What is speech pathology?

Speech pathologists are university trained, allied health professionals who assess, diagnose and treat communication and swallowing disorders. Speech and language make up communication. Language is the understanding and expression of ideas in words and sentences (including reading and writing). Speech Pathologists also understand cognition which is the process of thinking for communication.

Speech is how we say sounds and words. Speech Pathologists also assist people with disordered chewing and swallowing.

When would I need to see a Speech Pathologist?

A person can benefit from speech pathology services at various stages of their lives e.g. a child may have delayed development of speech and language for their age or an adult may have a communication disorder related to an event or a condition. It is important to contact the speech pathologist as soon as possible if there are suspicions of difficulties in cognition, language, speech or swallowing as early detection and treatment have been shown to be very beneficial.

Language disorders include delays or difficulties in one or more of the following areas:

• Understanding and remembering spoken language
• Cognition or thinking - including memory, attention, association – which affect ability to understand more complex concepts during communication
• Understanding and producing nonverbal communication e.g. gesture, facial expression, tone of voice
• Expression of language through verbal means, including finding the words, forming grammatically correct sentences and sequencing of sentences.
• Producing voice
• Being able to produce the sounds for speech
• Being able to sequence sounds for speech

Some neuromuscular conditions have a specific profile of cognitive impairment which is recognizable by a speech pathologist specializing in working with members of our community, for example, some children with Duchenne Muscular Dystrophy or some adults with Myotonic Muscular Dystrophy. The speech pathologist is able to recognize and target treatments for people with these recognizable difficulties.

A person with a neuromuscular condition may have difficulty with speech and a Speech Pathologist can help. Speech difficulties include:

• Weakened breathing muscles which are required to produce a strong voice with adequate volume
• Weakened muscles which are required to make clear and appropriately sequenced sounds to produce the spoken word. Because of these difficulties, the person may also experience muscle fatigue, resulting in imprecise or slowed speech
• Disorders in the sequencing of sounds in words
• Other difficulties which render the speech different from the average speaker including a flat tone, an uneven speech rhythm, a nasal tone.

People who experience difficulties swallowing food and drink safely can also be helped by a speech pathologist whose aim is a ‘safe swallow.’ A person with a muscle-wasting condition may have difficulties in chewing and coordinating a swallow or may experience fatigue as they take a long time to eat their meal.

If you have weakness of lack of coordination of the muscles involved in chewing and swallowing you may also notice signs such as:

• Choking, coughing or gagging when you are eating or drinking
• Feeling out of breath as breathing and the swallowing actions are closely related and need to be coordinated
• Food spillage e.g. if you have difficulty closing your lips
• Reduced control of your saliva when at rest, speaking or swallowing
• Loss of weight as you are unable to have adequate calorie intake or dehydration

Swallowing difficulties may appear at any life stage. A baby with weak muscles may have difficulty sucking during breast or bottle feeding or a person with significant muscle weakness may have difficulty swallowing at mealtimes.

What treatments do speech pathologist use?

Generally, the speech pathologist works through the following initial assessment and referrals:

• Discusses the issues with the person or their carers e.g. parents, spouse, relevant family members and gets a sense of the history, current difficulties and their impact upon the person.

• Observes the person’s communication/swallowing in different settings, for example,

1. With appropriate permission, the speech pathologist may also have conversations about the child’s ability to attend, listen, understand and remember what he hears in the classroom environment
2. With reported swallowing difficulties, the speech pathologist will have a detailed discussion about the ability to chew and swallow under different circumstances and observe eating and swallowing

• If appropriate, performs a formal assessment, for example,

1. For language and/or cognition, there are specific language/cognitive assessments developed within speech pathology practice
2. For children, an assessment of speech and language development against expected milestones. In some specific neuromuscular conditions, language and cognitive development have a recognizable pattern of delay
3. For speech, an assessment of competence in breathing, voice production and speech

• Makes appropriate referrals to medical and allied health professionals, for example,

1. A referral to a psychologist or an occupational therapist if there are concerns about cognition
2. A medical referral for a video fluoroscopy if the speech pathologist is concerned about the person’s ability to have a ‘safe swallow’ or a dietician if there are concerns about weight loss

At the conclusion of the assessment phase, the speech pathologist may write a report which you can use, for example, to take into your NDIS planning session or for providing information to relevant others (medical and allied health professionals).

In consultation with you (or, with permission, of relevant people in your circle of support), the Speech Pathologist then develops a treatment plan which he/she may directly implement or may work with others in the person’s environment to implement under his/her direction. There are complex interventions which the speech pathologist introduces depending upon the individual needs of the person. Some simplified examples of possible treatments may include:

• For language conditions, simplifying the inputs, providing cues, teaching specific language skills
• For speech, assisting the person to coordinate breathing and speech; teaching modifications to speed of speech.
• If appropriate, speech pathologists can also help you learn how to use ways to communicate that augment speech or offer alternatives to speech (Augmentative and Alternative communication AAC), for example, speech-generating devices and communication aids. Many smartphones and tablets have accessibility features that include changing the text display, alarms, calendars and reminders, voice to text capability and the ability to read text aloud.
• For swallowing difficulties, the speech pathologist can provide advice about the timing of the swallow and also about modifying the texture of food/drinks

The speech pathologist also regularly reviews and adjusts programs as improvements are made and/or conditions change.

Where do I find a Speech Pathologist?

Contact your local state or Territory neuromuscular organisation for information on where to find a Speech Pathologist. Some of these organisations have specialised allied health professional teams or may be able to advise on allied health professionals who have specialist expertise in treating people with neuromuscular conditions. A Speech Pathologist who specializes in neuromuscular conditions is preferable.

Speech Pathologists work in both the public and the private healthcare system. There are dedicated neuromuscular teams, linked to public hospitals in some capital cities in Australia which have a speech pathologist on the team, or who may be able to link you with a local speech pathologist who understands the difficulties experienced by a person with a neuromuscular condition

You can choose to see a private Speech Pathologist and pay through one or more of the following options:

• Your NDIS plan
• Private health insurance
• Medicare (Ask your GP about a chronic disease management plan)
• Privately fund