Speech Therapy - An Introduction

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 and other health professionals. They work in hospital and community settings; on inpatient wards, in outpatient clinics, schools, health centres and client's homes. There are around 10,000 practising speech and language therapists in the UK, most of whom are employed by the National Health Service.² Speech and language therapy is also available privately, for adults and children, through the Association of Speech and Language Therapists in Private Practice (ASLTIPP).

In the UK:

• 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 accident have a persisting speech and language disorder.¹

In the year 2004-05:

• There were 346,000 initial contacts, or new episodes of care, made by speech and language therapists working in the National Health Service in England.³
• Most of these referrals were made by hospital consultants in general medicine, geriatric medicine and ear, nose and throat specialties.³
• 38% of referrals were for pre-school or school age children.³

• Babies with feeding and swallowing difficulties
• Children with:
  • Mild, moderate or severe learning difficulties
  • Physical disabilities
  • Language delay
  • Specific language impairment
  • Specific difficulties in producing sounds
  • Hearing impairment
  • Cleft palate
  • Stammering
  • Autism/social interaction difficulties
  • Dyslexia
  • Voice disorders
• Adults with:
  • Eating and swallowing and/or communication problems following stroke
  • Neurological impairments and degenerative conditions including: head injury, Parkinson's disease, Motor-neurone disease and dementia
  • Cancer of the head, neck and throat (including laryngectomy)
  • Voice problems
  • Mental health issues
  • Learning difficulties
  • Physical disabilities
  • Stammering (dysfluency)
  • Hearing impairment

There is a three or four-year degree course accredited by the Royal College of Speech and Language Therapists and Speech and Language Therapists are registered by the college on graduation. A two-year postgraduate qualification can also be taken if the candidate has an appropriate first degree. All Speech and Language Therapists are registered with the Health Professions Council. Speech and Language Therapy Assistants or bi-lingual co-workers also exist. This team member works along side a speech and language therapist, including working with clients on a one-to-one basis, assisting in group therapy sessions, clerical and administrative work and advising on cultural and language differences.¹

Speech and language therapy, like every other aspect of medical care, should be subjected to vigorous scientific appraisal. Trials have been undertaken in the field of speech and language therapy but evidence from large randomised controlled trials is often lacking. A review of recent evidence has found the following:

• A randomised controlled trial of pre-school children referred for speech and language therapy looked at the differences in those children randomised to conventional treatment and those randomised to speech and language therapy assessment and advice. It showed limited evidence to support the effectiveness of speech and language therapy.⁴
• Another study evaluated the clinical effectiveness of speech and language therapy (SLT) for children with a primary speech/language disability.⁵ It showed that SLT is effective for such children but is more effective for speech disability and global language disability than for expressive disability.
• 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 also showed that there was mixed evidence for SLT interventions in children with expressive syntax and no evidence concerning interventions for those with receptive language difficulties.⁶
• One study in the USA reported that speech therapy for children who stutter appears to do little to improve their chance of recovery.⁷ However, larger, multi-centred randomised controlled trials are needed before conclusions can be drawn.

Speech and language therapy after cerebrovascular accident

• SIGN have issued guidelines on the management of patients with stroke. NICE are also due to issue guidelines on the diagnosis and acute management of stroke and transient ischaemic attacks in July 2008. As well as this, the Royal College of Physicians have issued national clinical guidelines for stroke which include referral to a speech and language therapist for patients with aphasia and dysphagia.⁸
• The SIGN guidelines recognise speech and language therapists as an integral part of the stroke care team. They state that speech and language therapists should have specific involvement in the assessment and management of communication disorders and dysphagia.^9,10
• The SIGN guidelines quote that there is good evidence that people with aphasia as a result of cerebrovascular accident benefit from speech and language therapy and this improves with the intensity of treatment.^11,12,9
• They also quote that a Cochrane review published in 2005 found that there are no large clinical trials testing the effectiveness of speech and language therapy interventions for dysarthria secondary to non-progressive brain damage (typically caused by cerebrovascular accident or traumatic injury). However, a randomised controlled trial of optimised speech and language therapy for communication difficulties after stroke has recently been commenced.¹³ Despite this, SIGN guidelines recommend that patients with dysarthria should be referred to an appropriate speech and language therapy service for assessment and management as expert opinion remains in favour of their effectiveness.⁹

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.