The terms speech therapist and speech pathologist can be used interchangeably.
Speech Therapy in Kenya
If I had a penny for how often I’ve been asked this in the last 7 years, I would have quite a collection.
Where do I live?
Well… I live in Nairobi, Kenya, which is considered an underserved country because of how few we are here.
There are less than 10 speech pathologists (or speech therapists) in Nairobi and a handful (if that) scattered about in the rest of the country.
Kenya has a population of 50+million, which means there is approximately 1 speech therapist for every 5 million people.
To put this shortage into perspective, consider that the recommended ratio of speech pathologists to students, in a report by one shire in Melbourne, Australia, was 1 for every 733 students.
So what do we do?
Speech-language pathologists (SLPs) work to prevent, assess, diagnose, and treat speech, language, social communication, cognitive-communication, and swallowing disorders in children and adults.
What does a Speech Therapist do?
1. Resolve Speech Difficulties
Despite what our title suggests, ‘speech’ isn’t all we do.
If anything, ‘speech’ only refers to how sounds are produced (mispronunciations) and whether they’re produced smoothly or fluently (stuttering).
Generally, ‘voice’ (voice disorders) and ‘resonance’ (breath support issues during speech) fall under ‘speech’.
Speech therapists are keen to make a distinction between ‘speech’ and ‘language’. To read more about this distinction, click here.
Where ‘speech’ is solely the mechanics of sound production, ‘language’ is a lot more.
2. Resolve Language Difficulties
My work as a speech therapist involves assessing and remediating issues with a person’s understanding (receptive language) of what is said to them.
A speech therapist also remediates issues pertaining to how someone organises their thoughts/ideas when speaking (expressive language).
It’s important to also note that language disorders are not just spoken, speech pathologists also intervene where a person presents with a written disorder.
This may be difficulty achieving reading success at school, persistent spelling issues, etc.
Language also encompasses how sounds are ordered in a word (morphology).
As a speech therapist, I will look at how a child (or adult) conjugates their verbs to be congruent with the tense (e.g. did the child include the past tense ‘ed’ in their re-tell of an event).
I may consider whether the right kind of vocabulary (semantics) have been used in a narrative (or story).
3. Provide aural hearing rehabilitation
Speech pathologists provide aural (hearing) re/habilitation to people who are hearing impaired and for whom, oral communication is a target.
There are various approaches to teaching an aided (with hearing aid/cochlear implant) child how to communicate orally and one of them is the auditory-verbal approach.
Auditory-verbal therapists (AVT) can be speech pathologists or teachers of the deaf, who have gone through rigorous training, documentation of sessions and mentoring by qualified and experienced AVTs.
It can take a further 2-3 years of on the job training in order to receive certification from the AVT group.
There is usually a misconception that speech therapists teach children with hearing impairment sign language.
Typically, speech therapists DO NOT teach sign language.
Instead, we teach children with hearing impairment how to communicate using speech. This is only possible if the child is young enough and if the child is adequately aided using hearing aides or a cochlear implant.
If you suspect your child may be having a hearing loss, read this article to learn more about the various hearing tests.
4. Resolve pragmatic Language Difficulties
A speech therapist is also concerned with whether language is being used appropriately in a social context (pragmatics).
For instance, when I am assessing a child, I am usually critical of:
-Whether the child is including enough details when narrating an event
-Whether they’re aware of a communication breakdown and what, if anything, they’ll do about it.
-Whether the child aware of my changing facial expressions and adapting their utterances to match.
-If I am looking bored, are they becoming more animated with their story or changing the topic altogether.
With topics of conversation, good pragmatic skills require that a child (or adult) is able to:
– Maintain a topic
– Know the right time to extend it; or
– Terminate it.
A person who sticks too long to 1 topic or changes topics too randomly or doesn’t share ‘talking’ time evenly with their conversational partner may be presenting with a language disorder, which is more pragmatic in nature.
5. Assist those with social communication disorders
Social communication disorders fall under the scope of practice of speech therapists.
Social communication involves being able to use verbal and/nonverbal communication for social purposes.
Children and adults who have Autism experience difficulties with social communication.
In Does My Child Have Autism, you can read more about this topic and/or watch a video clip of me discussing the Autism Spectrum Disorder.
Traumatic brain injuries can also cause disruptions in pragmatic skills.
Being able to answer social questions (e.g. those pertaining to your name, how you’re feeling, age, etc.) appropriately is part of using communication to fulfill social purposes.
Social communication also involves adjusting one’s talking to suit the listener’s age/status.
You tend to speak differently when you’re addressing your boss as opposed to your peer/a toddler.
Finally, good social communication involves respecting conversational rules;
– Topic initiation
– Topic maintenance
– Topic termination
– Communication breakdown repair, etc.
For instance, if someone asks you how your weekend was, you cannot start talking about astrophysics.
6. Assist those with Cognitive Communication Disorders
Cognitive communication disorders can result in a person experiencing varying degrees of any of the above difficulties, but the striking difference with cognitive disorders, is pronounced difficulties organising thoughts, paying attention, remembering, planning, and/or problem-solving (ASHA).
Children or adults with a cognitive impairment may present with skills that are significantly delayed with achievement not following typical patterns.
Causes of cognitive impairment could be congenital (from birth) or acquired as in the case of birth trauma, stroke or traumatic brain injury.
7. Resolve Swallowing Difficulties
Another little known area that speech pathologists work in is in assessing and remediation of swallowing (dysphagia) disorders.
Dysphagia may be as a result of illness, surgery, stroke or injury.
I have often been called to the hospital to assess whether a child on a tracheostomy tube is ready to transition to solid foods/fluids.
Such an assessment is very vital in order to ensure safety of swallow is ensured in order to prevent aspiration pneumonia which can lead to death.
In my clinical practice, I am also encountering more and more toddlers who are not chewing or who gag when they swallow.
It’s within our scope of practice to give strategies to promote the safe swallow of a variety of textures.
8. Provide augmentative and alternative communication
There are speech therapists who specialise in providing augmentative and alternative communication (AAC) systems to individuals with severe expressive or receptive language difficulties.
The systems could be in the form of electronic gadgets (hi-tech) or communication boards (low-tech) aimed at easing the physical demands of communication.
Individuals who benefit from AAC devices are normally severely handicapped or not able to use speech or sign language to communicate their needs.
For example, children with cerebral palsy, who may have severe motorical challenges may benefit from using AAC system.
9. Speech therapists provide corporate services
Some speech therapists choose to specialise in providing corporate services such as improving public speaking, interviewing or presentation skills.
In these cases, speech therapy is sought to enhance communication.
There are also adults who have an interest in modifying their accents.
In Kenya for instance, I am approached from time to time by adults who wish to get rid of dialectal influences/mother tongue interference which may stand in the way of them applying themselves effectively at work, at school or socially.
10. Speech therapist are involved in building awareness
Lastly, another area in which speech pathologists are constantly involved with is sensitising parents, teachers and other stakeholders on how to prevent and mitigate communication disorders.
I am personally involved in raising awareness of our profession, empowering parents, caregivers and schools.
I have a library of resources, which parents, teachers and other stakeholders can access to increase their knowledge of the speech therapy field.
I have also created a course designed to share tips of how parents can improve their child’s speech and language skills even when accessing speech therapy services may not be immediately possible.
The following course is designed to teach parents how to grow their child’s speech and language skills;
1. The Late-Talker’s Bootcamp 1.0; 2.0.
Parents can sample snippets of the the course for FREE and expect to learn the following things;
- What the critical brain development period is and why you cannot ignore this small window of opportunity in your child’s language development
- The impact screens (TV, smart phones, tablets, etc.) have on your child’s language development
- 2 common mistakes parents are making that discourage your child’s language growth and tips for how to start getting your child to talk more even if you’re not an expert
2. I also train speech therapist assistants on how to run therapy sessions.
Now, I bet there are those of you who hadn’t ever heard about speech therapy leave alone the varied scope of practice of speech pathologists.
What’s important to note is that speech pathologists specialise in different areas.
My areas of interest and specialisation include:
– Early intervention (late talking; delayed language skills; etc.)
– Literacy (teaching reading, writing and spelling to children)
– Aural habilitation (teaching speech to children with hearing impairment)
– Dysfluency (stuttering/stammering)
– Cleft and lip palate (improving speech after repair of cleft palate).
Read about the FREE Cleft Speech Therapy services we offer.
To find out if your child may benefit from speech therapy services, click here.
There are areas/disorders I don’t work with.
For instance, I, personally, do not work with adults presenting with voice disorders and possess little knowledge of high-tech AAC devices.
Next time you seek the services of a speech and language pathologist, make sure you find out your therapist’s area/s of specialisation to determine best fit.
To learn more about the various services we offer, click here
and to make a booking, click here.