By Stephanie Strickland
What exactly is a speech-language pathologist (SLP), or “speech therapist,” as they are frequently called? When someone mentions physical therapy, people instantly have some understanding of what lies before them: Some part of their body isn’t working quite right and so a therapist will physically work with them in order to correct or lessen the problem. But, speech therapy? Is the therapist just going to teach them how to talk? Much more than that, a speech therapist’s job is to evaluate and provide therapy for a variety of disorders, not all of which are speech based, but most deal with communication or the mouth and throat.
If you think of ways in which messages are transmitted on a daily basis, you will most likely identify the following forms of communication: verbal communication (speech), nonverbal communication (body language, gestures, eye contact, etc.), and written communication (text, email, notes, etc.). If you have ever walked into a room and waved to someone, even though no words were exchanged, you were communicating with the other person. If someone has lost the ability to speak, for example through stroke or other brain injury, a speech therapist can work with the patient on alternate ways to communicate: gesturing, writing, picture board utilization, or even through the use of eye gaze, depending on the extent of their injury.
For communication to be effective, we also must be able to receive the information that others send to us. This involves reading ability, visual acuity, comprehension of language, hearing acuity, and memory and recall to hold on to the information that is being presented. Because memory is an essential component of effective cognitive function — brain activity that leads to knowledge — and because cognitive function impacts our ability to communicate, speech therapists are often involved in a patient’s care who is experiencing early stages of a dementia or Alzheimer’s disease to train compensatory memory techniques. These techniques can lengthen the time the patient may be able to communicate effectively.
There are other cognitive functions that are important to linguistic function in addition to memory, such as orientation. Orientation is the ability to recognize yourself and where you are in relation to time and space. Without this understanding, a person will be less able to find the restroom when the need arises, or they may be unable to locate the checkout lanes in a supermarket. A speech therapist may intervene to create distinguishable labels for bathroom doors or to train a person to look for the exit signs when in a store in order to find their way to the checkout.
Attention, following directions, sequencing, and problem solving are also important cognitive skills involved in performing activities of daily living. These include basic activities like bathing, laundry, and grooming. A speech therapist might treat a patient to improve their ability to perform multi-step directions so that they can still follow a recipe and prepare meals for their family.
Speech itself can even be broken down into subsets that might develop slowly or become impaired. People may experience difficulties with the intricacy of articulating speech sounds correctly, the fluency of transmitting information smoothly and without breaks or hesitations, or even how much air flows through the mouth versus through the nose during the actual speaking process. In patients diagnosed with Parkinson’s disease, the majority will eventually experience some kind of vocal change. Most commonly, the voice becomes more quiet and breathy, which impacts their ability to be understood. Treatment may focus on respiratory control and increasing the muscular effort required for speech in order to achieve an appropriate loudness level to be heard and understood.
Dysphagias, or swallowing disorders, may arise as a neurological disease progresses (e.g., multiple sclerosis and Parkinson’s disease) or simply from advanced age when the muscles involved in swallowing become weaker. There are several types of dysphagia, and treatment will depend on the symptoms that are present. Some people might have weakness or paralysis in the lips, and may need to perform exercises to strengthen those muscles or learn how to place foods and liquids in the mouth in a way that reduces the frequency of items falling from the lips when they are trying to eat. Others might have increased coughing or choking while eating, indicating some kind of airway compromise. Treatments in this case may focus on neuromuscular stimulation application or learning an alternate way of swallowing to reduce the chance of foreign particles entering the lungs.
So, yes, a speech-language pathologist does teach people how to talk. But there is so much more involved in the job, and every day is an adventure.