarthia Apraxia of Speech Dysphagia Aphasia

Psychological, Emotional and Behavioral Based Communication Disorders:

Hyperactivity Autism Anxiety, depression, phobias.

STAMMERING

Stammering is a frequent disruption in the fluency of verbal expression and is a multi dimentional problem.

It is best categorized as a cluster of a particular kind of speech behaviors, feelings, believes, self concepts and social interactions

It may be characterized by: Blocking, prolongations, pauses, and repetitions.

with wide variety of secondary symptoms:Eye blinking,facial grimaces,head/ body jerking,and shaking the hands and limbs etc

STAMMERINGTherapeutic Techniques:

Consultation from the speech language therapist is required to modify the persons speech behaviors by:

The use of Exercises, Environmental manipulations, Counseling, Modeling, Direct and indirect therapy etc.

VOICE DISORDERS

“Voice” is a sound produced by the speech organs – The vocal cords.

A patient’s voice may become soft, harsh, breathy, hoarse, hypo or hyper nasal or even aphonic. A patient may even suffer from voice loss due to “ laryngectomee” or Tracheostomy.

Dysphonia refers to the impairment of voice.

VOICE DISORDERSCauses

VOICE DISORDERS

LARYNGEALPROBLEMS

Vocal Cord Palsy Localized Leisions

Laryngeal Nodules

Polyps

Cysts

Laryngeal Webs.

Spasmodic Dysphonia,Dysphonia

Plica Ventricularis

RESONANCE DISORDERS

Hypernasality Hyponasality

Cleft Palate, Oronasal fistulae

Palatal palsy.

Adenoids

Other causes of nasal obstruction.

FUNCTIONAL DYSPHONIA/APHONIA MISCELLANEOUS

Myasthenia gravis Parkinsonism

VOICE DISORDERSSpeech Therapists Role:

A Speech language therapist has Remedial techniques, therapies, that can help a person to produce more intelligible speech, to more normal vocal sound production, and more efficient trauma free voice production.

LANGUAGE DISORDERS

Language can be defined as the socially shared code or conventional system for representing concepts through the use of arbitrary symbols and rule governed combinations of those symbols.

In language disorders the person is either unable to comprehend the symbols of language used by the speakers, or he does not have the ability to use the language symbols on his own.

LANGUAGE DISORDERSCauses &Types

Receptive Language Disorders:

Comprehension, understanding, may be impaired.

Expressive Language Disorders:

Expression by the use of words, sentences, phrases, signs, gestures, facial expressions, body language may be impaired.

•Mental retardation•Lack of environmental speech language stimulation•Hearing loss•Behaviour problems•Speech Language Delay due to multiple reasons e.g., Hyperactivity, Brain disorders, autism, learning disability.

LANGUAGE DISORDERSSpeech Therapists role:

Speech Language Therapist helps the patient with the use of diagnosing, testing, screening tests and interventions, counselling and Behaviour therapy approaches (Reward, Reinforcement, punishment etc)

Prognosis: Depends on the cause, type, age, persistency of the therapy motivation and environmental variables.

APHASIA “Aphasia is an acquired language disorder

caused by Brain Damage, Resulting in Partial or complete Impairment of Language Comprehension, formulation and the use for communication”

In aphasia there is a break down in the ability of a person to formulate or to retrieve and to decode the arbitrary symbols of language.

Types: Fluent: Wernicke’s, Conduction, Anomic, Transcortica Non Fluent: Broca’s and Transcortical Motor aphasia Global or Mixed Aphasia.

APHASIASpeech therapists role:

Help the aphasic patient in reducing and minimizing the communication problem produced by any one of the cause.

Rehabilitation of the aphasic patient requires the cooperative efforts of a team consisting of Neurologist, psychiatrist, psychologist, physiotherapist and speech language therapist.

ARTICULATION DISORDERS

“Articulation refers to the movements of the articulators in the production of speech sounds that make up the words of our language.”

Types of Articulation Errors: Substitution, Distortion, Omission, Addition etc.

ARTICULATION DISORDERSCauses:

Orofacial Anomalies eg., cleft lip and palate Dysarthria Oral apraxia Cerebral palsy Hearing Impairment Tongue tie, Malocclusion

ARTICULATION DISORDERSTreatment:

Articulation problems are successfully identified ,assessed and treated with surgical and therapeutic measures

The Therapeutic measures include: Traditional articulation therapy, immitation, modeling and

Counselling etc. Prognosis: Depends upon the cause, age,

social variable, intelligence and socio-economic status of patient.

DYSARTHRIA

Dysarthia comprises of a group of related motor speech disorders.

Often patients may be distressed and frustrated by their impaired or total lack of physical state,

They may lack motivation and tire easily. They may experience a sense of loss of status

with in their families and society; and they may be suffering from a progressive, degenerative neurological disease.

DYSARTHRIACauses and Types:

Parkinson’s disease, multiple sclerosis, pseudobalbar palsy, or motor neuron disease etc.

In addition one must consider the countless number of brain damage clinents,whose dysarthria is due to acute trauma, tumor, inflammatory disease or stroke.

Flaccid, Spastic, Ataxic, Hypokinetic and

hyperkinetic Mixed

dysarthria.

DYSPHAGIADysphagia is a disorder of swallowing but from the

standpoint of rehabilitation it is an eating disorder.

Types:

Static or organic swallowing disorders Dynamic swallowing disorders

• CNS disorders• Cerebrovascular disorders• Degenerative Disease eg., Parkinson’s• Inflammatory Diseases Psueobulbar paralysis Bulbar paralysis Unilateral cerebral lesion.

• Peripheral Nervous System Disorder• Muscular Diseases eg., Myasthenia Gravis ,• Muscular dystrophy

•

DYSPHAGIAEvaluation:

Physician : Gastroenterologist E.N.T Surgeon Radiologist Paediatrician Speech therapist.

In speech therapy clinic dysphagia patients are referred from peads or neurology clinic after basic treatment of there disease when the patient comes to a speech therapist, his initial screening is done. A speech therapist assesses patients

Level of consciousness General health condition Laryngeal function Before subjecting the patient to swallow any thing. His present capability for swallowing is checked.

WE PERFORM :

Oral motor examination procedure

Laryngeal function Test RSST

(Repetative Saliva Swallowing Test)

Water drinking test Food intake test. Flourography

EXAMINATION PROCEDURES

Flourography is done in the Radiology department in the presence of a speech Therapist.

Then the decision about the therapeutic approach is taken after the case conference with the a doctor and dietitian dealing with the patients keeping in view his neurological status, general condition and swallowing ability.

FLOUROGRAPHY

Indirect swallowing training Direct swallowing training Posture management and food modification

approach

DYSPHAGIA Therapeutic Approaches:

Continued

Compensatory approaches or the combination of the three.Caregiver and family trainingEnvironmental approach.

AUTISM

“It is a developmental disability significantly affecting verbal and non verbal communication and social interaction, that adversely effects educational performance, involving extreme sense of isolation and detachment, from the world around them that characterize these individuals who are ‘autistic’”

AUTISMIntervention:

Educational Management Psychological Management Medical Management Behavioural Management

SPEECH THERAPY AND DISABILITY

According to WHO:“Disability is any restriction or lack resulting from an impairment of ability to perform an activity in the manner or within range considered normal for a human being”

Speech and language therapy helps the disabled or impaired individual, by providing maximum communicative potential, compensatory methods, rehablitation and mainstreaming.

Early diagnosis, treatment and intervening the communicative problem will reduce the intensity and severity of the problem which enhances the effectiveness of Speech Language Therapy.

SPEECH THERAPY AND DISABILITY

SPEECH THERAPY AND DISABILITY Hearing Impairment:

The impaired hearing either in childhood or adulthood leads to communicative disorders.

Speech Therapy procedures helps the hearing impaired individuals specially children, to acquire maximum of their interactive and communicative potentials.

SPEECH THERAPY AND DISABILITY Mental Retardation:

Speech Language Procedure cannot cure the organic cause but helps in developing more or near normal speech language acquisition, or may use compensatory approaches to minimize the communicative problems.

SPEECH THERAPY AND DISABILITY Cerebral Palsy:

Speech Therapy Procedures helps the C.P child by providing extensive home plans and management for compensation of the lost ability.

SPEECH THERAPY AND DISABILITY Visual Impairment:

Speech Language Therapy procedures help the V. Impaired individual in oral-verbal aspect of communication only.