Speech and language therapy: communication, voice, stammering and swallowing support

Speech and language therapy is not only about speech sounds. It covers how people understand and use language, how they make speech and voice, how fluently they speak, how they interact socially and how they eat, drink and swallow safely. The Royal College of Speech and Language Therapists describes its aim as enabling better lives for people with communication and swallowing needs.

Speech and language therapists are allied health professionals who complete a degree in speech and language therapy and register with the Health and Care Professions Council, which protects the titles speech and language therapist and speech therapist. They work in hospitals, community clinics, schools, nurseries, care homes and in private practice, and often within teams alongside doctors, ENT specialists, audiologists, dietitians, psychologists and teachers.

The work is highly individual. A therapist may help a toddler with a language delay, an adult who has lost words after a stroke, someone whose voice has changed after surgery, a teenager who stammers or an older person with Parkinson's disease who is coughing when drinking.

• Developmental speech and language difficulties in children, such as delayed language, speech sound disorder, developmental language disorder and childhood apraxia of speech.

• Stammering, which the NHS defines as repeating sounds or syllables, making sounds longer or having words get stuck, and which varies from person to person and situation to situation.

• Aphasia, difficulty speaking, understanding, reading or writing, often caused by stroke or brain injury, which the NHS notes is more common in people over 65.

• Dysarthria, slurred or slow speech caused by weakness or poor control of the speech muscles, seen after stroke and in Parkinson's disease, motor neurone disease and multiple sclerosis.

• Voice problems, including persistent hoarseness, vocal cord paralysis and spasmodic dysphonia, usually assessed jointly with ENT.

• Dysphagia, or swallowing difficulty, caused by stroke, neurological disease, head and neck cancer, dementia, or age-related change. The NHS lists coughing or choking while eating or drinking, a wet or gurgly voice and recurrent chest infections among the signs.

• Communication difficulties linked to autism, learning disability, hearing loss, dementia, cleft palate and selective mutism.

• Communication and swallowing support after laryngectomy or other head and neck surgery.

Assessment begins with a conversation about concerns, history and daily communication needs, followed by structured and informal tests of understanding, expressive language, speech sounds, voice quality, fluency or swallowing as relevant. For a child, therapists observe play and interaction and often involve parents and nursery or school staff, and a hearing check is commonly part of the assessment because hearing loss and glue ear can affect speech development.

Swallowing assessments start at the bedside, looking at the mouth and watching the person eat and drink different textures. If there is concern about food or fluid entering the airway, specialist tests may be used, such as a flexible endoscopic evaluation of swallowing, in which a thin camera is passed through the nose while the person swallows, or a video X-ray swallow study. Results guide whether diet textures need to be modified, which the NHS says can include softer foods and thickener in drinks.

Therapy may take the form of exercises for speech muscles, structured language work, strategies for stammering, voice care, communication aids or training communication partners. The NHS says for aphasia it can involve matching words to pictures, sorting words and practising non-verbal ways of communicating. For stammering the NHS says several therapy approaches exist and a plan is tailored to the child or adult. Therapy may be individual or in groups, face to face or online, with practice at home between sessions.

NHS referral routes vary. Children may be referred by a health visitor, GP, nursery or school, and in some areas parents can self-refer. The NHS says a GP may refer a child who stammers to a speech and language therapist for assessment. For adults, referral usually follows a hospital team after stroke or surgery, or a GP referral for persistent voice, speech or swallowing problems. Urgent swallowing assessments are made in hospital after stroke or when aspiration is suspected.

Waiting times can be long in some areas, and therapy may be time-limited, with a mix of direct and indirect support. Privately, a therapist can usually be seen directly. Check registration with the HCPC, ask about experience with your particular problem, how often sessions are recommended, how progress will be measured and how information will be shared with the school, GP or other professionals involved.

• What are the main difficulties identified and what are the goals of therapy?

• How many sessions are likely, and what should be practised at home or at school?

• Does a hearing test or other medical assessment need to be done alongside this?

• For swallowing, what textures are safe, what should be avoided and who should be told, including carers and care home staff?

• Are there communication aids, apps or adaptations that would help?

• Call 999 for sudden speech difficulty with face drooping or arm weakness. Get urgent advice from a GP or NHS 111 for repeated choking, coughing during eating, recurrent chest infections or a feeling of food sticking, as the NHS advises.