Treatments and diagnostic tests

What is speech therapy?

Speech therapy can help people who have difficulty speaking to communicate better and to break down the barriers that result from speech impediments. The goals of speech therapy include improving pronunciation, strengthening the muscles used in speech, and learning to speak correctly.

Speech therapy can be used for a lot of different speech problems and disorders, from smaller problems like a hoarse voice up to partial loss of speech due to brain damage. Depending on the type of disorder, other medical or psychological treatments may be used as well.

What kinds of disorders can speech therapy treat?

Speech therapy can be used to treat language disorders, speech disorders and swallowing problems.

Language disorders

A childhood language disorder can affect the child’s ability to learn to speak, to name objects and build complete sentences. Although the causes of these disorders are often not clear, the main known risk factors include hearing problems, general developmental problems and disorders affecting the development of the brain.

Language disorders in adults are almost always the result of brain injury or disease. People who have had a stroke, for example, often have trouble forming sentences or remembering words. That type of disorder is called aphasia.

Speech disorders

People with speech disorders have difficulty producing the sounds of speech, saying words clearly or talking fluently.
Children often have trouble with pronunciation, and may have a lisp or swap certain sounds for others. Speech disorders may be the result of developmental disorders, but psychological factors might also play a role. Adults with neurological diseases sometimes have speech disorders too, often making it hard to understand them.

Another group of speech disorders, known as fluency disorders, involve problems with the flow or evenness of speech. People with this sort of disorder may stutter or “clutter,” for example. When people stutter, there are often silent pauses in their speech, or they repeat or lengthen certain sounds or syllables. Cluttering is abnormally fast speech that makes the pronunciation imprecise or leaves out sounds or parts of words.

Voice disorders (dysphonia)

A voice disorder is a persistent change in someone’s voice. They might sound hoarse, strained, raspy or nearly silent. Often the voice is somewhat weak – in other words, it cracks easily or the person is not able to speak loudly. Voice disorders may arise from speaking too much or too loudly, from using the wrong breathing technique, or from problems with the voice box (larynx) like vocal nodules. Psychological causes like depression or a reaction to a distressing event can change a person’s voice too.

Trouble swallowing

In people with swallowing problems, the movements of the muscles involved in swallowing are affected. This leads to problems transporting food through the mouth and throat. The cause is often a disease or disorder of the nervous system, such as Parkinson’s disease, multiple sclerosis, dementia, an infection like Lyme disease or tetanus, or a head injury. If food gets into the lungs because of a swallowing disorder, it can lead to life-threatening complications.

What treatments are used in speech therapy?

There are various speech therapy techniques for each of the areas described above – the ones that are considered depend on the particular disorder. A long series of treatment sessions is typically needed, with each lasting 30 to 60 minutes. They may take place in a group or one-on-one.

The treatment approaches used in speech therapy include:

  • Perception exercises, for example to differentiate between individual sounds and syllables
  • Exercises to produce certain sounds and improve the fluency of speech
  • Exercises to improve breathing, swallowing and the voice
  • Help with communication using things like sign language, communication boards and computer-assisted speech
  • Advice for people who need speech therapy, their parents and other loved ones
  • Support in implementing these measures in everyday life

For the treatment to help over the long term, it’s often important to also regularly practice the techniques at home.

Where is speech therapy offered?

Speech therapy is offered at the following facilities:

  • Speech therapy practices
  • Rehabilitative care centers
  • Special needs schools
  • Children's day care facilities specializing in speech therapy

Besides speech therapists, there are a number of other specialists who also use similar methods. These include breathing, speech and voice coaches.

Do statutory health insurers cover the costs of speech therapy?

Note: The procedures and requirements for applying for and receiving speech therapy may vary according to your country. This information describes the current situation in Germany.

To have outpatient treatment at a speech therapy practice, you need a prescription from a doctor. An initial prescription will generally include up to 10 treatments, each typically lasting 30 to 60 minutes. Appointments are usually offered one to three times per week.

For the medical conditions listed above, prescribed speech therapy is often covered by statutory health insurers (apart from a fixed amount that you have to pay yourself, known as a copayment). The copayment does not have to be paid when getting a treatment that has been prescribed for children. If speech therapy is given as a part of rehabilitative care, an accident insurer or pension fund will cover the costs.

The copayment that you have to pay for yourself is 10 euros per prescription plus 10% of the treatment costs. If each treatment costs 55 euros, for example, for ten treatments you would have to pay 65 euros (the basic fee of 10 euros per prescription plus 10 x 5.50 euros).

Some speech therapists may offer certain treatments without a prescription. You then have to pay for all of the costs yourself. In Germany, these are known as individual health care services (individuelle Gesundheitsleistungen, or IGeL for short).
The German Federal Association of Speech Therapists (DBL) has a search function for speech therapists on their website (in German).