Speech language pathology, or speech therapy, isn’t just about helping people with speaking or talking.
“Some people wonder why they need to see a speech therapist, because they don’t have trouble speaking,” says Gigi Lough, MA, CCC-SLP, a speech therapist at UPMC’s outpatient rehabilitation clinic in New Castle at Nesbitt Place.
People are often surprised that speech therapy exercises can help with everything from swallowing to reading comprehension. “We do a lot,” Lough says. “From birth through geriatrics, we deal with a variety of disorders.”
Speech language pathologists (SLPs) work with patients in inpatient rehab, outpatient rehab, schools, and in home settings. Children may see an SLP after a preschool or elementary school screening, or if a parent, teacher, or pediatrician has concerns.
Adults usually find their way to speech therapy after a hospitalization. In addition to working one-on-one with an SLP, patients usually have speech therapy exercises at home to practice.
Usually, a referral is needed to see a speech therapist. However, exceptions can occur if a school or early intervention program is providing speech therapy.
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Who Can Speech Therapy Exercises Help?
“There are a vast array of exercises and treatments that we do,” Lough says. This is because speech therapy helps with a broad range of physiologic and neurologic conditions.
SLPs may see people with:
- Swallowing issues, where food is getting stuck in the throat or the person can’t use their tongue, lips, and jaw properly to chew, gather, and push food back into the throat so that it can be swallowed. In other swallowing cases, food or liquid may be going into the lungs, which can cause pneumonia or affect nourishment and hydration.
- Problems with speech fluency or stuttering.
- Problems relating to weakened speech muscles. This includes dysarthria, which can affect the ability to clearly pronounce words.
- Problems with voice.
- Speech or language delays (in children).
- Issues related to speech sound production (how someone says their words). This includes lisps of the ‘s’ or ‘z’ sounds and other misarticulated speech sounds,as well as apraxia, which is a neurological condition that makes it difficult to pronounce words correctly. It can affect both children and adults.
- Problems with receptive language (understanding spoken language you hear or written language you read). This can include aphasia, which is a neurological issue that often happens after a stroke.
- Problems with expressive language, or being able to communicate through speaking, gestures, and writing. This can also be a symptom of aphasia.
- Cognitive issues that affect memory, reasoning, attention, problem solving, and executive functions such as planning, organizing, and flexibility.
The exercises SLPs do with adults and children depend on the speech or language condition someone has.
“When people think of exercises, they think physical, but sometimes our speech therapy exercises are more mental,” Lough says. “Mouth exercises are a small part of what we do.”
Therapy may also involve things such as practicing conversation, problem solving, or memory strategies. Patients sometimes learn strategies for using visual prompts to help remember things. “We might need to do exercises to help a patient remember what they are supposed to do when they see the visual prompt,” Lough says.
For patients who are nonverbal or severely struggle with expressive language, SLPs are an important partner because they help to create strategies for communication using augmentative and alternative communication (AAC). This can mean using gestures or writing to communicate or using some type of electronic or non-electronic device, such as picture boards. “When using electronic AAC devices, we often work on motor memory exercises, where clients practice pressing a button or sequence of buttons on their device, so they can learn how to automatically go to the buttons they need to express themselves without needing to take extra time to search for them,” Lough says.
How Speech Language Pathologists Help Children
Children often start speech therapy because parents have had a concern about speech delays or other issues affecting speech. But families don’t always realize the delay, and even doctors may take a “let’s wait and see” approach, Lough says. “There is so much learning that happens in the preschool years. It’s best to start the therapy early, rather than waiting to see.”
A lot of the issues children have relate to how they are pronouncing their words. “With kids, we do a lot of drills related to articulation,” she says. “We work to build their motor memory.”
For example, a child with a lisp on an “S” sound has learned to produce an “S” in a certain way. In order to physically change how they make the sound in their mouth, an SLP may show or help patients position their mouth correctly and combine that position with proper airflow and voicing to produce a desired sound. Then, they’ll work with you to practice that sound repeatedly in various exercises, in order to develop motor memory. By doing so and learning to say a certain sound by itself, patients can then work to progress further and begin speaking syllables, words, phrases, sentences, and finally, a conversation.
Sometimes, a child’s speech sound production issues are more challenging than just articulation due to an apraxia of speech. Apraxia affects motor planning to coordinate their mouth movements to produce and combine their speech sounds. Speech therapy exercises for a child or adult with apraxia may include practicing certain words and sentences, as well as the way sounds blend together. Repeated practice or “drill” exercises can help develop motor planning of the muscles and muscle memory.
Other exercises related to receptive language might involve breaking down complex sentences or directions into smaller chunks. For children struggling with expressive language, an SLP may help them use vocabulary to build sentences and make meaning.
Helping children with autism
Lough says that she and her team also work with many children who are on the autism spectrum, who may have receptive and/or expressive language impairments, or some social communication challenges. “Autism spectrum disorders almost always affect language skills, but the impact can range from very severe to a very mild degree of impairment,” she says.
Speech Therapy After Stroke or Traumatic Brain Injury
Our brains have neuroplasticity, Lough says. “This means our brain can rewire itself. So, if you have damage to one area, you can use healthy areas of the brain to take over the damaged area.”
This is how we build new neural connections, which is what speech therapy exercises help patients do after a stroke.
For example, a stroke or other traumatic brain injury can cause aphasia. A person may have trouble finding words, forming sentences, or understanding conversation or what they’re reading.
Lough says that she might do exercises that teach word finding strategies or sentence formulation strategies. “We might just work to find strategies to make the stronger areas of the brain take over,” she says.
If the stroke has caused dysarthria, the exercises are different. In this case, Lough would work to strengthen their voice or their breath support for their voice, and she may work on stress patterns in sentences or inflection to make speech sound more natural. “Often with dysarthria, we do exercises to strengthen the tongue, lips, and jaw, as well as exercises to practice overemphasizing their words so that they can say their words more clearly. We’ll also do exercises that involve slowing their rate of speech, which allows their mouth more time to clearly produce their words,” she says.
Apraxia, however, is not related to a weakness of the speech muscles. Rather, it’s related to motor planning. If the stroke has caused apraxia, Lough may work with patients to practice certain words and sentences, as well as the way sounds blend together, in order to develop motor planning of the muscles and muscle memory.
If a stroke or other condition has affected swallowing, she might have a patient do exercises with their throat to practice squeezing the food down and protect their airway. “It’s not always exercises; sometimes, we might modify diet, too,” she says. “Swallowing also may require mouth exercises to strengthen and coordinate the tongue, lips, and jaw to chew, gather, and push food back to the throat to swallow.”
Another type of exercise SLPs may teach to clients are swallowing strategies, which one can do while swallowing to protect their airway or make the food go down more easily. Or, speech therapists can also use thermal stimulation—such as cold—to help trigger and improve swallowing.
SLPs may recommend speech therapy exercises at home, but they tailor those exercises to each patient. “It’s all about helping people build on their strengths,” she says.
With hard work, people can make tremendous progress, Lough says. “Sometimes we see people who aren’t yet able to communicate or work because of deficits. When they’re able to do those things again, it’s very rewarding.”
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The UPMC Rehabilitation Institute offers inpatient, outpatient, and transitional rehabilitation, as well as outpatient physician services so that care is available to meet the needs of our patients at each phase of the recovery process. Renowned physiatrists from the University of Pittsburgh Department of Physical Medicine and Rehabilitation, as well as highly trained physical, occupational, and speech therapists, provide individualized care in 12 inpatient units within acute care hospitals and over 80 outpatient locations close to home and work.