Monday, August 3, 2009

Speech Language Therapy

1. What Is Speech-Language Therapy?

Speech-language therapy is the treatment for most kids with speech and/or language disorders. A speech disorder refers to a problem with the actual production of sounds, whereas a language disorder refers to a difficulty understanding or putting words together to communicate ideas.

2. Speech Therapy

When there is an underlying medical condition and a speech disorder, speech therapy may be utilized. Prior to the initiation of speech therapy, a comprehensive evaluation of the patient and his or her speech and language potential is generally required before a full treatment plan is formulated.

Speech therapy services should be individualized to the specific communication needs of the patients. It should be provided one-to-one by a speech-language pathologist educated in the assessment of speech and language development, the treatment of language and speech disorders, and the evaluation of people with swallowing disorders. A speech-language pathologist can offer specific strategies, exercises and activities to regain function communication abilities (Kortte and Palmer, 2002).

Before speech therapy is initiated a complete evaluation by the speech-language pathologist should be performed. As part of the evaluation, standardized assessment tests should be used for evaluations to identify and quantify impairment (Kortte and Palmer, 2002): Tests include the following:

Coverage Policy Number: 0177
• Receptive-Expressive Emergent Language Scale (REEL): infants (birth to three years)
• Test of Language Development (TOLD): school-age children
• Porch Index of Communication Ability (PICA): adults
• Boston Diagnostic Aphasia Examination: adults
• Peabody Picture Vocabulary Test (PPVT): for all ages

For the child with speech delay, the speech/language evaluation may demonstrate that the potential exists that, through speech therapy, the child will reach an age-appropriate level of speech. Some situations for which speech therapy may be appropriate in the prelingual child include: following long-term intubation, chronic otitis media, or after cochlear implant or cleft palate surgery.

A hearing test may also be conducted to determine if the child is experiencing mild hearing loss as a result of transient or persistent ear infections or allergies. Should these conditions be identified, then medical management and monitoring should be used to minimize the effects that this could have on future language learning. Comorbid psychiatric disorders, environmental deprivation, pervasive developmental disorders, mental retardation, autism and selective mutism should all be considered in cases of language delay (Johnson, 2005).

Speech therapy is generally not appropriate for use in prelingual children when there is no identified underlying medical condition or there is no possibility of the child reaching an age-appropriate level of speech (e.g., autism, pervasive developmental disorders developmental delay or mental retardation; the inability to construct sentences, stuttering or tongue thrust) (Johnson, 2005; Bressmann, 2005; Kroll, 2005).

Documentation of the proposed treatment should include all of the following:
• findings of the speech evaluation, including motor and expressive results
• short- and long-term measurable goals, with expectations for progress
• specific treatment techniques and/or exercises to be used during this treatment
• determination of how the goals will be measured and reported every two weeks
• expected duration of therapy for goals to be met
• documented strategy to transition this supervised therapy to a patient-administered or caregiver-directed maintenance program

Before continuing speech/language services, the results of these patient-specific measures should demonstrate that the individual is consistently improving and that a plateau (i.e., where no additional meaningful improvements are being measured or are expected to occur) has not been reached. Once the individual has reached their goals or a therapeutic plateau has been reached, then ongoing therapy becomes maintenance in nature.

The use of group therapy is not one-on-one, individualized to the specific patient needs. Services that are provided by speech therapists and occupational therapists may overlap (Michaud, et al., 2004). Speech therapy that is being provided as part of an occupational training program is considered duplicative in nature.


Robert, SLP said...

Good summary. It is important to keep in mind that if you think your child may have a speech or language impairment, you should seek an evaluation from a qualified speech-language pathologist (SLP). Diagnosing and treating speech or language disorders is not something you should do on your own, since appropriate treatment depends on a number of factors that might not be obvious to the untrained observer.