Speech and language therapy

Communication: language production and understanding, speech clarity, voice, and the social use of language. Swallowing: assessment and treatment of the mechanics of eating and drinking safely, which is a medical safety issue rather than a comfort one.

The same profession covers both because the same anatomy and neurology underlie them, but they are separate problems and a patient may have either or both.

Aphasia, dysarthria and apraxia of speech after stroke or brain injury. Voice and speech changes in Parkinson's disease, where intensive voice therapy reduced the everyday impact of voice problems in a large randomised trial 1. Communication after traumatic brain injury. Dysphagia from any neurological cause.

In children: speech sound disorders, language delay, stammering, and feeding difficulties. In head and neck cancer: speech and swallowing rehabilitation after treatment.

Speech and language therapy has to be delivered in the patient's own language. Interpreting works for a physician consultation and for physiotherapy; it does not work here, because the language is the therapy rather than the medium for it.

We confirm availability for your language before including it in a plan rather than after you arrive. If we cannot deliver it, we say so and build the programme around what we can.

Silent aspiration — food or liquid entering the airway without producing a cough — is common and cannot be detected by watching someone eat. It leads to repeated chest infections and pneumonia.

Assessment identifies which phase of the swallow is failing, which determines the treatment. Modifying diet without knowing that can increase aspiration risk rather than reduce it.

Evidence in aphasia links therapy at a higher intensity, at a higher dose or over a longer period with better functional communication, although more people drop out of the most intensive schedules 2. That shapes how blocks are scheduled here.

It also has to be balanced against fatigue, which limits how much a person early after stroke can absorb. The plan states the intended intensity and adjusts it to tolerance rather than to a template.

Aspiration causes pneumonia, and silent aspiration — where nothing is coughed — is common enough that clinical observation alone misses it. This is why instrumental assessment is used where risk is suspected.

Diet texture, positioning, and specific swallowing exercises follow from that assessment. Families are trained, because most meals happen without a therapist present.

Yes, on current evidence. A Cochrane review of 57 randomised trials with 3,002 participants found that therapy improved functional communication, reading, writing and expressive language compared with no therapy 2. Fewer trials measured outcomes later on, and in those the benefit was not evident at follow-up 2.

Starting late is not in itself a reason to go without. In a German trial of 158 people aged 70 or younger whose aphasia had lasted six months or more, three or more weeks of intensive therapy — at least ten hours a week — improved everyday verbal communication, while the group whose therapy was deferred did not change 3.