What is speech therapy?

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

A language disorder can affect your ability to distinguish between different speech sounds, to name objects and build complete sentences. In children, the causes of these disorders are often unclear. The main risk factors are hearing disorders, general delayed development and brain development disorders.

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.

People with speech disorders have difficulty producing certain speech sounds, saying words clearly or talking fluently.

Children often have problems with pronunciation. That usually involves a lisp - and most often affects the pronunciation of "S" or "Z" sounds. Speech disorders may be the result of developmental disorders, but psychological factors might also play a role. Adults who have neurological illnesses can also develop speech disorders. This makes it difficult 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. Fluency disorders typically have a genetic cause.

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.

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. Damage to the nervous system is often the cause – which could be caused by a stroke, Parkinson's, multiple sclerosis, dementia or infection such as Lyme disease or tetanus, for example. Other possible causes include diseases affecting the mouth or throat (like inflammations or tumors), deformities or a head injury. If food gets into the lungs because of a swallowing disorder, it can lead to life-threatening complications.

People who are affected by hearing loss (a hearing impairment) are unable to hear speech and sounds properly. A person who is unable to hear or hears hardly anything is said to be deaf. Hearing disorders can be caused by infections, sudden hearing loss or injuries. Loud sounds can also harm your hearing and lead to permanent hearing loss. Adults mostly develop hearing disorders in old age (age-related hearing loss). In children they are likely caused by improper development before birth.

There are various speech therapy techniques for each of the areas described above – the ones that are considered depend on the particular disorder. These techniques 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 expand vocabulary, word recall and grammar
• Breathing, voice, swallowing and hearing exercises
• Help with communication using things like sign language, communication boards and computer-assisted speech
• Exercises for using and hearing with a hearing aid (cochlear implant)
• 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.

Speech therapy is offered at the following facilities:

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

Besides speech therapy, a number of related specialists use similar techniques. These include breathing, speech and voice coaches.

In Germany, speech therapy is considered part of a group of special therapies called “Heilmittel.” The costs are covered by public health insurers. In hospitals or rehabilitative care centers, the speech therapy is often part of the treatment, and is then covered in full. Adults have to pay part of outpatient speech therapy if they are required to make co-payments. This co-payment amounts to 10 euros per prescription plus 10% of the treatment costs. The costs for children and teenagers are fully covered by public health insurers.

Depending on the specific condition, the first prescription is for up to 10 or up to 20 units of therapy. The treatment appointments typically take place one to three times per week, with each appointment lasting 30 to 60 minutes. Group therapy sessions of 45 to 90 minutes are also possible.

The important thing is that the therapy start within 28 days of the date on the prescription. After that, the prescription is no longer valid. If the treatment is needed urgently, it must start within 14 days of the date on the prescription. It is possible to take a break of up to 14 days between two treatment appointments without having to give a reason. Breaks of up to 28 days require a good reason. If the break lasts more than 28 days, the remaining appointments expire.