What is Speech and Language Therapy (SLT)?

SLT involves assessing and treating children with specific speech, language, and communication problems; to enable them to communicate to the best of their ability. In order to do this one must understand the clear definition of these 3 terms which are most often interchangeably used.

Speech
The word ‘speech’ can be used in a general way by parents and others to mean what a child says and how clear it is. However, speech and language therapists use the word speech in a specific way and includes the ability to:

• Listen to the differences between sounds (phoneme)
• Articulate sounds that make up your language eg: /sss/ (morpheme)
• Combine these sounds to make words (lexicon)
• Speak with appropriate rhythm and intonation-rise and fall of the voice (articulation)
• Speak without too many hesitations (fluency)

Language
Most people understand ‘language’ to mean different languages like English, Hindi, Tamil, Telugu, etc.  However, speech and language therapists use the word language to mean what we are talking about and the way we put words together. This includes:

• Understanding the meaning of spoken words and sentences (semantics)
• Putting words together in a meaningful way to make sentences, stories, and conversations (syntax)

Communication
The word communication can be used in many ways. It is often used in a general way to mean how we connect with one another. However, speech and language therapists also use the word communication in terms of Receptive and Expressive Language.

• Receptive language means the ability to understand information. It involves understanding the words, sentences and meaning of what others say or what is read.
• Expressive language means being able to put thoughts into words and sentences, in a way that makes sense and is grammatically accurate. Expressive language also informs an individual’s writing.

Communicating appropriately means saying the right thing in the right way, at the right time!

What does SLT involve?

A Speech and Language Therapist works directly with the client and provides support to them and their care-givers. The therapists will work with a child one-on-one, or in a small group, to overcome difficulties involved with a specific language disorder.

The therapy sessions will vary depending on all the goals set for every individual child. However, there are some basic things one may see in a session:

• Sessions will have a beginning, middle and an end
• Sessions may start with a review of the last session
• There will be activities set up and often these are play based
• The therapist will work with the child/children on their goals in various ways through the play based activities
• At the end concepts worked on may be reviewed and, session goals and homework will be addressed with the parent

Therapists use a variety of strategies, including:

Play-based interventions – Play-based interventions are primarily used for children in their early years. Play is flexible, non-literal, episodic and process-oriented. During play, the child is actively engaged and intrinsically motivated. True play has no extrinsic goals, but some sacrifices are made to ensure that target skills are practiced. When designing play-based lessons, the less the therapist deviates from true play, the better.

The first step of planning a play-based therapy session is to select targets to teach. Next, the targets during play are identified. It starts with the lesson, not with the toy or game. One may think in terms of how to give access to something the child wants following skill demonstration. This “something” can be toys, food, parts of a whole (for example, puzzle piece, song phrase, portion of a motor sequence), social interaction, or a funny or amusing consequence. Memorable episodes are set up to enable better learning. The more episodic and story-like the play-based session is the better. This is because associated events scaffold memories.

With play-based therapy, one can really capture a child’s attention and make memories that will extend beyond the therapy session. These memorable moments support learning and retention, and are essential when treatment sessions are infrequent. Part of the reason it is so difficult to explain how children learn by play is because play isn’t simple – it is instead complex.  Learning through play is not about children wandering aimlessly around a room dumping baskets and throwing blocks. Instead, learning through play takes a carefully prepared environment that invites young children to explore, examine, question, predict, test, investigate, trial and error, and manipulate.

Language intervention activities – The therapist will interact with a child by playing and talking, using pictures, books, objects, or ongoing events to stimulate language development. They may also model correct vocabulary and grammar and use repetition exercises to build language skills.

Articulation therapy – Articulation, or sound production, exercises involve having the therapist model correct sounds and syllables in words and sentences for a child, often during play activities. The level of play is age-appropriate and related to the child’s specific needs. The therapist will physically show the child how to make certain sounds, such as the “r” sound, and may demonstrate how to move the tongue to produce specific sounds.

How does it help?

Speech and Language Therapists are the specialists that help children with speech, talking and communication. However one may be surprised at how broad this field of speech-language therapy really is and just how many skill areas SLTs are trained to build and expand in young children.

At DIRECT, SLTs can help children with…

1. Articulation Skills/Speech Intelligibility – Articulation is the physical ability to move the tongue, lips, jaw and palate (known as the articulators) to produce individual speech sounds which we call phonemes.

Intelligibility, refers to how well people can understand a child’s speech. If a child’s articulation skills are compromised for any reason, his/her intelligibility will be decreased in compared to other children his/her age. SLT’s can work with children to teach them how to produce the specific speech sounds or sound patterns that he/she is having difficulty with, and thus increasing his/her overall speech intelligibility.

2. Expressive Language Skills – While speech involves the physical motor ability to talk, language is asymbolic, rule governed system used to convey a message. In English, the symbols can be words, either spoken or written. We also have gestural symbols like shrugging our shoulders to indicate “I don’t know” or waving to indicate “Bye Bye” or the raising of our eye brows to indicate that we are surprised by something. Expressive language then, refers to what one child says. Speech-language therapists can help a child learn new words and how to put them together to form phrases and sentences (semantics and syntax) so that the child can communicate.

3. Receptive Language/Listening Skills – Receptive language, refers to a child’s ability to listen and understand language. Most often, young children have stronger receptive language skills (what they understand) than expressive language skills (what they can say). An SLT can help teach children new vocabulary and how to use that knowledge to follow directions, answer questions, and participate in simple conversations with others.

4. Speech Fluency/Stuttering – Stuttering is a communication disorder that affects speech fluency. It is characterized by breaks in the flow of speech referred to as disfluencies and typically begins in childhood. Everyone experiences disfluencies in their speech.  Some disfluencies are normal but having too many can actually significantly affect one’s ability to communicate. In stuttering, the often seen of primary behaviours: repetitions, prolongations, interjections, and blocks. There may also be secondary behaviours, typically in more severe cases of stuttering such as tension in the neck, shoulders, face, jaw, chest; eye blinks, nose flaring, other odd facial movements; clenched fists, stomping of feet; jerking or other unusual motor movements in arms, hands, legs, feet. SLTs can teach children strategies on how to control this behavior and thus increasing their speech fluency and intelligibility.

5. Voice and Resonance– It refer to disorders that effect the vocal folds that allow us to have a voice. These can include vocal cord paralysis, nodules or polyps on the vocal folds, and other disorders that can cause hoarseness or aphonia (loss of voice). Resonance refers to “the quality of the voice that is determined by the balance of sound vibration in the oral, nasal, and pharyngeal cavities during speech. Abnormal resonance can occur if there is obstruction in one of the cavities, causing hyponasality or cul-de-sac resonance, or if there is velopharyngeal dysfunction (VPD), causing hypernasality and/or nasal emission.”

6. Social/Pragmatic Language – Social/ pragmatic language refers to the way an individual uses language to communicate and involves three major communication skills: 1) using language to communicate in different ways(like greeting others, requesting, protesting, asking questions to gain information, etc.), 2) changing language according to the people or place it is being used (i.e. we speak differently to a child than we do to an adult; we speak differently inside vs. outside), and 3) following the rules for conversation (taking turns in conversation, staying on topic, using and understanding verbal and nonverbal cues, etc). SLTs work with children to teach them these social language skills so that they can more appropriately and participate in conversations with others.

7. Cognitive-Communication Skills – Cognitive-communication disorders refer to the impairment of cognitive processes including attention, memory, abstract reasoning, awareness, and executive functions (self-monitoring, planning and problem solving). These can be developmental in nature (meaning the child is born with these deficits) or can be acquired due to a head injury, stroke, or degenerative diseases. SLTs work with children to help build these skills and/or teach them compensatory methods to assist with their deficits.

8. Educating and Empowering parents/caregivers on how to best help their child – A speech-language therapist may spend an hour or so a week with a child, but the parent/caregiver spend hours and hours a week interacting with the child. When they are equipped with the knowledge, skills, and confidence they can be the best “speech therapist” the child could ever have. Together they can make an amazing team and change the child’s life, one word at a time.

Who does it help?

SLTs are provided for children/adults with any form of a speech-language disorder. A speech disorder refers to a problem with the actual production of sounds. A language disorder refers to a problem understanding or putting words together to communicate ideas.

Speech disorders include:

• Articulation disorders: difficulties producing sounds in syllables or saying words incorrectly to the point that listeners can’t understand what’s being said.
• Fluency disorders: problems such as stuttering, in which the flow of speech is interrupted by abnormal stoppages, partial-word repetitions (“b-b-boy”), or prolonging sounds and syllables (sssssnake).
• Resonance or voice disorders: problems with the pitch, volume, or quality of the voice that distract listeners from what’s being said. These types of disorders may also cause pain or discomfort for a child when speaking.

Language disorders can be either receptive or expressive:

• Receptive disorders: difficulties understanding or processing language.
• Expressive disorders: difficulty putting words together, limited vocabulary, or inability to use language in a socially appropriate way.
• Cognitive-communication disorders: difficulty with communication skills that involve memory, attention, perception, organization, regulation, and problem solving.

Dysphagia/oral feeding disorders are disorders in the way someone eats or drinks, including problems with chewing, swallowing, coughing, gagging, and refusing foods.

How do we achieve this at DIRECT?

All speech and language therapists at DIRECT are post graduates in Speech and Language Pathology with minimum one year training in the therapeutic setup. All therapists undergo intensive observational and practical training for a minimum of 250 hours before beginning practice. SLT sessions are conducted with a focus on –

• identifying children’s developmental speech and communication difficulties/disorders
• devising, implementing and revising relevant treatment programmes
• advising caregivers on implementing treatment programmes and training other professionals in therapy delivery
• assessing communication environments
• monitoring and evaluating clients’ progress
• working with clients on a one-to-one basis, and in groups, to deliver therapy
• writing and maintaining confidential client case notes and reports, as well as information for clients, caregivers and other professionals
• managing a caseload taking account of priority cases, waiting lists, successful outcomes, referral and discharge of service users
• working with others to improve the effectiveness of service delivery.