Speech therapy - an introduction

What is speech therapy?

Speech and language therapists assess and treat speech, language and communication problems in people of all ages. They help people to become independent communicators using speech, gesture and/or communication aids as needed. They also work with people who have eating, drinking, chewing and swallowing difficulties.¹

They work as part of a multidisciplinary team and have close links with teachers, doctors, nurses, psychologists, occupational therapists and other health professionals. They work in hospital and community settings: on inpatient wards, in outpatient clinics, and in schools, health centres and clients' homes.

Speech and language therapy (SLT) is also available privately, for adults and children, through the Association of Speech and Language Therapists in Independent Practice (ASLTIP).

The scope of the problem

In the UK:²

• 2.5 million people have a speech or language difficulty.

• 5% of children enter school with difficulties in speech and language.

• 30% of people who have had a cerebrovascular event have a persisting speech and language disorder.

• More than 60% of young offenders have some form of speech and language impairment or communication needs.

• Over 75% of people with mental health disorders have communication difficulties.

Increasing demand is likely to result from the ageing population, the rise in dementia and the increasing number of children with complex speech, language and communication needs.³

Typical patients seen by speech and language therapists⁴

These include:

• Babies who have problems with feeding and/or swallowing.

• Children with:
  

  • General learning disability.

  • Physical disability.

  • Language delay.

  • Difficulties in sound production.

  • Hearing problems.

  • Cleft palate.

  • Stammering.

  • Autistic spectrum disorders.

  • Dyslexia.

  • Voice disorders.

  • Selective mutism.

• Adults with:
  

  • Eating, swallowing and/or communication problems following stroke.

  • Neurological impairment or degenerative conditions such as head injury, Parkinson's disease, motor neurone disease and dementia.

  • Cancer of the head, neck or throat (including laryngectomy).

  • Voice problems.

  • Mental health problems.

  • Learning difficulty.

  • Physical disability.

  • Stammering.

  • Hearing problems.

Training to become a speech and language therapist⁵

There is a three- or four-year degree course accredited by the Royal College of Speech and Language Therapists (RCSLT) and graduates are registered by the college. A two-year postgraduate qualification can also be taken if the candidate has an appropriate first degree. A degree apprenticeship has also been approved.

All speech and language therapists are registered with the Health and Care Professions Council (HCPC). To be registered, speech and language therapists must meet the Council's standards for their training, professional skills, behaviour and health.

SLT assistants, support workers and bilingual co-workers also exist. These team members work alongside a speech and language therapist, including working with clients on a one-to-one basis, assisting in group therapy sessions, clerical and administrative work or advising on culture and language differences.

The evidence base for speech and language therapy

SLT, like every other aspect of medical care, should be subjected to vigorous scientific appraisal. Trials have been undertaken in the field of SLT. Evidence from large, randomised controlled trials (RCTs) is the gold standard. A review of evidence found the following:

• A Cochrane review, published in 2003, concluded that there was some evidence for the effectiveness of SLT for children with expressive phonological and expressive vocabulary difficulties. It showed that there was mixed evidence for SLT interventions in children with expressive syntax difficulties and that more research was needed concerning interventions for those with receptive language difficulties.⁶

• A Finnish study found that intensive speech therapy could help some patients who stuttered.⁷

• A Cochrane review published in 2012 showed some indication that SLT for people with aphasia after a stroke is effective. There seemed to be some evidence that people who had intensive SLT may do better, although in the trials reviewed, more people withdrew from intensive SLT than from conventional SLT. Overall, there was insufficient evidence to draw conclusions about the most effective way of delivering SLT.⁸

• Another Cochrane review found that more research is needed to determine the effectiveness of SLT in people with Parkinson's disease who have dysarthria.⁹

• A Cochrane review looking at children with cerebral palsy found no firm evidence of the positive effects of SLT. Again, the authors noted that further research is needed.¹⁰ Likewise, more evidence is required to support the use of interventions for childhood apraxia of speech and dysarthria associated with acquired brain injury in children and adolescents.^{11 12}

Speech and language therapy after a cerebrovascular event

Following a stroke, the incidence of dysphagia has been reported in a variety of studies as being between 40-78%. This may put them at risk of aspiration and pneumonia. Stroke patients can also have speech, language and communication problems.¹³

The National Institute for Health and Care Excellence (NICE) has issued guidelines on the diagnosis and acute management of stroke and transient ischaemic attacks.¹⁴

A core multidisciplinary stroke rehabilitation team should comprise consultant physicians, nurses, physiotherapists, occupational therapists, speech and language therapists, clinical psychologists, rehabilitation assistants, and social workers.¹⁵

Conclusion

Speech and language therapists and their assistants form an important part of the multidisciplinary team. Their specialist training allows assessment and treatment of patients of all ages with varied and complex medical and developmental problems. They are governed by their own professional standards and guidelines, supported by evidence from the literature and consensus expert opinion.