Unit 3: Introduction to Speech and Language Therapy

3.1 Importance of Speech and Language Therapy

3.2 Functional assessment – phonology, syntax, semantics and pragmatics

3.3 Meaningful acquisition of Speech & Language

3.4 Types of speech and language disorders

3.5 Enhancing and integrating speech and language into classroom context modes of communication

 

 

 

 

 

 

3.1 Importance of Speech and Language Therapy

Communication is unique to human being which has a major role in all walks of life, and gives human beings a distinct identity. Communication is achieved verbally or nonverbally with the use of language. Communication refers to the sending and receiving of messages, information, ideas or feelings (Hulit and Howard 2002). Speech and language are the components of communication. Bloom (1988) describes language as a code whereby ideas about the world are represented through a conventional system of arbitrary signals for communication. Speech is the oral expression of language (Hulit and Howard 2002).

Speech and language disorders refer to problems in communication and related areas such as oral motor function. These delays and disorders range from simple sound substitutions to the inability to understand or use language or use the oral-motor mechanism for functional speech and feeding. Some causes of speech and language disorders include hearing loss, neurological disorders, brain injury, mental retardation, drug abuse, physical impairments such as cleft lip or palate, and vocal abuse or misuse. Frequently, however, the cause is unknown.

What is Speech Therapy? “Speech Therapy is a rehabilitative procedure undertaken in order to help the people having any kind of Communication Disorders or Problems and some swallowing problems”

 

Or, it is the treatment of speech and communication disorders. The approach used varies depending on the disorder. It may include physical exercises to strengthen the muscles used in speech (oral-motor work), speech drills to improve clarity, or sound production practice to

improve articulation.

 

Who is a ‘Speech Therapist’? A person who specializes in the diagnostic procedures, evaluation techniques, assessment tools and various therapeutic techniques related to different communicative disorders.

 

 

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. They work as part of a multidisciplinary team and have close links with teachers, doctors, nurses, psychologists, occupational therapists and other health professionals. 

A speech pathologist's narrow, well-defined objectives work toward achieving broad therapeutic goals. This professional develops an individualized treatment plan for each patient, which often includes time-based objectives. For example, his objectives may include helping a patient correctly say several new sounds by the end of a quarter, marking period or year. Other objectives can include helping a patient to understand and to explain a speaker's gestures, demonstrate newly learned conversation strategies, explain the perception of body language, speak for a period of time without stuttering and improve reading comprehension to a specific level.

The main objectives of speech therapy is to improve communication. Some of the goals of speech therapy might include:

·         Improving coordination of speech muscles through strengthening and coordination exercises, sound repetition and imitation.

·         Improving communication between the brain and the body through visual and auditory aids such as mirrors and tape recorders.

·         Improving fluency through breathing exercises.

·         Enhancing the learning of language through language stimulation and the use of language through positive reinforcement.

·         Improving communication by helping a child learn alternative way to communicate. This might include gestures, signing or augmentative communication devices.

Each child will have a different outcome depending on his or her particular challenges and abilities. The length of time in speech-language therapy depends on many factors such as severity of the problem, the frequency and consistency of therapy and the consistency of help at home.

3.2 Functional assessment – phonology, syntax, semantics and pragmatics

In typically developing preschool children, language is developing at a rapid pace; their vocabularies are growing, and they are beginning to master basic sentence structures. For children with language difficulties, this process may be delayed. For children in this population, areas targeted for intervention typically include:

Phonology

Semantics

Morphology and syntax

Pragmatics

3.3 Meaningful acquisition of Speech & Language

Acquisition of speech and language skills follows a fairly systematic progression, with easily identifiable milestones associated with specific ages in each area.

First language acquisition refers to the way children learn their native language. Second language acquisition refers to the learning of another language or languages besides the native language.

For children learning their native language, linguistic competence develops in stages, from babbling to one word to two word, then telegraphic speech. Babbling is now considered the earliest form of language acquisition because infants will produce sounds based on what language input they receive. One word sentences (holophrastic speech) are generally monosyllabic in consonant-vowel clusters. During two word stage, there are no syntactic or morphological markers, no inflections for plural or past tense, and pronouns are rare, but the intonation contour extends over the whole utterance. Telegraphic speech lacks function words and only carries the open class content words, so that the sentences sound like a telegram.

Acquisitions
Phonology: A child's error in pronunciation is not random, but rule-governed. Typical phonological rules include: consonant cluster simplification (spoon becomes poon), devoicing of final consonants (dog becomes dok), voicing of initial consonants (truck becomes druck), and consonant harmony (doggy becomes goggy, or big becomes gig.)

Morphology: An overgeneralization of constructed rules is shown when children treat irregular verbs and nouns as regular. Instead of went as the past tense of go, children use goed because the regular verbs add an -ed ending to form the past tense. Similarly, children use gooses as the plural of goose instead of geese, because regular nouns add an -s in the plural.

The "Innateness Hypothesis" of child language acquisition, proposed by Noam Chomsky, states that the human species is pre-wired to acquire language, and that the kind of language is also determined. Many factors have led to this hypothesis such as the ease and rapidity of language acquisition despite impoverished input as well as the uniformity of languages. All children will learn a language, and children will also learn more than one language if they are exposed to it. Children follow the same general stages when learning a language, although the linguistic input is widely varied.

The poverty of the stimulus states that children seem to learn or know the aspects of grammar for which they receive no information. In addition, children do not produce sentences that could not be sentences in some human language. The principles of Universal Grammar underlie the specific grammars of all languages and determine the class of languages that can be acquired unconsciously without instruction. It is the genetically determined faculty of the left hemisphere, and there is little doubt that the brain is specially equipped for acquisition of human language.

The "Critical Age Hypothesis" suggests that there is a critical age for language acquisition without the need for special teaching or learning. During this critical period, language learning proceeds quickly and easily. After this period, the acquisition of grammar is difficult, and for some people, never fully achieved. Cases of children reared in social isolation have been used for testing the critical age hypothesis. None of the children who had little human contact were able to speak any language once reintroduced into society. Even the children who received linguistic input after being reintroduced to society were unable to fully develop language skills. These cases of isolated children, and of deaf children, show that humans cannot fully acquire any language to which they are exposed unless they are within the critical age. Beyond this age, humans are unable to acquire much of syntax and inflectional morphology. At least for humans, this critical age does not pertain to all of language, but to specific parts of the grammar.

3.4 Types of speech and language disorders

Delayed language 

Children with delayed language learn words and grammar much more slowly than other children. There are many reasons for delays in speech and language. Hearing loss is a common reason. A child who cannot hear well or at all will have trouble learning, copying, and understanding language. Speech delays may also be caused by what is called “oral-motor” problems. Oral-motor problems are difficulties with using the lips, tongue, and jaw to make speech sounds. Sometimes these problems start in the areas of the brain that are responsible for speech and language development.

Children are different from each other in the way they develop. Some are faster, and some are slower, but they might all be developing normally. It is hard to tell if there is a real language delay. There are some guidelines about children’s speech and language skills that will help you decide if the child is delayed. These are known as “developmental milestones.” 
Articulation disorders

Articulation means making sounds and words. To do this, the lips, teeth, tongue, jaw, and palate (roof of the mouth) need to move together to make shapes. They change the movement of the air that comes from the vocal chords. That is how people make sounds, syllables, and words. A child has an articulation disorder when he makes sounds, syllables, and words incorrectly. The listeners do not understand what he is saying.

There are three types of articulation disorders. They are called omissions, substitutions, or distortions. Omission means leaving something out. An example of a speech omission is saying “at” for “hat” or “oo” for “shoe.” Substitution means putting something where something else belongs. An example of a speech substitution is the use of “w” for “r” and saying “wabbit” for “rabbit.” Another example is using “th” for “s” and saying “thun” for “sun.” Distortion means that the parts are mostly there, but they are a little wrong. The child says a word that sounds something like what it should, but it is not quite right. An example is “shlip” for “ship.”

Articulation disorders are not the same as “baby talk.” It is important to know the difference. Baby talk happens in young children who mispronounce words. That is normal and not a disorder. In older children it is no longer cute. Articulation problems then get in the way of good communication. Sometimes a different accent may be confused with articulation problems. An accent is a problem for a child only if it gets in the way of the child’s communication. As a general rule, a child should be able to make all the sounds of English by the age of 8.

Articulation problems may come from: 
   • Physical handicaps such as cerebral palsy, cleft palate, or dental problems
   • Hearing loss
   • Incorrect speech and language models for a child

Stuttering

Stuttering is when speech does not flow smoothly. It is interrupted by: 
   • Stopping in the middle (no sound comes out at all)
   • Repeating sounds (for example, st-st-strong)
   • Holding a sound or syllable for a long time (for example, sssssssstrong)

When children stutter, they often blink their eyes quickly. Their lips might shake, or they might move in another way that shows they are struggling to get the word out. “Stuttering” is the same as “stammering;” the words mean the same thing.

Most children stutter a little when they learn to talk. It is most common in children between the ages of 2 and 6. They are just starting to develop their language and speech skills. Boys are three times more likely to stutter than girls. Stuttering when learning language is natural and common. Most children outgrow it.

Some children may stutter more in certain situations. They may stutter when they have to speak in front of many people or speak on the telephone. Some children who stutter may not do so when they talk to themselves or when they sing.

Stuttering may be caused by:
   • Developmental causes – Developmental stuttering happens when a child is learning to talk. He cannot find the words that
     he wants to say as fast as he thinks. This type of stuttering is normal. It goes away as the child grows. 

   • Neurogenic causes (causes that start in the nervous system) –Stuttering may be caused by problems in the brain,
     nerves, or muscles. The part of the brain that is responsible for speech and language development may be damaged by a
     stroke or by a head injury. The muscles that are responsible for forming sounds and words may be damaged. 

   • Psychogenic causes (causes that start in the way a person thinks or feels) – Stuttering may be caused by severe
     damage or stress to the mind. This type of stuttering happens in children with mental illness. Very few children stutter
     because of these causes.

   • Hereditary causes – Stuttering may run in the family and be passed to a child from her parents. Some experts disagree
     with this theory.

Voice disorders

A voice disorder happens because the vocal cords that produce sound are damaged. The vocal cords are the muscles in the throat that are responsible for making sounds and words. Children can damage their vocal cords by shouting, screaming, and talking extremely loudly and very often. Their voice may become harsh and they may find it very difficult to talk. Also, when they try to talk, their throat may hurt a lot. Voice disorders are sometimes called “voice abuse.”

Voice disorders in children can be corrected with speech therapy. In speech therapy, children are taught to speak softly. They are also taught not to scream, shout, or do anything that may hurt their vocal cords and affect their voice. Remember that children like to copy what the adults around them do. So if they see you speaking loudly or shouting, they will do the same. Practice speaking softly so that the children around you will do the same.

Voice disorders are not common in children. Also, they are usually temporary.

Aphasia

Aphasia is a language disorder. It is caused by injury to those parts of the brain that are responsible for language. This is mostly the left side of the brain. Aphasia may be caused suddenly, perhaps from a stroke or a head injury, or it may develop slowly, perhaps from a brain tumor.

Aphasia affects the way children talk and the way they understand what others are saying. It weakens a child’s ability to read and write.

Aphasia is very rare in children.

Speech and language disorder due to hearing impairment

Children learn to talk by listening to speech. The first few years of life are a critical time for speech and language development. Children must be able to hear speech clearly in order to learn language. A fluctuating hearing loss due to repeated ear infections might mean the child doesn't hear consistently and may be missing out on critical speech information. Permanent hearing loss will also affect speech and language development, especially if it is not detected early. The earlier a hearing loss is identified and treated, the more likely the child will develop speech and language skills on par with normally hearing children.

3.5 Enhancing and integrating speech and language into classroom context modes of communication

Interventions for children identified as having speech and/or language disorders include a variety of practices (methods, approaches, programmes) that are specifically designed to promote speech and/or language development or to remove barriers to participation in society that arise from a child’s difficulties, or both.

Intervention may take place in many different environments, for example, the home, school or clinic and will vary in duration and intensity dependent on the resources available, perceived needs of the child and policies of individual speech and language therapy services. Intervention may also be delivered indirectly through a third person or directly through the clinician. Direct intervention focuses on the treatment of the child either individually or within a group of children depending on the age and needs of the children requiring therapy and the facilities available. Indirect intervention is often perceived to be a more naturalistic approach where adults in the child’s environment facilitate communication.

Any type of intervention designed to improve an area of speech or language functioning concerning either expressive or receptive phonology (production or understanding of speech sounds), expressive or receptive vocabulary (production or understanding of words), or expressive or receptive syntax (production or understanding of sentences and grammar).

Goals for Early Intervention

Promote pre-linguistic communication

·        Communication intention (e.g.,Request, comment, protest)

·        Communication modalities

1.     Vocalizations

2.     Gesture

3.     Sign

Early linguistic communication

·        Early vocabulary development

·        Word combinations

·        Syntax/morphology

·        Articulation

·        Pragmatics

Early Intervention, especially where language delay is involved, works best when the following techniques are learned, used, and established: 

 

·        Joint Attention Skills: When looking at pictures, reading books, or even just playing with children, especially those with, decreased vocabulary, it is important that the child engages or attends to an object, picture, or toy that the caregiver is talking about. This ensures that the child is listening and is able to receptively understand the object or picture being labeled and described. 

 

·        Turn-Taking: This is teaching children to respond to physical and verbal cues, which helps set the stage for adequate communicative exchange in which there is a speaker and a listener. For example, if the parent pushes the car to the child and says “vroom-vroom”, the parent waits for the child to respond by pushing the toy car back to them and imitating the sound. Some children need to be taught this skill explicitly to establish meaningful communicative exchange. 

 

·        Language Stimulation: The caregiver or care providers follows the child’s lead during play or in everyday activities and responds to the child’s actions by saying out loud what they are doing such as naming the item they are manipulating, talking about the action the child is performing with the object, and describing the physical characteristics of the object. All this is done while not requiring the child to respond or to say a specific word or sentence. Only stimulating their language and providing them with temptation to talk. 

 

·        Play Skills: how children discover and learn about objects, people and the world around them. Through play, children often show us what they understand about the world. Play is a good skill to teach speech and language concepts relevant to children’s everyday life, which will help them to become better communicators. 

 

Treatment Modes/Modalities

The treatment modes/modalities described below may be used to implement various treatment options.

Augmentative and Alternative Communication (AAC)—supplementing or replacing natural speech and/or writing with aided (e.g., picture communication symbols (PECS), line drawings, speech generating devices, and tangible objects) and/or unaided (e.g., manual signs, gestures, and finger spelling) symbols. Whereas aided symbols require some type of transmission device, production of unaided symbols only require body movements. .

Computer Based Instruction—use of computer technology (e.g., iPads) and/or computerized programs for teaching language skills, including vocabulary, social skills, social understanding, and social problem solving.

Facilitated Communication—use of a "facilitator" who provides physical and other supports in an attempt to assist a person with a significant communication disability to point to pictures, objects, printed letters and words, or to a keyboard and thereby communicate.

Video-Based Instruction (also called Video Modeling)—use of video recordings to provide a model of the target behavior or skill. Video recordings of desired behaviors are observed and then imitated by the individual. The learner's self-modeling can be videotaped for later review.

Effective communication is fundamental to human development and plays a critical role during the formative years of a child’s life. Without the ability to communicate clearly, children lose access to many of the educational experiences that will mold them into adults. The situation is frustrating and debilitating for the children involved, and stressful and painful for their families. Speech language pathologists can step in to address those problems at the very source with life-changing therapeutic interventions that make a real difference for those children and their families.