---

• Prerequisites and learning objectives
• Lesson
  • Content
    • 1 - How to prescribe speech therapy
      • 1.1 - Introduction
      • 1.2 - Indication of the speech and language assessment
      • 1.3 - Speech therapy for hearing loss
      • 1.4 - Impairment in written language
      • 1.5 - In the case of children with multiple disabilities
      • 1.6 - Speech therapy in pharyngolaryngeal disorders, including dysphonia
      • 1.7 - Speech therapy in dysphagia
      • 1.8 - Speech therapy and velo-palato-pharyngeal and buccal conditions
      • 1.9 - Speech therapy and neurological disorders
    • 2 - How to prescribe physiotherapy
      • 2.1 - Introduction
      • 2.2 - Maxillofacial physiotherapy and re-education
      • 2.3 - Physiotherapy and facial paralysis
      • 2.4 - Physiotherapy and vestibular re-education
        • 2 . 4 . 1 - Benign paroxysmal positional vertigo
        • 2 . 4 . 2 - Other vertigo-inducing situations
      • 2.5 - Physiotherapy and cervical carcinological surgery
  • Teachers version
  • PDF Version
• Your opinion
• Teachers resources

• Help
• Authors
• Contacts

1 . 4  -  Impairment in written language

Speech and language therapy can be requested for written language difficulties, which is often a cause why children fail at school. There is frequently a disorder associated with oral language, but this is not always the case.

Dyslexia is often associated with problems in learning to read, with confusion of graphemes and the inversion or omission of letters. Dysorthographia concerns disorders of the acquisition of spelling rules. Dysgraphia is noted following excessively bad calligraphy. It can also include disorders in logical reasoning, notably revealed by major difficulties in mathematics.

In practice, when faced with school difficulties of this type, it is good to firstly check keenness of hearing, and secondly to request a speech and language assessment.

1 . 5  -  In the case of children with multiple disabilities

Speech therapy is part of a multidisciplinary therapeutic strategy, developing all means of communication with the surrounding world, even in the case where children are fully incapable of oral and/or written language, and even in the absence of peripheral hearing loss.

1 . 6  -  Speech therapy in pharyngolaryngeal disorders, including dysphonia

In this case, there is impairment of the laryngeal function and therefore, often impaired deglutition. Either the larynx is damaged following surgery or its mobility is altered.

In laryngeal paralysis, the speech therapist assesses the phonatory state and implements a treatment plan to compensate for the unilateral lack of mobility by the other side. The accurate diagnosis of the laryngeal condition is essential and partially directs speech and language therapy (position and tonicity of the vocal chord). In the case of bilateral affliction, the role of the speech therapist is more relative. In intermittent functional impairment with spasmodic dysphonia, speech therapists help the subjects to master their phonation. In cases of laryngeal misuse with vocal forcing, the role of the speech therapist is essential to teach the patients how use their voice and to breathe better, so as not to induce the formation of vocal nodules (also known as kissing nodules). Speech therapy must regulate all function-related vocal microsurgery acts.

In cases of organically afflicted conditions of the larynx, often occurring following surgery, speech therapy is fundamental to achieve two essential goals :

• an audible phonation;
• correct deglutition avoiding false passages.

In these cases, speech and language therapy is not only aimed at improving larynx mobility, but also for good pharyngolaryngeal coordination during phonation and above all, deglutition. In the extreme case of total laryngectomy, speech therapy allows for the acquisition of the laryngeal voice by using the pharyngeal muscles.

In all cases, it is essential to provide the larynx-operated-on patient with speech therapy.

1 . 7  -  Speech therapy in dysphagia

In addition to larynx impairments, there may be deglutition disorders. The typical case is following oropharynx surgery. Certain teams reported a frequency of almost 40% for deglutition impairment in these patients. Speech therapy in these cases mobilizes the neopharynx and makes the patient aware of the deglutition movements so as to avoid false passages.

1 . 8  -  Speech therapy and velo-palato-pharyngeal and buccal conditions

Speech therapy is a fundamental support for the correct acquisition of speech in cases of cleft palate or other velo-palato-pharyngeal malformations, or in cases of velopharyngeal functional disorders. Speech therapy helps to cope with velar insufficiency with rhinolalia (air leakage in the nasal cavity during phonation). If reconstructive surgery is contemplated, speech therapy is essential for functional recovery.

1 . 9  -  Speech therapy and neurological disorders

Especially after a stroke, central complex disorders affecting both phonation and deglutition may occur. These disorders not only affect laryngeal or pharyngeal motility, but also pharyngolaryngeal coordination. Speech production may also be impaired as well as language. In disorders that often lead to a least partial recovery, speech therapy is an indispensable tool used not only to promote recovery as much as possible, but also to help the patient adapt to each unstable state at each stage of recovery, if and when they arrive.

Speech therapy is, in practice, recommended in the following cases :

• Neurological disorders :
  • language disorders (aphasia, dementia, especially Alzheimer's disease, and aging with cognitive decline),
  • speech (dysarthria),
  • written language (central neurovisual impairment),
• Dysphonia,
• Deglutition disorders.