1  -  How to prescribe speech therapy

1 . 1  -  Introduction

Generally, a speech therapist is requested when the medical profession notes a difficulty with spoken language. The main objective of a speech therapy is to correct (if possible) or improve oral communication. By extension, as speech therapists intervene in cases of oral language difficulties, their help is often required in a broad range of communication difficulties, for example, in cases of neurological deficiencies or multiple neurosensory disabilities. Speech therapy is fundamental in cases of delayed speech in children. This is where the acquisition of oral language is rendered difficult by impaired hearing. The audio-phonatory loop is often stated as having two functions, auditory and phonatory, which are closely connected and in constant interaction. For example, it is very difficult to sing correctly if one cannot hear well. Due to their central interest in the production and understanding of language, speech therapists are often consulted to help patients suffering from a functional impairment of the larynx, which is the main sound producing organ. One example of where their help is essential is in cases of complete absence of the larynx, e.g., in cases of cancer surgery. Equally, since the larynx is primordial in deglutition, speech therapy is required in cases of difficulties in swallowing that are not related to sound production difficulties. Therefore, speech therapy has a vast range of applications. Consequently, it is not unheard of that speech therapists prefer to become highly specialized in a certain area, such as in either hearing loss, or pharyngolaryngeal deglutition disorders and dysphonia.

In practice, the physician has primarily a diagnostic role and puts forward the indication of a speech and language assessment. It is at the end of this assessment that the speech therapist decides on the type of adapted patient management and the number of sessions required. Although the term may be controversial, one often speaks of speech and language re-education.

1 . 2  -  Indication of the speech and language assessment

This is the physician's fundamental role. Physicians should consider speech therapy every single time they encounter a language, phonatory or deglutition impairment in a patient under their care. Of course, the diagnostic approach to the cause of the impairment must always be considered either prior to, or simultaneously during speech assessment but never retrospectively.

For example, the physician should not even consider speech therapy in a dysphonic patient before checking the larynx, a fortiori if the subject is at risk of laryngeal cancer.

For childhood deafness, the approach is a little different inasmuch as the speech therapist helps the physician assess the linguistic handicap induced by the hearing loss. The physician, therefore, participates in the evaluation of the severity of the hearing impairment. Nevertheless, the physicians must do their utmost to characterize the type of hearing loss, its stage, as well as its etiology. In other words, the physician should not rely on the speech therapist to establish a diagnosis on his/her behalf, even if the latter's help often proves highly valuable.