Speech and Language Therapy

Oral motor functioning depends on an intricate process of sending and receiving messages to various facial, throat and neck muscles to coordinate breathing, talking, chewing, swallowing and digestion. Speech and language pathologists improve communication and speech, but also improve swallowing and digestion. They work closely with respiratory therapists, registered dietitians, and gastroenterologists.

What is speech and language therapy?

Speech and language therapy (sometimes referred to as ST) aims to improve, and make possible, a child with Cerebral Palsy’s ability to effectively communicate their thoughts and ideas to the world. Communication skills are a vitally important aspect of interacting with others, developing relationships, learning, and working. Speech therapy increases a child’s potential for independence and positively impacts their quality of life.

Speech and language therapy is a process by which a licensed therapist treats the communication, speech and language disorders. Speech pathologists increase a child’s oral motor skills and communication acumen by using exercises that train the brain to pronounce – as well as understand and interpret – individual words, sounds, numbers and gestures. Additionally, speech and language pathologists improve functioning of the mouth, jaw and throat muscles (oral motor functioning) that can interfere with not only speech, but also breathing and swallowing – two issues that can pose a significant danger to a child.

Cerebral Palsy often affects the language centers of the brain that control speech. In mild cases of Cerebral Palsy, a child may have difficulty using the correct words, but in more severe cases, a child’s ability to verbally express himself or herself might be seriously impeded. Under these circumstances, the speech and language pathologist will assist in finding ways in which the child can begin to communicate through cues (winking or lifting a finger), sign language, or with the assistance of augmentative communication devices (DynaVox or computers).

Speech therapy addresses conditions such as:

• Aphasia – the loss of partial loss of verbal expression
• Dyspraxia – understands language, but unable to consistently and correctly pronounce words because of muscle coordination
• Dysprosody – disruptions in speech timing and cadence
• Dysarthria – Abnormal facial muscle tone
• Stuttering, fluency disorders – chronic interruption or repetition in speech
• Dysphagia – causes difficulty swallowing, chocking, breathing issues
  Articulation disorders – adding or omitting required sounds, distorting sounds
• Prosodic issues – intonation and rhythm
• Phonation disorders – issues with pitch
• Resonance disorders – vocal tract issues

Additionally, speech pathology includes developing not only the act of speaking, but the ability to fully comprehend language.

Some aspects of speech a therapist will address include:

• Word formation
• Pronunciation
• Fluency
• Listening
• Language and vocabulary development
• Word comprehension and meaning
• Word-object association
• Engaging in direct conversation
• Mouth and throat muscle coordination and strength

In children that are non-verbal, a speech pathologist will identify ways for the child to express themselves that substitutes speaking and promotes human interaction. To accomplish that goal, therapists rely on physical cues, movements, conventional tools, and technology to help a child compensate for his or her limitations. Some of these tools include:

• Gestures
• Symbols
• Signing
• Touching
• Picture boards
• Computer-based aids
• Voice synthesizers

Children with Cerebral Palsy often experience a high level of dysphagia, or trouble swallowing. Dysphagia is caused by congenital, neurological or physiological abnormalities, or by anatomical obstructions or irregularities in the child’s throat or esophagus.

Though only indirectly related to speech, pathologists also work with children to minimize the effects of conditions, which include:

• Pulmonary aspiration
• Chocking on food or liquids
• Breathing abnormalities
• Increased coughing
• Dehydration
• Malnutrition

Who benefits from speech and language therapy?

According to the U.S. Department of Education, about 20 percent of the children attending special education classes in public schools attend speech therapy.

Speech therapy is an intervention that benefits children with Cerebral Palsy, their caregivers, and members of the child’s family. Speech therapy’s biggest contribution is providing a child a mode of interaction with those who care about him or her. They develop the ability to relate words to their environment for a complete understanding of concepts and events, and the ability to express thoughts, desires and opinions.

Additionally, speech therapy greatly expands a child’s understanding of the world around them by allowing them to experience stimulations and developmental milestones, such as:

• Developing relationships with family
• Socializing and making friends
• Accurately and consistently communicate ideas
• Learning
• Developing interests
• Participating in activities at home or at school
• Engaging with surroundings
• Avoiding isolation and loneliness

Children with Cerebral Palsy will face many challenges. They can succumb to depression if they don’t have interaction to people and experiences. For this reason, the speech therapy is an essential step in the development into becoming a well-adjusted adult.

Parents and caregivers benefit from speech therapy because, as a child’s communication skills and comprehension improve, parents and caregivers can better develop an emotional bond with the child. This paves the way for a child to play a more integral role in the family unit, the community, and eventually, school and work.

What are the benefits of speech and language therapy?

Communication is one of life’s most enjoyable experiences, and it’s a big part of what shapes us into the personalities we become. It forms our experiences and influences our perceptions – it’s a part of the larger human experience.

Therefore, children who face challenges in their ability to communicate their thoughts are at a disadvantage that, with the proper interventions from qualified professionals, can be mitigated.

The benefit of speech therapy is that the child will learn adaptive and compensatory strategies to communicate. Children with Cerebral Palsy often face other developmental delays, but many have talents and abilities they cannot properly express because of speech and communication issues.

The benefits to speech and language therapy are numerous, and include:

• Supports learning and education
• Improves literacy
• Increases confidence and independence
• Improves socialization
• Eliminates self-consciousness
• Reduces shyness

Children with Cerebral Palsy have different capabilities and limitations. Speech therapy is beneficial because a plan of treatment is individualized, allowing a child and therapist to work extensively on very specific issues that, once addressed, can progress quickly.

Speech disorders, and how they affect a child, are also diverse. A speech pathologist is responsible for outlining a course of treatment for the child which will address a number of problematic circumstances.
Through therapy, a child will learn strategies to:

• Eliminate pronunciation issues
• Implement proper word usage
• Understand grammar
• Develop controlled speech cadence
• Speak using complex sentences
• Expand vocabulary
• Develop conversational capabilities
• Comprehend words and statements
• Improve memory and recall
• Draw parallels between the spoken and written word

If a child has a more severe case of Cerebral Palsy, he or she may not have verbal abilities, and in this circumstance, therapists will work with the child so he or she can benefit by learning to communicate.

Children will learn how to communicate effectively using tools. These aids are varied; some are technology-based, others are not. Verbal cues, physical movement, sign language pointing to cue cards are possible.

Tools used to help non-verbal children include:

• Sign language
• Pads of paper or picture boards
• Computers and keyboards
• Specialized software
• Computerized voice systems
• Augmentative communication devices

Another direct benefit of speech therapy is that children with Cerebral Palsy will learn how to work, if necessary, with impaired throat, jaw and mouth muscles that are used for speaking, but also used for drinking, eating, breathing and other physical functions. If a child’s swallowing issues are neurologically- or cognitively related, the child will participate in exercises designed to improve complex muscle coordination.

When is speech and language therapy advised?

Speech and language therapy typically begins shortly after a child is diagnosed with Cerebral Palsy. This means that therapy often begins in infancy – when speech and language are developmentally appropriate.

Studies show that speech and language therapy poses the greatest chance of success the earlier it is introduced into a child. This means that the sooner therapy commences, the brain can begin to make crucial connections that cannot be made later in life.

If speech therapy is delayed, a child will need to change established learning patterns and physical habits. They will be forced to catch up. Also, speech is interconnected to a child’s physical, social, occupational, and psychological development – all of which could be negatively impacted if speech therapy is delayed.

When speech therapy begins in infancy, issues beyond speech and communication, including dysphagia and other physical issues, can be addressed. Children with Cerebral Palsy sometimes have weakened muscles in the throat, mouth and jaw, and it’s beneficial to begin training these muscle groups to enhance speech and functionality as soon as possible. Learning to breathe, talk and swallow—sometimes simultaneously—involves one of the body’s most complex muscle coordination processes. Performing incorrectly can result in choking, aspiration, and evenly pneumonia.

Childhood is a time when infants need to explore their environment and interact with others. Speech therapy helps integrate positive aspects of life, such as play and socialization, into a child’s routine. Communication opens opportunities for inclusion and acceptance of others.

How is speech and language therapy performed?

Speech therapy begins with an assessment of a child’s physical and cognitive capabilities by a trained speech pathologist, shortly after a child is diagnosed with Cerebral Palsy.

The role of the pathologist is to help children speak clearly, communicate effectively, and control the muscles involved in speaking, eating, drinking, and swallowing. They are further charged with the responsibility of building a child’s vocabulary, listening skills, interpretation, or capacity to communicate through non-verbal means.

The first step for the speech pathologist is to conduct a thorough assessment of a child’s physical and cognitive functioning. This assessment will determine the nature of a child’s speech and communication abilities, identify causative factors, and determine the best approach to therapy.

A diagnosis will be made after the assessment is complete. The initial assessment will include:

• Case history – A pathologist will examine all medical records and ask parents or caregivers several questions about a child’s overall physical and cognitive functioning.
• Examination of the oral cavity – The pathologist will identify, using tools, whether any irregularities of the oral cavity or throat might be inhibiting speech. If obstructions are identified, the child may require surgery, or treatment plans will be modified.
• Audiology tests – There is a strong correlation between a child’s ability to hear and listen to others. This impacts language development because if a child cannot hear, he or she will not interpret sound in a correct fashion. Speech pathologists need to know if hearing loss is at the root of a child’s speech problems, and if it is determined to be a factor, the child will be referred to an audiologist or an otolaryngologist.
• Articulation assessments – Pathologists will conduct tests to determine if a child is dropping sounds or syllables from words. For example, if a child is attempting to pronounce the word “friend” but actually says “frien,” articulation is a problem. A pathologist will also look for certain nouns or consonants that cannot be pronounced, such as problematic “s” and “r” pronunciation.
• Language and fluency assessments – These tests measure a child’s fluency and ability to respond to statements in an unstructured fashion.
• Cognitive assessments – The pathologist will determine what cognitive or developmental issues are affecting the speech centers of the brain.

Once a pathologist has completed the examination, he or she will devise a plan of treatment that address all of the issues a child is coping with.

There are several methods speech pathologists use to treat speech and communication disorders, including:

• Articulation therapy – showing a child how to make proper sounds, sometimes by physically manipulating the mouth or tongue.
• Blowing exercises – used to help children breathe appropriately during speech.
• Drills – tackling problematic sounds by pronouncing words or sounds of vowels and consonants in rapid succession.
• Language and word association – using photos, objects and books to help a child expand his or her vocabulary so the child can learn to correctly pronounce the word and understand its meaning and purpose. Often, a pathologist will have the child use an object, or play with it, so the child makes a connection between the word and its meaning.
• Tongue exercises – strengthening the tongue and teaching proper tongue placement required for specific sounds.
• Jaw exercises – strengthening the jaw to support proper speech and the ability to chew food, and drink liquids safely.
• Breathing exercises – regulating breathing so that a child can develop disciplined speaking and minimizing breathlessness.

Non-verbal children are often taught sign language, or are taught gesturing, to communicate with others. But, advancements in technology – and some old stand-bys – have proven especially effective in allowing children to compensate for gaps in their abilities.

Manual tools a pathologist may use include:

• Erasable boards
• Picture board or books a child can point to
• Word cards to express thoughts
• Flip charts to relay more complex messages

Assistive technologies include:

• Alternative communication systems which use symbols for communication
• Computers used to type simple messages
• Computers that are pre-programmed with messages
• Vocal synthesizers
• Software that allows a child to push a lever or point to pictures or words, sometimes with a joystick or an infrared pointer

Where do you go for speech and language therapy?

Where a child receives therapy will be largely dependent on a child’s age, the child’s medical status, the availability of services in his or her community, and what insurance will approve. Children may receive service in a group setting, or one-on-one.

Additionally, a child may receive speech therapy from a professional pathologist in his or her home, and in most cases, a parent or caregiver will be given exercises for a child to practice at home as part of his or her plan of treatment.

The best case scenario for a child with Cerebral Palsy that has difficulty speaking or communicating is to receive professional therapy, and also practice at home to help build his or her skills.

Some places that a child may receive speech therapy services include:

• Clinical practices
• Community health centers
• Hospitals
• Rehabilitation centers
• Public schools
• Nursing homes
• State health departments

Who provides speech and language therapy?

Speech and language pathologists are trained, certified professionals that work with persons of all ages to adapt to and compensate for limited communication capabilities.

The pathologist diagnoses, treats and monitors issues that interfere with speech and communication; whether they are congenital, cognitive, acquired or developmental in nature. They often collaborate with a child’s medical team, including physicians, physical therapists, occupational therapy, psychologists, and social workers, to establish an effective plan of treatment.

Because speech pathologists must have extensive knowledge of the anatomy of the mouth, throat and esophagus, as well as familiarity with developmental and cognitive issues that impede speech and communication, successful completion of a wide range of courses is required of all students in American Speech-Language-Hearing Association-accredited academic programs.

The coursework includes:

• Pathology
• Audiology
• Anatomy and physiology
• Speech and language intervention
• Diction and voice
• Speech and language assessment
• Linguistics
• Phonetics
• Speech disorders
• American sign language
• Human development
• Psychology
• Social work

Speech and language therapists must hold a master’s degree in speech and language pathology to practice. Most states require certification through ASHA to practice; some states require additional certifications.

ASHA certification requires completion of an accredited master’s degree program, an acceptable score on the Praxis exam, and the successful completion of a clinical fellowship or internship.

Because speech pathologists are expected to continually seek up-to-date training on new concepts and techniques, the ASHA certification maintenance standards requires therapists to accumulate 30 hours of professional development during a three-year certification interval.

During therapy, a pathologist may require the assistance of a speech pathology assistant. The assistant typically holds a bachelor’s degree in speech and language pathology, and is also required to seek licensure. The role of the assistant is to support the therapist in implementing the child’s treatment plan.

Because speech disorders are often tied to audiology and hearing problems, a speech pathologist may complete audiology course work and can apply for dual certification through ASHA.

Are there any risks or special considerations with speech and language therapy?

There are more risks for a child if he or she does not take full advantage of what speech and language therapy offers.

These special considerations include the isolation a child will face if he or she is unable to communicate with others. Also, removing speech therapy from a child’s multi-disciplinary treatment may severely hinder their social, physical, educational and psychological development, and slow the progress of other interventions aimed at helping the child.

Additionally, speech therapy also trains the muscles of the mouth, throat and jaw that control eating, drinking and other necessary functions, which helps a child and their caregiver avoid potentially lethal issues like choking and aspiration when a child swallows food, sucks liquids or attempts to obstruct breathing while swallowing.