If I had a penny for how often I’ve been asked to describe my work as a speech therapist in the last 8 years, I would have quite a collection.
Where do I live?
Well… I live in Nairobi, Kenya, which is 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 45+million, which means there is approximately 1 speech therapist for every 4 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 (ASHA).
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‘.
‘Speech‘ is solely the mechanics of sound production, ‘language‘ is a lot more.
My work as a speech pathologist involves assessing and remediating issues relating to a person’s understanding (receptive language) of what is said to them and how they organise 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). 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 also consider whether the right kind of vocabulary (semantics) have been used in a narrative (or story) and whether there is appropriate use of language 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.
Is 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 even 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.
Social communication disorders fall under our scope of practice. Children and adults who have Autism experience difficulties with social communication.
Traumatic brain injuries can also cause disruptions in pragmatic skills. Social communication involves being able to use verbal and/nonverbal communication for social purposes.
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/maintenance/termination, turn-taking, breakdown repair, etc.).
For instance, if someone asks you how your weekend was, you cannot start talking about astrophysics.
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 organizing 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.
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.
Hospitals often call me 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.
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.
Speech therapists do not teach sign language.
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.
Speech pathologists are also involved 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, adults who wish to get rid of dialectal influences/mother tongue interference do seek my services. Their articulations may hinder them from applying themselves effectively at work, at school or socially.
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 the speech therapy profession, empowering parents, caregivers and schools. 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:
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 pathologist, make sure you find out your therapist’s area/s of specialisation to determine best fit.