Article by:
Sarah Morales, BS
Children’s Speech Care Center

The beginning of speech and/or language therapy involves gathering and analyzing information about a person’s linguistic, speech and physical abilities (as related to speech/communication). It also looks at the ways in which the individual’s environment influences these abilities. The brain and body interact to produce speech and language, as well as a vast number of other behaviors and automatic processes (e.g,. heartbeat, breathing). A speech-language pathologist’s body of knowledge is based on two key ideas: the different, yet overlapping, areas of speechand language. These terms are defined in other sections (i.e. overview, glossary of terms) as concepts in and of themselves, without consideration of the areas of the brain and body that create speech and language. Please refer to these sections for more general definitions of these terms. The paragraph below will describe the anatomical (location/identity of a body part) and physiological (functions of body parts) sources of speech and language.

Language occurs within the brain, and involves the ability to understand what we hear or read and express our ideas in words (spoken or written). Speech also originates in the brain, and is the audible output of language. For speech to occur, the brain must program components of the oral cavity such as the lips, tongue, jaw, and components of the larynx, or “voice box,” such as the vocal cords, for movement. These anatomical structures (body parts) are the “hardware” for speech, whereas the actions of these parts constitute the “software” for speech. For example, the respiratory system (lungs, trachea or windpipe, ribcage) allows us to breathe, but it also helps us speak by providing air to make the vocal cords vibrate, producing sound. Another important system is our auditory system (outer and inner ear, auditory canal, auditory nerve, auditory receptors within the brain). This system allows us to monitor our own speech and understand and respond to others’ speech. In sum, the brain is essential in both speech and language. It is the interpreter of language and helps us generate language. It also programs bodily organs and muscles to act together to generate clear, well-articulated speech.

In evaluating a person in need of speech and/or language therapy, the speech-language pathologist must examine the individual’s anatomical and physiological state, either directly or through the reports of other health professionals (e.g., audiologists, psychiatrists, physicians, neurologists, etc.). Physicians and neurologists are examples of medical professionals who treat certain physiological or structural (e.g., deformities) problems with medication or surgery. Speech-language pathologists, audiologists, physical therapists, and other such professionals specifically treat problems of physiology, or function, of bodily systems. For example, a speech-language pathologist may learn about a client seeking help by reading his/her physician’s reports to learn about anatomically based problems and treatments, but the speech-language pathologist will conduct direct observations of the client to determine his/her functioning. Sometimes a client’s difficulties do not have any clear pathological (e.g., disease, physical deformity, etc.) origin. These problems are functional in nature. This means that the impairment has occurred without any detectable anatomical or physiological abnormality or dysfunction.

After learning about a client through talking with and/or gathering documentation from other professionals, and then conducting direct observations through an assessment process, the speech-language pathologist makes a diagnosis, labeling the client’s condition. Speech and language impairments are often named with codes for clarity among professionals (e.g., for insurance coverage, for other health professionals’ evaluations, etc.). The level of severity is also noted. Next, the speech-language pathologist plans treatment.

Treatment type and duration vary based on the client’s needs. For example, voice disorders such as hoarseness or vocal fatigue are usually more easily and quickly treated than conditions that involve brain dysfunction or damage, such as severe autism or a stroke. An athletic coach with a hoarse voice from yelling can easily be instructed in ways to refrain from yelling (e.g., using a megaphone, whistle), whereas an autistic child who does not talk presents with more pronounced difficulties. Therapy in the latter case may require several years of direct, regular contact with a speech-language pathologist and other professionals to be effective. Families of persons with speech and language impairments are in key positions to help that individual progress in therapy. In fact, in many treatment approaches, family members themselves implement therapy! “Homework assignments” may be given as part of therapy, or family members may be responsible for implementing the therapy plan (e.g., helping a smoker with voice problems stop smoking; helping in the set-up, use, and maintenance of special communication devices; cleaning and maintaining hearing aids; etc.).

In sum, speech and language are amazingly complex. In fact, when one considers the number of processes and body parts that are components in speech and language, one may find it wondrous that humans can talk at all! To help improve a person’s abilities in such complex activities, complex problem solving is required. A vast amount of knowledge and decision-making are involved in finding a diagnosis and planning treatment. The field of speech-language pathology itself is complex and constantly changing; it is a field wherein absolutes do not exist, and numerous solutions may be effective for any single problem.