Updated: Aug 21, 2019
Speech and language therapy involves:
Assessing your communication and/or swallowing abilities
Discussing your goals
Providing supportive strategies
Discussing therapy options
Reviewing your progress in therapy
Adjusting therapy programmes accordingly
Informing other healthcare professionals about your input (e.g. your GP)
Communication assessment involves looking at your strengths and difficulties in a range of areas. This may include listening, speaking, reading, and writing. It also involves having a discussion with you and others (e.g. your family) about what you want to achieve.
There are many different types of communication assessment. You will probably start with an informal assessment, such as having a chat. From there, tasks will be completed to gain an understanding of all of your different communication abilities. For example, your understanding of single words, simple sentences, more complex sentences, whole paragraphs of information. If you are being seen about your voice or speech, you may be asked to read a passage aloud.
Assessment can also involve trialling different supportive strategies and different therapy approaches to see what you respond well to. This can help inform what therapy approaches may be more suitable for you.
Assessment will involve asking you and others (e.g your family or close friends) what has changed, what you find helps and what does not help. Your feelings about your communication will also be discussed. For example, some people do not mind if they experience word finding difficulties or if their speech is less clear; other people find this incredibly upsetting.
A swallowing assessment involves discussing what and how you have been eating and drinking. Your speech and language therapist will want to know what you find easier and more difficult.
An oromotor assessment will then be completed. This looks at all of the nerves/muscles involved in swallowing. It involves different tasks with your face, mouth, tongue and voice. For example, your tongue's range of motion, coordination and strength will be looked at. This gives information as to what may be impacting your swallowing, e.g. a weak tongue.
You will then eat and drink with your speech and language therapist observing and potentially feeling your hyolaryngeal excursion (the movement of your 'Adam's apple') and listening to your breathing with a stethoscope (cervical auscultation). If, for example, an individual has cognitive impairment and would be distressed by having their throat felt or the speech and language therapist being close enough to auscultate, then these methods may not be used.
You will try drinks and foods of different consistencies as appropriate. You may also trial using different equipment. This may be trying using different types of cups, straws etc. You may also trial a swallowing strategy (e.g. swallowing twice per sip of drink).
Every person's goals are different. Therapy should be tailored to what is important to you.
In order to meet a larger goal, it may be appropriate to set smaller goals to reach this.
For example, if you have aphasia (language disorder) following a stroke and want to get back to work then this may require many smaller goals such as being able to read emails, being able to write emails, understanding complex instructions you are given and being able to communicate clearly. Within each of these areas, smaller goals may be set, e.g. to write an email you will need to be able to spell individual words and put them together into a sentence.
If you have dysphagia (swallowing disorder) and you are currently on a pureed diet (smooth foods requiring no chewing) and your ultimate goal may be to eat (battered) fish and chips again then you will need to take smaller steps to get here. Your first goal will be working towards having foods that require a little chewing (minced and moist diet).
During the assessment session, some supportive strategies may be recommended.
Supportive strategies are things that you or others can do to support you with your communication and/ or swallowing. Strategies will be discussed, trialled and practised with you.
Your conversation partner writing down keywords during conversation with you.
Speaking slowly and focusing on over-pronouncing words.
Using gesture to support your expression.
Simple strategies such as reducing background noise (e.g. turning off the TV or radio) so that it is easier to hear you.
Discussing how your favourite meals can be adapted to your current swallowing recommendations, so that you are able to swallow them safely. For example, having flaked fish in a sauce with mashed potato rather than battered fish and chips.
Using a different type of cup
Using a specialist piece of equipment, e.g. a straw with a one way valve
Having breaks between your courses to limit your fatigue to aid your swallowing
The next steps will then be agreed between you and your speech and language therapist. The therapy options available will be discussed. This should involve discussing the evidence base of the therapies and what is involved.
With private therapy, you get to decide how much input you want. Would you rather have a programme to practise yourself everyday and have a review session with your speech and language therapy every few weeks? Or would you rather have weekly therapy sessions so that your therapy programme can be adjusted more frequently as you progress? Some people decide to have therapy more often than this (e.g. multiple sessions per week). It depends on what you think will help you. Your speech and language therapist can discuss the different options available to you.
Your progress will be reviewed. The time frame for this will vary depending upon factors such as the skill being targeted, the intensity of the therapy and the severity of the difficulty. If you improve faster than expected or you do not 'get on' with the therapy programme, you can always request an earlier review than originally agreed.
It is best that a letter is written to your GP informing them of:
Your strengths and difficulties - this is so they are aware and can then make any changes they need to do also support you. For example, if you need longer to understand information or to express yourself, you could have longer-than-normal GP appointments.
Any recommendations - for example, if you are recommended to have thickened fluids then you GP will have to be aware that they can prescribe a thickener. It is also useful to have this on your records in case you are admitted to hospital.
Any therapy input - this is so they can contact your speech and language therapist if they have any questions.
It may also be recommended that this letter is sent to other professionals too, such as your Stroke Consultant or Parkinson's Disease Consultant, your specialist nurse or your other therapists.
Do you have any questions about what speech and language therapy will involve?
Further articles will discuss different therapy approaches and resources.