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The Benefits of Speech Therapy

What to expect, frequently asked questions.

A speech-language pathologist (SLP) can help you with speech, language, and swallowing. They provide speech therapy to children and adults who may have speech or language disorders.

People with certain medical conditions may also benefit from speech therapy. Medical conditions that may cause speech or swallowing impairment include traumatic brain injury , stroke (brain damage due to a blood vessel blockage or bleed), and dementia (decline in memory and thinking functions).

This article looks at the various uses for speech therapy, what to expect during a session, and the techniques involved in this type of therapy. 

Verywell / Theresa Chiechi

Speech therapy can help with a variety of conditions.

Speech Disorders

Speech therapy may help with speech disorders like:

• Stuttering : Stuttering may involve repeating parts of words, prolonging words, or struggling to get out certain words. You may be more likely to have a stutter if you have a family history of stuttering.
• Apraxia : This motor speech disorder makes it difficult to move the tongue and lips to make sounds required for speech. In some cases, people with apraxia cannot speak at all. Causes for this disorder include brain tumors, dementia, stroke, and any other condition that causes brain injury.
• Voice : Voice disorders can be temporary or permanent and make it hard to speak. Chronic voice disorders include chronic cough, vocal fold paralysis, vocal polyps (growths on the vocal cords), and spasmodic dysphonia (vocal cord spasms).
• Dysarthria : People with this speech disorder have muscle weakness that makes it difficult to talk. They may slur or mumble their words. Dysarthria can happen due to brain injury or chronic degenerative conditions like Parkinson’s disease or Huntington’s disease .

Language Disorders

A language disorder ( aphasia ) is a condition that makes it difficult for a person to read, write, speak, or understand speech or other modes of communication. 

Someone with this type of disorder may struggle to:

• Use incorrect words for things
• Say complete sentences 
• Understand what other people say
• Understand jokes
• Read or spell 

Brain tumors, traumatic brain injuries, and degenerative disorders that affect cognitive function can all cause aphasia.

Feeding and Swallowing Disorders

Feeding and swallowing disorders can occur in both children and adults. A feeding disorder involves trouble with eating, sucking, drinking from a cup, or chewing. The specific term for swallowing disorders is dysphagia . Children or adults with dysphagia have trouble swallowing food or drink. 

Problems swallowing or feeding may or may not be related to a medical condition. Conditions that may cause a swallowing or feeding disorder include:

• Cleft palate or cleft lip
• Asthma and other breathing issues
• Heart disease
• Premature birth
• Nervous system disorders
• Reflux 
• Muscle weakness 
• Sensory issues
• Autism  
• Behavior problems
• Certain medications

Speech therapy begins with an evaluation to assess your difficulties and whether any structural issues contribute to your speech, language, feeding, or swallowing problems. An evaluation may involve a standardized test to help determine what you most need help with. Informal conversations may also help figure out your needs. 

A speech-language pathologist will then work with you to help improve your ability to speak, converse, or swallow. This may involve:

• Educating you on how to do certain things like articulating or pronouncing sounds
• Teaching you language skills
• Providing you with educational materials
• Giving you exercises to help strengthen your muscles 
• Giving you exercises that help you breathe better
• Participation in group therapy sessions 

You should also expect to practice the skills and exercises you learn in speech therapy sessions at home. Your speech-language pathologist may provide you with workbooks, worksheets, or virtual apps for at-home practice.

Speech Therapy for Adults

Depending on the reason you’re seeking out speech therapy, a speech-language pathologist may:

• Help you learn to move your muscles correctly to make sounds if you have apraxia or dysarthria
• Teach you how to use your breath to speak louder if you have dysarthria
• Help you learn to manage stuttering by teaching you to lower stress levels in certain situations
• Help you strengthen your mouth muscles to make it easier to swallow and eat if you have a feeding or swallowing disorder due to a brain injury or disease

Speech Therapy for Children

A speech-language pathologist’s approach will depend on the child. When working with a child who has a feeding or swallowing disorder, they might focus on:

• Strengthening the muscles of the mouth
• Helping the child with chewing
• Encouraging the child to try new food and drink
• Changing food texture to make it easier to swallow food 
• Helping with sensory issues related to food

Other skills a speech-language pathologist may work on with a child include:

• Language complexity : For example, they might teach words like "and" and "or" to connect ideas within sentences.
• Conversation skills : This may include role-playing to help the child with socialization and improve their read of social cues. 
• Vocabulary : They may use games or storytelling to help build the child’s vocabulary. 
• Phonological awareness : This recognition of the sounds that make up words is an important skill for reading. The SLP may work on helping the child identify sounds and rhymes in words to build this skill.

Healthcare professionals will also test your child’s hearing to see if hearing loss may be contributing to language and speech issues.

If you or your child is getting speech therapy from a qualified speech-language pathologist, you might wonder how likely it is that you’ll see improvement in speech, language, or feeding. 

Results will depend on the individual. It’s also essential to follow the exercises, tips, and strategies provided by the speech-language professional. Regular visits and keeping up with practice activities and exercises make it more likely to see an improvement in yourself or your child. 

A speech-language pathologist works with children or adults who have speech, language, or feeding and swallowing disorders. Typically the first session will involve an evaluation to determine the areas that are causing you the most problems. 

From there, they may teach you exercises and strategies to improve your speech, language, or ability to swallow and eat. 

A Word From Verywell

Think you or your child would benefit from speech therapy? Get in touch with your primary healthcare provider and ask for a recommendation. You can also use the American Speech-Language-Hearing Association’s (ASHA)  Find a Certified SLP Tool . 

Not all children develop at the same rate, but if your child has issues understanding language, doesn’t use gestures, or doesn’t seem to be learning new words, you might consider having them evaluated by a speech therapist. 

While this may depend on the individual and the cause of speech-related problems, research suggests that speech and language therapy can significantly improve speech and language issues.

One example of a typical speech therapy technique is articulation therapy. This technique teaches the person to make specific sounds, sometimes by showing them how to move their mouth or tongue.

A language delay is when a child has difficulty in speaking and understanding speech that is unusual for their age.

American Speech-Language-Hearing Association. Stuttering .

American Speech-Language-Hearing Association. Apraxia of speech in adults .

American Speech-Language-Hearing Association. Voice disorders .

American Speech-Language-Hearing Association. Dysarthria .

American Speech-Language-Hearing Association. Aphasia .

American Speech-Language-Hearing Association. Feeding and swallowing disorders in children .

Brainline. Speech therapy .

Understood for All. What is speech therapy .

Centers for Disease Control and Prevention. Languages and speech disorders in children .

Broomfield J, Dodd B. Is speech and language therapy effective for children with primary speech and language impairment? Report of a randomized control trial . Int J Lang Commun Disord . 2011;46(6):628-640. doi:10.1111/j.1460-6984.2011.00039.x

Nemours Children's Health. Speech-language therapy .

By Steph Coelho Steph Coelho is a freelance health and wellness writer and editor with nearly a decade of experience working on content related to health, wellness, mental health, chronic illness, fitness, sexual wellness, and health-related tech.She's written extensively about chronic conditions, telehealth, aging, CBD, and mental health. Her work has appeared in Insider, Healthline, WebMD, Greatist, Medical News Today, and more.

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What Is Speech Therapy?

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Speech therapy is a form of healthcare that helps improve communication and speech. It can also help improve swallowing function and other behaviors related to feeding.

About one in 12 children in the United States has a speech or swallowing disorder. Disorders are most common in young children, but many adults have a related condition. For example, about one million adults in the United States have aphasia (difficulty expressing or comprehending written and verbal language).

Speech therapists (STs) or speech-language pathologists (SLPs) assess and treat people of all ages. They use various techniques to help people with challenges related to speech production, language comprehension, hearing, voice quality, fluency, and swallowing. 

What Does Speech Therapy Treat?

Speech therapy treats various disorders involving hearing, speech, language, literacy, social communication, voice quality, executive functioning (for example, memory and problem-solving), feeding, and swallowing.

Specific speech disorders include:

• Articulation disorders: Difficulty pronouncing words or sounds such as the “s” sound (for example, saying “thun” rather than “sun”). This can occur during childhood language development or with structural problems like tongue-tie. A tongue tie is when a small band of skin connects the tip of the tongue to the bottom of the mouth. It is congenital, meaning it's present at birth.
• Dysarthria: Slow, slurred, or unclear speech. This occurs with oral (mouth) muscle control decline due to neurological conditions (related to the brain or nervous system), such as multiple sclerosis (MS) —a condition that occurs when the immune system attacks myelin, the covering wrapped around nerve cells.
• Apraxia: Knowing what you want to say but having difficulty producing the correct sounds or words. Apraxia can cause slow, error-prone speech or the need to intentionally move your tongue and lips in order to produce sounds and words. Apraxia can be present at birth, but it can also occur as a result of brain injuries, brain tumors , or a stroke .
• Fluency disorders: Speech flow disruptions like stuttering. Stuttering is experiencing interruptions in speech and repeating sounds, syllables, or words. Researchers are still exploring possible causes of dysfluency, but they seem to include genetics, developmental components, neurological factors (how the brain processes), and brain injury. Many children outgrow fluency disorders, but they can persist into adulthood.
• Voice disorders: Vocal cord spasming (choppy voice), hoarseness, pitch problems, or voice fatigue are examples of voice disorders. This can result from infection, overusing the vocal cords, or neurological disorders. 

Language or communication disorders include:

• Aphasia : Aphasia is a language disorder in which you have difficulty expressing or comprehending written and verbal language. Receptive aphasia is difficulty understanding written or verbal words. Expressive aphasia is difficulty communicating thoughts and ideas with language components like vocabulary, grammar, and sentence formation. Aphasia can occur with childhood development, language impairment, autism spectrum disorder (ASD), brain injury, or neurological disorders.
• Pragmatic language disorder: This relates to social communication. Signs include misunderstanding social cues like eye contact, body language, and personal space. It can occur during childhood development or with underlying neurodivergence (brain variation), such as autism spectrum disorder (ASD) , a brain development condition that affects how a person perceives and socializes with other people.
• Accent or tone: While this is not a disorder, speech therapists can also work with people who wish to modify their accent or an unusual speech rhythm, pitch, or tone. For example, a high-pitched, sing-song, or robotic tone can occur with ASD.
• Executive functioning: Executive functioning challenges include difficulty with memory, planning, organization, problem-solving, and attention. This can occur due to brain injuries or conditions like ASD and attention-deficit hyperactivity disorder (ADHD) , a neurodevelopmental disorder characterized by inattention (being distracted), hyperactivity (feeling restless), and impulsivity (making hasty decisions).
• Auditory processing disorder: This is a neurological condition that makes it difficult to make sense of sounds. 

Feeding and swallowing disorders affect how you suck, chew, and swallow food and drinks. Difficulty swallowing is also known as dysphagia , which can result in choking during meals—and lung infections if food or liquid enters the airways.  It can occur with structural abnormalities, muscular weakness, or neurological conditions like a stroke.  

How Does Speech Therapy Work?

Speech therapy involves techniques like language practice, pronunciation exercises, voice therapy, and swallowing exercises. It begins with a thorough assessment, including observation of communication strategies, challenges, and frustrations.

Speech therapy for infants, toddlers, and children involves fun and engaging activities like play, language exercises, reading, picture cards, and modeling correct sounds. This helps make learning more enjoyable.  

Parents or caregivers often attend sessions and learn ways to support children at home. The ST or SLP will tailor the treatment plan to the child’s developmental stage. Early recognition and intervention (treatment) can help improve outcomes.

With adults, the ST or SLP will begin with an assessment to identify specific challenges. They will then create a specific care plan that addresses underlying concerns such as:

• Medical conditions
• Accent modification
• Voice challenges
• Pronunciation
• Conversational language
• Problem-solving
• Memory exercises

What To Expect During Speech Therapy

Speech therapy can occur in a class, small group, online, or one-on-one. Speech therapists typically assign exercises to practice at home in order to reinforce what you learn. Activities might include:

• Vocal warm-ups like humming 
• Tongue twisters to improve articulation
• Breaking words into syllables to improve clarity
• Contrasting word exercises—for example, "ship" versus "sheep"
• “Pausing” practice (for stuttering)
• Repetition after listening to a native speaker 
• Repetition exercises for sounds like “s” 
• Speech rate control—for example, by tapping hands to a beat
• Pitch exercises
• Breathing and posture exercises

Receptive language exercises include:

• Memory or problem-solving exercises
• Reading comprehension (similar to a book report)
• Speech supplementation (written, gestural, voice amplifier, speech-generating devices)
• Word association
• Communication partner exercises, such as practicing eye contact and active listening

Exercises for swallowing and feeding include:

• Diet modification (pureed to solid foods)
• Oral muscle strengthening (like tongue “push-ups”)
• Swallowing exercises

Benefits of Speech Therapy

One of the main goals of speech therapy is to enhance a person’s ability to express thoughts, ideas, and emotions effectively. This can lead to a greater sense of self-expression, meaningful interactions with others, and less frustration. Other benefits include:

• Greater self-confidence: Gaining more control over language and communication can increase confidence and boost self-esteem. As a result, you might be more willing and excited to engage in social activities. 
• Improved academic or professional performance: Clear speech and language can lead to enhanced skills in comprehension, reading, and writing. This can support academic success. Better articulation, language, and presentation abilities can help with career development.
• Greater independence: Speech therapy can lead to greater self-reliance, especially if you have severe communication challenges. For example, augmented and alternative communication (AAC) methods , such as speech-generating devices (SGDs), can allow you to express yourself more independently.

How Successful Is Speech Therapy?

Speech therapy's “success” depends on your goals. The meaning of success can vary based on your underlying communication or medical condition and its severity, as well as your motivation and commitment to therapy, the therapist's expertise, and your support systems. The time it takes to reach your goals also varies based on underlying factors like these.

For example, you may define success as improved pronunciation, or you may work towards more effective communication, more skilled accent modification, or swallowing without choking. If you stutter, your goal might be improved fluency or feeling more comfortable communicating openly with a stutter. For most people, what’s most important is to set realistic expectations and recognize that any improvement in communication is a success.

How To Find a Speech Therapist

A qualified speech therapist or speech-language pathologist holds a master's degree in speech-language pathology and state licensure to practice in your area. You can find speech therapists in settings like:

• Home health agencies
• Rehabilitation centers
• Private practice
• Telehealth (online)

You can also ask for recommendations from healthcare providers or school personnel who may know local speech therapists. The American Speech-Language-Hearing Association (ASHA) also offers an online directory of certified speech therapies to help you locate someone in your area.

Check with your health insurance provider to see if they cover speech therapy. They can provide you with information about your co-payments and deductibles. If your insurance doesn't cover the cost, the clinic or speech therapist may offer payment plans. Some children may also qualify for:

• Individualized education programs (IEPs) that cover speech therapy costs as a service from the school district
• Early intervention (EI) or Preschool on Preschool Special Education (CPSE) programs for infants and toddlers for little or no cost to families
• State and federal programs, like Medicaid
• Financial assistance programs from non-profit and advocate organizations

A Quick Review

Speech therapy is a specialized healthcare field in which trained professionals help improve speech, language, hearing, swallowing, and feeding for people of all ages. Speech therapists (STs) and speech-language pathologists (SLPs) thoroughly assess and develop specific treatment plans for a wide range of conditions including difficulty communicating or processing language, stuttering, and voice disorders.

Speech therapy takes place in locations like schools, hospitals, and private practice. It can be one-on-one or in a group setting. Success depends on underlying factors such as the severity of the condition. It also depends on personal goals and your definition of success—which can vary widely from person to person.

Many people who have speech therapy experience powerful benefits that affect them in nearly every aspect of life, including greater self-confidence and self-reliance.

National Institute on Deafness and Other Communication Disorders. Quick statistics about voice, speech, language .

Houtrow A, Murphy N. Prescribing physical, occupational, and speech therapy services for children with disabilities . Pediatrics ; 143 (4): e20190285. doi:10.1542/peds.2019-0285

American Speech-Language-Hearing Association. Who are speech-language pathologists, and what do they do? .

National Institute on Deafness and Other Communication Disorders. Stuttering .

American Speech-Language-Hearing Association. Stuttering .

Law J, Dennis JA, Charlton JJ. Speech and language therapy interventions for children with primary speech and/or language disorders . The Cochrane Database of Systematic Reviews . 2017 (1). doi:10.1002/14651858.CD012490

Krekeler BN, Weycker JM, Connor NP. Effects of tongue exercise frequency on tongue muscle biology and swallowing physiology in a rat Model . Dysphagia . 2020; 35 (6):918. doi:10.1007/s00455-020-10105-2

National Institute of Deafness and Other Communication Disorders. Speech and language developmental milestones .

National Institute of Health Clinical Center. Speech and language pathology .

American Speech-Language-Hearing Association. Dysarthria in adult

Brady MC, Kelly H, Godwin J, Enderby P, Campbell P. Speech and language therapy for aphasia following stroke . The Cochrane Database of Systematic Reviews . 2016 (6). doi:10.1002/14651858.CD000425.pub4

American Speech-Language-Hearing Association. Scope of practice in speech-language pathology .

American Speech-Language-Hearing Association. Help finding a professional .

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• Speech and language therapy

What is speech and language therapy?

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What do speech and language therapists do, who do speech and language therapists work with, where do speech and language therapists work, speech and language therapy research.

• Speech and language therapy assistants/support workers

Speech and language therapy provides treatment, support and care for children and adults who have difficulties with communication, or with eating, drinking and swallowing.

Speech and language therapists (SLTs) are allied health professionals. They work with parents, carers and other professionals, such as teachers, nurses, occupational therapists and doctors.

There are over 18,300 practising SLTs in the UK working in a variety of settings .

• Download our What is speech and language therapy? factsheet (PDF) .
• See the  Welsh language version of this page.

Speech and language therapists provide treatment, support and care for people of all ages who have difficulties with speech, language, communication, eating, drinking and swallowing.

Using specialist skills, SLTs work directly with clients and their carers to assess, treat and provide them with tailored support.

They also work closely with teachers and other health professionals, such as doctors, nurses, other allied health professionals and psychologists to develop individual treatment programmes.

Watch our video on becoming an SLT

Speech and language therapists work with people of all ages with a range of communication, eating or swallowing difficulties.

Babies and children

SLTs babies with feeding and swallowing difficulties.

They support children with:

• Autism/social interaction difficulties
• Cleft palate
• Language delay
• Language disorders
• Learning difficulties  – mild, moderate or severe
• Physical disabilities
• Selective mutism
• Specific difficulties in producing sounds
• Voice disorders

SLTs can help adults who have communication or eating and swallowing problems, including those that are a result of neurological impairments and degenerative conditions, for example:

• Brain injury
• Parksinon’s disease
• Head and neck cancer
• Learning disabilities
• Mental health (adults)

Full list of topic pages

Visit our clinical information A to Z for information on the full range of areas an SLT may work in.

SLTs work all kinds of settings including education , justice and children’s services , in the NHS or as an independent/private speech and language therapist.

They work in all settings within the NHS, from acute adult wards to providing services to children within local schools, from general services to highly specialist settings.

How much do speech therapists earn in the NHS?

Visit the NHS careers website for information on pay scales.

Speech and language therapy is a research-active profession, with SLTs taking an evidence-based approach to practice.

Many SLTs may choose to undertake research as part of their career, for example by studying for a master’s or PhD, or they may use their clinical work to investigate research questions by collecting data on patient/client outcomes following a particular intervention.

Research evidence is taken into consideration by a SLT, alongside a patient’s/client’s, or family member’s preferences for their care and appraised in light of a SLT’s clinical expertise to deliver meaningful and effective speech and language therapy – this is the basis of evidence-based practice (or EBP).

How the RCSLT supports research

The RCSLT helps SLTs to access and understand the latest and best evidence about ways of working with people with speech, language, communication and swallowing difficulties. For example, six times a year our journal, the International Journal of Language and Communication Disorders publishes the latest research undertaken in these areas.

We are carrying out a  research priority setting project to identify the top most important areas that require further research in speech and language therapy as agreed upon by a range of stakeholders, including people with speech, language, communication and swallowing difficulties.

You can view our research priorities for  dysphagia , learning disabilities and developmental language disorders .

Speech and language therapy support workers

The speech and language therapy support workforce is an integral part of speech and language therapy services. Currently there is no set academic requirement in order to become a support worker, instead there will be local requirements for these roles.

The best way to find support worker/assistant roles within the NHS is to check the NHS jobs website  or to approach services directly to enquire about vacancies.

Visit our support workers hub to learn more about the role.

Related content

• Learning and development
• Professional guidance

Become a speech and language therapist

Explore the different routes to becoming a speech and language therapist

How to find a speech and language therapist

Details on how you can find a speech and language therapist

Where speech and language therapists work

Explore the different settings SLTs work to learn about the varied roles

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SPEECH ASSESSMENTS

In-home speech therapy, school-based services.

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“Working with The Speech Exchange has been amazing! When my son turned 19 months and still wasn’t saying many words, I started to worry. Although I knew that children move in their own time, I still wanted to make sure that I was helping him along in any way that I could. The Speech Exchange not only provided me with the tools that I needed to give him a nudge in the right direction, but also reassurance that everything was going to be just fine.”

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“Dr. K has been such a blessing to our family! My two and a half year old twins have a speech delay and cannot communicate well which makes  it hard to understand their wants and needs, and causes major frustration within the household. Dr. K has discussed many different techniques making it easy to understand and comprehend so I can easily work with the twins. She takes a keen interest in them and is willing to listen to me about the issues they are facing, while keeping up on all of the current teachings and theories to better help her clients. We have been with her only a short time, but I can already see a difference! We are definitely blessed to have her support and knowledge!”

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Speech, Language, & Social Skills Therapy for Children in Atlanta, GA

Talk. Play. Grow.

The Speech Center, LLC!

The Speech Center is a pediatric speech therapy clinic located in Atlanta, GA. Our mission is to provide the highest quality speech, language, and social skills therapy to children and adolescents from the ages of 2 to 18 years! We acknowledge that caregivers are a child's most influential teachers, so we incorporate education and parent coaching into each therapy session - empowering you to support your child's communication development with confidence. 

Speech Sounds

Our speech therapy sessions are high-energy and tailored to meet your child's individual needs! We combine evidence-based approaches with motivating activities to help your child practice challenging sounds and sound combinations. We also take the time to provide you with strategies and tips to help your child practice their new skills at home. Speech therapy will help your child speak clearly, use all age-appropriate speech sounds, and effectively communicate their needs, wants, and ideas.

We take a holistic approach to stuttering therapy. Our goal is to educate your child about stuttering, teach them fluency enhancing strategies to help them stay in control of their speech, and address any negative perceptions or feelings about stuttering. Together, we can help your child gain confidence in their communication skills! Fluency therapy will support your child in using helpful strategies, stuttering less frequently, and decreasing tension when speaking.

Language Skills

We support language development for children of all ages in a fun and engaging environment. Whether your child needs support gaining early language skills or they are working on building their reading, spelling, and writing abilities, our goal is to give them the skills and tools they need to achieve social and academic success. Language therapy will help your child gain new vocabulary words, use longer sentences, ask and answer questions, tell stories, and follow directions. We also address literacy skills for school-age children.

Social Skills

Social communication skills are important for play, learning, and relationship building. We teach social skills in naturalistic ways to give your child plenty of opportunities to observe and learn how to confidently interact with other children and adults. Caregivers are also provided with helpful tips to try at home or out in the community. Social skills therapy will help your child increase their joint attention, learn new pretend play routines and skills, build social-emotional awareness, and practice self-advocacy in social situations.

MEET YOUR SPEECH THERAPIST!

Kemyauna johnson, m.a., ccc-slp.

Owner, Speech-Language Pathologist

Kemyauna is a compassionate speech therapist with over 10 years of experience working with children in public schools, pediatric clinics, private practice, homes, daycares, and online teletherapy settings. She founded The Speech Center out of a desire to serve her local community and help children become better communicators. Kemyauna believes that the best way to support a child is to empower their whole family, and she is committed to educating parents and caregivers throughout the therapy process. Kemyauna earned her master's degree in Speech-Language Pathology from South Carolina State University. In her spare time, she likes to travel, shop, read, and put puzzles together!

Getting Started

The Speech Center accepts the following medical insurance plans:  Aetna, Anthem BCBS, Care Source, Peach State, Amerigroup, & Medicaid

Start with a free consultation call to discuss your concerns and get your questions answered. We will schedule your first visit and send intake paperwork at this time. 

Get an evaluation to determine the presence and severity of a communication disorder. We will share our results and work with your family to develop goals and a plan of care.

Begin therapy at a location, length, and frequency that works for you. We will monitor progress and ensure that your child is on their way to achieving their goals!

Where We Meet You

The Speech Center is located in Atlanta, GA and offers a child friendly environment to learn and play. Family members are always welcome to join in on the fun!

We travel to provide speech therapy at local daycares and preschools. These services are available to families within the East Point and College Park areas of GA.

Our teletherapy services are convenient and accessible for all GA families. All you need to participate is a device with a video camera, microphone, speaker, and WiFi connection.

"THE MOST BASIC OF ALL HUMAN NEEDS IS THE NEED TO UNDERSTAND AND BE UNDERSTOOD. THE BEST WAY TO UNDERSTAND PEOPLE IS TO LISTEN TO THEM. ­"

~ Ralph G. Nichols

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Speech-Language Therapy

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What Is Speech-Language Therapy?

Speech-language therapy is the treatment for most kids with speech and/or language disorders.

What Are Speech Disorders?

A speech disorder refers to a problem with making sounds. Speech disorders include:

• Articulation disorders: These are problems with making sounds in syllables, or saying words incorrectly to the point that listeners can't understand what's being said.
• Fluency disorders: These include problems such as stuttering , in which the flow of speech is interrupted by unusual stops, partial-word repetitions ("b-b-boy"), or prolonging sounds and syllables (sssssnake).
• Resonance or voice disorders: These are problems with the pitch, volume, or quality of the voice that distract listeners from what's being said. These types of disorders may also cause pain or discomfort for a child when speaking.

What Are Language Disorders?

A language disorder refers to a problem understanding or putting words together to communicate ideas. Language disorders can be either receptive or expressive:

• Receptive disorders are problems with understanding or processing language.
• Expressive disorders are problems with putting words together, having a limited vocabulary, or being unable to use language in a socially appropriate way.
• Cognitive-communication disorders are problems with communication skills that involve memory, attention, perception, organization, regulation, and problem solving.

What Are Feeding Disorders?

Dysphagia/oral feeding disorders are disorders in the way someone eats or drinks. They include problems with chewing and swallowing, coughing, gagging, and refusing foods.

Who Gives Speech-Language Therapy?

Speech-language pathologists (SLPs), often called speech therapists , are educated in the study of human communication, its development, and its disorders. SLPs assess speech, language, cognitive-communication, and oral/feeding/swallowing skills. This lets them identify a problem and the best way to treat it.

• at least a master's degree
• state certification/licensure in the field
• a certificate of clinical competency from the American Speech-Language-Hearing Association (ASHA)

An ASHA-certified SLP has passed a national exam and completed an ASHA-accredited supervised clinical fellowship.

Sometimes, speech assistants help give speech-language services. They usually have a 2-year associate's or 4-year bachelor's degree, and are supervised by an SLP.

What Do SLPs Do?

In speech-language therapy, an SLP works with a child one-on-one, in a small group, or in a classroom to overcome problems.

Therapists use a variety of strategies, including:

• Language intervention activities: The SLP will interact with a child by playing and talking, using pictures, books, objects, or ongoing events to stimulate language development. The therapist may model correct vocabulary and grammar, and use repetition exercises to build language skills.
• Articulation therapy: Articulation, or sound production, exercises involve having the therapist model correct sounds and syllables in words and sentences for a child, often during play activities. The level of play is age-appropriate and related to the child's specific needs. The SLP will show the child how to make certain sounds, such as the "r" sound, and may show how to move the tongue to make specific sounds.
• Oral-motor/feeding and swallowing therapy: The SLP may use a variety of oral exercises — including facial massage and various tongue, lip, and jaw exercises — to strengthen the muscles of the mouth for eating, drinking, and swallowing. The SLP may also introduce different food textures and temperatures to increase a child's oral awareness during eating and swallowing.

Why Do Some Kids Need Speech-Language Therapy?

Kids might need speech-language therapy for many reasons, including:

• hearing impairments
• cognitive (intellectual, thinking) or other developmental delays
• weak oral muscles
• chronic hoarseness
• cleft lip or cleft palate
• motor planning problems
• articulation problems
• fluency disorders
• respiratory problems (breathing disorders)
• feeding and swallowing disorders
• traumatic brain injury

Therapy should begin as soon as possible. Children who start therapy early (before they're 5 years old) tend to have better results than those who begin later.

This doesn't mean that older kids won't do well in therapy. Their progress might be slower, though, because they have learned patterns that need to be changed.

How Do I Find a Speech-Language Therapist?

To find a specialist, ask your child's doctor or teacher for a referral, check local directories online, or search on ASHA's website . State associations for speech-language pathology and audiology also keep listings of licensed and certified therapists.

Your child's SLP should be licensed in your state and have experience working with kids and your child's specific disorder.

How Can Parents Help?

Parents are key to the success of a child's progress in speech or language therapy. Kids who finish the program quickest and with the longest-lasting results are those whose parents were involved.

Ask the therapist what you can do. For instance, you can help your child do the at-home activities that the SLP suggests. This ensures the continued progress and carry-over of new skills.

Overcoming a speech or language disorder can take time and effort. So it's important that all family members be patient and understanding with the child.

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Role of the Speech & Language Therapist

The information below about the role of a speech and language therapist (SLT) has been adapted from information provided by the Royal College of Speech and Language Therapists (RCSLT) ,  Association of Speech and Language Therapists in Independent Practice (ASLTIP)  and NHS Careers .

What does a speech and language therapist (SLT) do?

The  Royal College of Speech and Language Therapists (RCSLT) describe speech and language therapy as helping manage disorders of speech, language, communication and swallowing in children and adults.

Speech and language therapists assess and treat a person with specific speech, language and communication problems to enable them to communicate to the best of their ability. They work directly with people of all ages. As allied health professionals they also work closely with parents, carers and other professionals, including teachers, nurses and occupational therapists.

There are around 13,000 practising SLTs in the UK and around 2.5 million people in the UK have a speech or language difficulty:

• 5% of children enter school with difficulties in speech and language
• 30% of people who have had a stroke have a persisting speech and language disorder

In the  US  the term used is  speech and language pathologist  (SLP).

Examples of when an SLT can help

• early play and communication skills
• feeding and swallowing difficulties
• mild, moderate or severe learning difficulties
• physical disabilities
• language delay
• specific language impairment
• specific difficulties in producing sounds
• hearing impairment
• cleft palate
• autism/social interaction difficulties
• voice disorders
• selective mutism
• swallowing difficulties
• communication and swallowing problems following acquired neurological impairments and degenerative conditions, including stroke, head injury, Parkinson’s disease and dementia
• head and neck cancer
• voice problems
• mental health issues
• learning difficulties

Where do speech and language therapists work?

• community health centres
• hospital wards
• outpatient departments
• children’s centres
• day centres
• clients’ homes
• young offenders’ institutions
• independent/private practice

Speech and language therapy also has support roles such as assistant practitioner, assistant speech and language therapist, support worker and bilingual co-worker.

How can I find a speech and language therapist?

You can refer yourself to your local NHS speech and language therapy service. Or ask your GP, district nurse, health visitor, nursery staff or teacher to make a referral. Contact your local primary care trust (PCT) or GP surgery for the phone number of your local NHS speech and language therapy service. For more information visit: RCSLT online directory .

NHS therapists are members of The Royal College of Speech and Language Therapists (Cert. MRCSLT) and must be registered with the Health and Care Professions Council (HCPC) .

You can find a private SLT at the Association of Speech and Language Therapists in Independent Practice (ASLTIP) .

ASLTIP members are certified members of The Royal College of Speech and Language Therapists (Cert. MRCSLT) and must be registered with the Health and Care Professions Council (HCPC) .

Royal College of Speech and Language Therapists 2 White Hart Yard London SE1 1NX Tel: 020 7378 1200 Email: [email protected] Website: www.rcslt.org.uk

Health and Care Professions Council (HCPC) 184-186 Kennington Park Road London SE11 4BU Tel: +44 (0)20 7582 5460 Website: https://www.hcpc-uk.org

• Careers Leaflet available to download from NHS Careers

Although we believe this information to be accurate, we strongly advise you to make your own independent enquiries.

• Factsheet – Causes of Dysarthria
• Factsheet – Dysarthria and Dysphasia
• Factsheet – Funding for communication aids
• Factsheet – Role of the Occupational Therapist
• Factsheet – Role of the Speech & Language Therapist
• Factsheet – The right communication aid?
• Factsheet – What is a communication aid?
• Factsheet – What is a stroke?
• Factsheet – What is Aphasia?

Speech Therapy for Children: What are the Benefits?

Ellen seder, what is speech therapy.

Speech therapy consists of techniques and activities aimed at improving overall communication by addressing speech delays and disorders in expressive/receptive language , articulation, oral motor dysfunction, apraxia of speech , social language, fluency (stuttering) , feeding and swallowing, and cognitive skills.

At NAPA Center, we provide pediatric speech therapy for children of all ages. Our trained speech language pathologists, or speech therapists, work closely with your toddler or child to assess their ability to speak and understand others properly before creating customized therapy sessions based on each kid’s specific speech and language goals.

Why Would My Child Need Speech Therapy?

Children are treated for different speech disorders, stuttering, problems pronouncing words, trouble with pitch, volume or quality of speech, and having a limited understanding of words and their meaning. Some children have problems putting words together or use language in an inappropriate way. Others have memory and attention disorders. Some children have problems swallowing, chewing, coughing and refusing food . Additionally, speech therapy may be necessary for a child who has experienced speech impairment due to an illness or injury. There are a variety of reasons why a child may need speech therapy. If you notice that your child is not on par with their peers or developmental milestones for their age, ongoing or intensive speech therapy sessions may be beneficial to your child.

What are the Benefits of Speech Therapy for Children?

Speech therapy has many benefits for children, including:

• Improving communication so they will be able to express thoughts and feelings
• Enabling them to speak so that others will understand what they are saying
• Preparing them for school so that they can keep up with other children in learning
• Improves vocal quality
• Increases self-esteem and independence

1. Helps with Communication

Providing children without a voice a way to communicate through unaided and/or aided communication (e.g. no tech communication books, low and mid tech communication devices, high tech communication devices and/or communication apps). Speech and language therapy is not just about speech; it also includes language. Many people have a misconception that speech therapy is just about the speech but it is so much more than that.

2.  Helps with Social Skills

Appropriate pragmatic/social skills are a key component to interacting with others in their community and life. When you have limited, or have no functional speech, pragmatic language skills are often significantly delayed and disordered. Social skills can be targeted with the use of video modeling, role playing, specific therapy apps, social stories and other various strategies and tools. The use of aided communication with these strategies to work on improving these social skills is an important aspect of speech therapy.

3. Hel ps with Reading

Speech delay can cause problems listening, reading and writing. Reading and literacy skills can significantly aid in communication. When you can spell, you can communicate freely. Teaching these essential skills can be the key to better communication with others.

4. Enhances Alternative Communication Methods

Work on other communication strategies to aid communication such as gestures, sign language, approximations, vocalizations, and/or other means of communication. As humans, we communicate with a total communication approach . We communicate via speech, facial expressions, gestures, eye contact, writing, typing and many other forms of communication.

Teaching on how to communicate in other ways in addition to a formal means of aided communication (e.g. use the sign for “bathroom”, “eat” and “drink”, tap on a person’s shoulder to get their attention, etc). Also, if a child has specific sounds that are being used consistently, make them meaningful. For example, if a child can say “ha,” use that for “help”. For the approximation, “ba” you might use that for “book” if that is important to that specific individual.

5. Reduces Communication Frustrations

Speech therapy helps children improve communication skills with other children and adults. It focuses on improving speech muscles through special exercises. Speech exercises involve repeating sounds and imitating the speech therapist.

What Does a Speech Therapy Session Look Like?

Sound exercises are an important part of speech therapy. The therapist often goes over letter sounds and words. The therapist shows the child how to say the word or make the sound. They may even demonstrate how to move the tongue when pronouncing certain words.

Speech therapy involves oral feeding and swallow therapy at times. The therapist might massage the face and perform tongue, lip, and jaw exercises to strengthen the jaw. They introduce food at different temperatures and textures to increase the child’s awareness of differences in sensation. This therapy is for children with swallowing difficulties. At NAPA Center, we provide speech therapy sessions customized to your child’s needs. We love speech therapy!

Looking for Some Fun Speech Activities and Resources? Check Out These Blogs!

• 5 Tips to Help Your Toddler’s Speech, Language, and Communication Development
• The Difference Between Receptive and Expressive Language
• Speech Therapy Toys Our Therapists Love
• Summertime Speech and Language Activities
• 5 Ways to Improve Your Child’s Social Thinking Skills 

About NAPA Center

NAPA Center is a world-renowned pediatric therapy clinic, offering speech therapy for children of all ages in traditional or intensive settings. With multiple clinic locations worldwide, NAPA is committed to helping children lead their happiest, healthiest lives. At NAPA, we take an individualized approach to therapy because we understand that each child is unique with very specific needs. For this reason, no two therapeutic programs are alike. If your child needs our services, we will work closely with you to select the best therapies for them, creating a customized program specific to your child’s needs and your family’s goals. Let your child’s journey begin today by contacting us  to learn more.

NAPA SLP Overview

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What Is Speech Therapy?

I f your child needs speech therapy, you're not alone. Here's everything you need to know about speech therapy for kids and toddlers.

If your child is currently in speech therapy or you're wondering if they might be a candidate for it, you're not alone. According to the American Speech-Language Hearing Association (ASHA), almost 8% of children in the United States have a communication or swallowing disorder. It doesn't mean you've done anything wrong, but it can be tough for families. The good news is speech therapy can make a difference.

So, what is speech therapy and how can it help? Here’s everything you need to know. 

How Does Speech Therapy Work?

Speech therapy is the treatment of communication, voice, and feeding/swallowing disorders by a trained professional.

Speech-language pathologists (SLPs) have a master's degree in speech-language pathology and specialize in evaluating, diagnosing, treating, and preventing these disorders. SLPs hold a license to practice in their state. 

You may also come across ASHA-certified SLPs. They have taken an additional step to pass a national exam and complete an ASHA-accredited supervised clinical fellowship.

Related: Everything You Need to Know About Language Development and Speech Delays in Children

What Does Speech Therapy Treat?

There are various reasons a child may need speech therapy. Common ones include:  

1. Speech sound disorders. This means a child has difficulty with the production of speech sounds and how we combine them into words.

2. Language disorders. A child will have difficulty understanding and/or using language to communicate. Language disorders may impact vocabulary development, grammar, as well as the ability to tell a story, follow directions, answer questions, and more.

3. Social communication disorder/pragmatic language disorder . In this case, a child will have difficulty using language to socialize. This may include difficulty understanding social cues, taking turns during conversation, initiating or maintaining a conversation, and understanding personal space. A social communication disorder often leads to difficulty forming friendships. Children with these language barriers may have a concurrent diagnosis of autism spectrum disorder .

4. Cognitive - communication disorder . This includes difficulty with memory, reasoning, problem solving, and organization, impacting the ability to communicate.

5. Voice disorder . Children will have differences in voice quality (e.g., being too hoarse or too nasal).

6. Fluency disorder/stuttering . Kids will have difficulty maintaining a smooth flow of speech. A fluency disorder may include repetitions of sounds within words, prolongations of parts of words, and/or pauses in speech.

7. Feeding/swallowing disorder . This presents as a difficulty with sucking, chewing, and/or swallowing food or liquid.

Signs a Child May Need Speech Therapy

Children may need speech therapy when they have not acquired speech/language milestones by an expected age. While milestones can vary from child to child, parents should refer their child for an evaluation if they have any concerns. Evaluation, which may include both standardized and non-standardized testing as well as observation, can help diagnose a speech/language disorder.

Some signs that may indicate a need for speech therapy include:

• A child isn't babbling by 6-7 months
• The child is having difficulty with feeding and/or swallowing
• A child beyond the age of 1 has no words
• A child beyond the age of 2 is not combining words into phrases
• The child's speech is difficult to understand
• The child is omitting syllables or sounds in words
• Speech errors are noticed during conversation
• The child has difficulty following directions or understanding spoken language
• The child has difficulty answering questions
• The child has a smaller vocabulary than what is expected for their age
• The child is stuttering
• The child's voice quality has changed or is noticeably hoarse or nasal
• The child has difficulty communicating with others socially
• The child has hearing loss
• The child has a cleft lip or palate

Related: Parenting a Child With a Speech Delay Can Be Lonely

What is Early Intervention Speech Therapy? 

Early intervention refers to state-funded evaluations and interventions—including speech therapy—for children, ages birth to 3, and their families. In some states, early intervention continues until the age of 5. While professionals may refer a child to early intervention, parents can also refer their child on their own.

Speech Therapy for Toddlers 

Speech therapy for toddlers usually resembles play where toys are used to elicit target skills, says Dominica Lumb, M.S., CCC-SLP, who has over 30 years of experience conducting speech therapy with children in various settings. 

Children are given choices during play to encourage the need to communicate. While working on language skills, toddlers are encouraged to request objects, ask questions, answer questions, and use appropriate vocabulary.

Parents may be included in therapy sessions at this age. They may be taught to model speech sounds or how to label objects and actions during everyday routines to enhance vocabulary development.

Speech therapy can also work differently depending on a child’s needs. For example, one may require a mode of communication that differs from speaking. That’s referred to as augmentative and alternative communication (AAC) and may include picture boards or computers/iPads for communicating through text or voice synthesizer. This can begin in early intervention and beyond.

Speech Therapy for Elementary-Aged Kids

Speech therapy at this stage is typically more structured. Games are often used for motivation, but goals are targeted through practice and repetition. Children practice new skills throughout a continuum until they're able to use these skills naturally in all environments.

After early intervention, children may continue receiving services in elementary school through an individualized education plan (IEP). The IEP is written by all specialists who will be working with the child. It states the child's goals and documents any accommodations the child may need to meet them.

Therapy at this age may follow a “pull-out” model where a child receives support in a separate classroom or a “push-in” model where an SLP provides services within the regular classroom. This model can change throughout the duration of therapy. For example, a child working on the correct production of a sound will typically begin with pull-out therapy and, when ready, will be observed in their classroom to assess for carryover of this skill.

SLPs in the school setting also consult with teachers to provide the support children need to communicate effectively in the classroom.

What About Private Speech Therapy?

While children must qualify for speech therapy through early intervention and in public schools, private practices can provide services beyond these standards.

Speech therapy in the private practice setting typically occurs one-on-one with the child receiving the SLP's undivided attention. But group therapy may occur when beneficial to the child.

"Therapy in the private practice setting is very child and family focused," explains Shanna Klump, M.S., CCC-SLP, CEO of Kid Connections Therapy in Severna Park, Maryland. "The family's goals for their child are often at the forefront of the work we do. In addition, parents and other family members often participate in the sessions to learn strategies that can be implemented at home to encourage generalization of skills."

What Age Is Best To Start Speech Therapy?

Parents should refer their child for a speech/language evaluation when they first notice their child is falling behind in any area of speech/language or is no longer meeting speech/language milestones . It is never too late or too early to start therapy but, in general, earlier intervention leads to a better outcome. If you're unsure if your child requires speech therapy, a referral to an SLP is always recommended.

Related: 7 Ways to Help Your Child's Language Development

How Parents Can Refer Their Child for Speech Therapy

A parent can contact their local early intervention office to learn about speech therapy options. The Centers for Disease Control and Prevention (CDC) provides early intervention contacts by state. Parents can also reach out to their child's health care provider to determine where their local early intervention office is located.

A school-aged child can be referred for a speech/language evaluation by reaching out to the child's teacher or the school's SLP.

An evaluation by a private SLP is an option at any age, but evaluations through early intervention or a public school district are provided at no cost. ASHA ProFind connects parents to SLPs who have indicated they are accepting referrals.

Does Insurance Cover Speech Therapy?

While public school therapy is free, private outpatient speech/language therapy is often covered by health plans, but with limitations.

According to Klump, insurance coverage for speech therapy varies by state, insurance plan, and diagnosis. She explains that while some states require habilitative service coverage for children, others do not.

Often, private practices, including Klump's Kid Connections, complete a benefits verification before initiating speech evaluation or therapy. In her experience, therapy sessions without insurance coverage may cost between $100-150, depending on location.

As each health plan has its own coverage, it is important to reach out to your insurance company to determine your out-of-pocket costs.

Insurance and Speech Therapy Coverage

If you're looking to see what insurance covers, Shanna Klump, M.S., CCC-SLP, CEO of Kid Connections Therapy, suggests parents obtain the following information from their insurance carrier:

• Visit limit. This may be a hard or soft limit which refers to whether an extension of services could be granted if deemed medically necessary
• Whether the visit limit is combined with other services. For example, occupational therapy and physical therapy are sometimes grouped with speech therapy in the number of sessions covered
• Whether there are exclusions to coverage for different diagnoses
• If a deductible must be met
• The co-pay amount per session

How Long Will My Child Be in Speech Therapy?

Speech therapy can take anywhere from months to years. Each child makes progress at their own rate and has individualized goals based on their communication needs. Just as children develop and meet milestones individually, the time it takes them to master new skills will vary.

How Effective Is Speech Therapy?

Speech therapy has been found to be effective for children. One study of more than 700 children with speech or language disorders up to 16 years old, found an average of six hours of speech therapy over six months significantly improved communication performance. Speech therapy was shown to be much more effective than no treatment over the same period.

Children of all ages typically find speech therapy engaging, fun, and rewarding. They're able to see their progress and use their newly learned skills proudly. Speech therapy is an effective way to enhance a child's ability to communicate and through these communication skills, a child will have better access to the world.

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132 Erin LoPorto: Why Telling Your Child, “Don’t Worry” Doesn’t Help The Language of Play - Kids that Listen, Speech Therapy, Language Development, Early Intervention

Hey Friends~  Your Feelings are a message from your body.  It’s the same for your kids.   How do you attune to your child’s feelings - instead of telling them not to feel as they do?   Do quickly tell your child how to behave?  (“Don’t worry.”  “Settle down.”  or “You don’t need to feel that way.”)  This kind of response backfires in relationships   Or  Do you reflect back to them how they are feeling?  This is not an easy skill.  However, it is a skill that is learnable!     Always cheering you on! Dinalynn   CONTACT the Host, Dinalynn:  [email protected]   ABOUT THE GUEST:     Erin LoPorto is a somatic well-being and intimacy coach and the creator of the Embodied Freedom Formula for transformation and healing. After her own recovery, she studied with experts in yoga and somatic therapy, energy healing, bodywork, meditation, and trauma. She's been coaching since 2011 with a focus on trauma, eating disorders, and relationships. She brings a playful, intuitive, and compassionate spirit as she speaks on topics of self-love, self-care, and the importance of embodiment. CONTACT THE GUEST:   [email protected] www.erinloporto.com   RESOURCES from The Language Of Play Sign up for my newsletter! Newsletter Opt-in Sign up for FREE 21 Days of Encouragement in your inbox! Encouragement Sign-up Join my new FREE Facebook Community HERE! Sign up for a 15 min "Let's Meet Session" on zoom!  Let's Meet Session For Speaking Engagements or For 1:1 or Group Parent Coaching (virtual or live), contact me at [email protected]   If You Liked This Episode, You Will Want To Listen To These Episodes:  06 Helping Kids Share Thoughts, Feelings and Ideas 36 Tantrum Vs Meltdown. Know the Difference and Respond Effectively 102 Top 4 Mistakes Parents Make And How to Correct Them! 114 Time IN or Time Out? EXPERT: KAREN HALL helps us support our kids while not taking on their Big Feelings 121 Sherry Darden: Think Your Child Expresses Feelings The Same As You? Ways to Notice Your Child’s Communication Patterns    

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Impact of COVID-19 on the Speech and Language Therapy Profession and Their Patients

Katie chadd.

1 Research and Outcomes, Royal College of Speech and Language Therapists, London, United Kingdom

Kathryn Moyse

Pam enderby.

2 Health Services Research, The University of Sheffield, Sheffield, United Kingdom

Associated Data

The datasets presented in this article are not readily available because this is anonymised routine patient data. Requests to access the datasets should be directed to gro.tlscr@toor .

Introduction: The UK's response to the COVID-19 pandemic presented multiple challenges to healthcare services including the suspension of non-urgent care. The impact on neurorehabilitation professions, including speech and language therapy (SLT), has been substantial.

Objectives: To review the changes to SLT services triggered by the COVID-19 pandemic with respect to referral rates, service delivery and outcomes, as well as examining the contribution of SLTs to the neurorehabilitation of COVID-19 patients.

Methods: Two surveys were distributed to Royal College of Speech and Language Therapists (RCSLT) members exploring experiences of service provision at 6 weeks and 22 weeks after the pandemic was declared in the UK. Responses to closed-ended questions, including questions regarding referral numbers were analyzed descriptively and compared at the two time-points. A database comprising routine clinical data from SLT services across the UK was used to compare information on patients receiving services prior to and during the pandemic. Data on COVID-19 patients was extracted, and findings are provided descriptively.

Results: Referrals to SLT services during the acute COVID-19 period in the UK were substantially less than in the same period in 2019. A number of service changes were common including adopting more flexible approaches to provision (such as tele-therapy) and being unable to provide services to some patients. Database analysis suggests fewer patients have accessed SLT since the pandemic began, including a reduction in neurorehabilitation patients. For those who received SLT, the outcomes did not change. SLTs supported a range of needs of COVID-19 patients. Treatment outcomes for COVID-19 patients with dysphagia were positive.

Discussion: The pandemic has affected neurorehabilitation and SLT services broadly: referral patterns are different, usual care has been disrupted and interventions have been modified affecting the impact on patient outcomes both positively and negatively. Some patients with COVID-19 require and benefit from SLT intervention.

Introduction

Rehabilitation and enablement services have been modified significantly over the last decade in response to changes in demography and increasing care in the community, leading to demand outstripping capacity progressively over many years. People are living longer with complex health needs and there is increased evidence of the impact of rehabilitation services on improving independence and well-being leading to greater expectations and demand ( 1 ). Following the outbreak of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2 or COVID-19) and the subsequent global health emergency ( 2 ), neurorehabilitation services entered the response when the requirement was already outstripping supply. An important element of the multi-disciplinary approach to neurorehabilitation is speech and language therapy (SLT), which attends to the assessment and management of those with speech, language, communication and swallowing disorders. As such, this profession was similarly affected by the demand and supply contention.

The evidence indicates a large and important role of neurorehabilitation services in the response to COVID-19. It is well-documented that the virus commonly affects the functioning of the nervous system and patients sustain a degree of ill-health for several weeks post-infection ( 3 ). Common symptoms observed in post-acute COVID-19 patients include dyspnea (or shortness of breath) and muscle weakness causing mobility difficulties ( 4 ). Moreover, COVID-19 patients can experience fatigue, neuropsychological and cognitive problems, dysphagia (swallowing difficulties), and general impairments in their activities of daily living ( 5 ). Rehabilitation services, thus, are warranted and indeed critical for treating COVID-19 patients. Consequently, strains are put on non-COVID-19 related rehabilitation services, especially those occupying hospital bed spaces, as the need for re-organization arises following the increase in patient admittance ( 6 ).

By the end of February 2020, the first case of within-country transmission of COVID-19 in the UK was recorded and on March 18, 2020, UK National Health Service (NHS) providers were given the directive to postpone all non-urgent and elective activity. By March 19, 2020 many community health services were stopped. A UK-wide lockdown shortly followed on March 23, 2020, and by March 25, 2020, all NHS hospital visits were suspended, and services were told to plan for the redeployment of clinical staff, including speech and language therapists (SLTs), to attend to critical COVID-19 related services ( 7 , 8 ). Individuals who were identified as being “extremely vulnerable” to catching the virus and experiencing severely ill health or death, received a governmental directive to “shield” and completely self-isolate for the lockdown period ( 9 ).

As the spread of the virus accelerated and hospitalizations surged, thus did the demand for SLTs to be part of the team managing critically ill COVID-19 patients. Dysphagia (an impairment in swallowing function) emerged as a frequent complication in such patients with estimates of around 30% of those admitted to hospital with COVID-19 needing a swallow assessment ( 10 ), and many who were intubated requiring swallow rehabilitation ( 11 ). Not only does an impairment in swallow function result in difficulties with oral feeding, but it is also a risk factor for developing aspiration pneumonia, which has also been documented in COVID-19 patients ( 12 ). However, early evidence does indicate that dysphagic COVID-19 patients can make a recovery following swallow rehabilitation ( 13 ) which in the UK is carried out by SLTs. Some questions remain as to the extent of late swallowing complications, potentially arising from virus-induced bulbar nerve damage ( 14 ) which may highlight the need for ongoing intervention. Thus, SLTs are an integral part of the intensive care unit team ( 15 ) and the longer-term rehabilitation team. Moreover, SLTs have a role in the management of dysphonia, another frequently reported symptom of the virus, reported in patients with mild to moderate COVID-19 ( 16 ). Furthermore, high rates of difficulties with vocal function following intubation has been reported ( 17 ). Thus, the pandemic has had a wide-ranging impact on SLT services arising from the suspension of many therapy services, the redeployment of clinicians, and the demand for specialists within critical, acute and rehabilitation services. Consequently, disruption to SLT services has been noted.

The theory of disruption ( 18 ) suggests that a sudden break or interruption of usual practice and break with established routines and models may lead to innovation as well as unintended consequences, both positive and negative. The Royal College of Speech and Language Therapists (RCSLT), the professional body for SLTs in the UK, was aware at an early stage that the pandemic would lead to breaks with established models of service provision. This offered the opportunity to examine the impact on service provision and patient outcomes.

There are two key ways of learning from major disruption. Firstly, being able to compare data, such as referral rates, patient characteristics, care pathways and outcomes, during a period of disruption with that recorded beforehand, is likely to give useful insight into intended and unintended consequences. The second source of information is the reactive experience of practitioners. This paper aims to utilize both methods to explore the changes to SLT practice and service delivery arising from the pandemic, specifically by asking the following two research questions:

• How has COVID-19 impacted on SLT both generally, and in neurorehabilitation, in terms of (a) referral rates, (b) service provision and (c) therapy outcomes?
• What is the contribution of SLT in COVID-19 management?

A mixed methods approach was taken, including the distribution of two surveys to SLTs in the UK exploring their experiences following the outbreak of the pandemic at two different time points, and interrogation of a UK database ( The RCSLT Online Outcome Tool) . Neither contribution to the database nor participation in the survey was mandated and were not specific to SLTs working in neurorehabilitation alone.

Two surveys were developed using Survey Monkey ( 19 ) and distributed to ~17,000 RCSLT members through different communication channels including newsletters and social media. The first survey was open between 23 April and 29 April 2020, inclusive, and the second ran between 12 August and 7 September 2020, inclusive. The questions for both surveys were developed iteratively by a working group consisting of SLTs and piloted by SLTs not involved in the development. They comprised open- and closed-ended questions. The analysis of and findings from the latter are reported here.

The surveys aimed to explore the experiences of UK-based SLTs by asking a series of closed-ended questions. The first survey included 15 questions, including 13 multiple choice questions, referring to the nature of changes in roles, responsibilities and duties, the extent to which intervention was being provided to individuals requiring speech and language therapy, any changes that were of benefit to clinical practice, service delivery and/or patients. The second survey included 3 questions contained in the first survey, and 46 additional questions about referral data and those developed from the often-reported experiences from the first survey, including teletherapy, workforce capacity and the barriers service users faced when accessing services. For each multiple-choice question in both surveys, participants were asked to select all statements which reflected their experience, which is analyzed descriptively regarding how often statements were selected. The full versions of both surveys can be found in the Supplementary Material .

To explore the impact of COVID-19 on SLT referral rates across speech and language therapy services, the responses to the questions on the second survey of “how many referrals did your service receive for speech, language and communication needs in the following periods” and “how many referrals did your service receive for dysphagia in the following periods” (periods specified as: 1 April−31 May and 1 June−31 July in 2019 and 2020) were combined, and a percentage change across the 2 years calculated. Data specifically for referrals from neurorehabilitation services was not collected.

To examine the impact on service provision we present findings from the surveys regarding reported experiences around changes in the roles, responsibilities and duties of SLTs, the provision of intervention and the barriers to accessing services, alongside an analysis of changes observed in the ROOT data for treatment episodes ending between 1 March 2019 and 31 August 2019 and 1 March 2020 and 31 August 2020, i.e. prior to and during the pandemic.

The RCSLT Online Outcome Tool

The RCSLT had been supporting SLT services with routinely collecting data prior to the pandemic. The national database, the “ROOT” ( 20 ), supports SLTs from across the UK with collecting and collating data on referrals, case mix, presentation and outcomes of individuals of all ages receiving SLT. It generates reports which contributes to quality assurance and benchmarking ( 21 ). The data collected includes de-personalized patient information, including: gender, age, medical diagnosis, and descriptors on the swallowing or communication condition [using codes given in the International Statistical Classification of Diseases and Related Health Problems-10th Revision ( 22 ) herein, “ICD10 codes”], as well as information from the Therapy Outcome Measure (TOM) ( 23 – 26 ).

The TOM is designed to be a simple, reliable, cross-disciplinary, and cross-client group method of gathering information on the impact of enablement and rehabilitation. It has been rigorously tested for reliability and clinical validity ( 23 – 26 ) and comprises four domains, the first three of which are based on the WHO's International Classification of Functioning (ICF) definitions of Impairment, Activity and Participation ( 27 ). The fourth domain of well-being, of both the individual and the carer, was added to the TOM due to the finding that having an impact on well-being is an objective of most neurorehabilitation services and thus needs to be separately identified in the outcome measure. The TOM has an 11-point ordinal scale. A rating from 0 to 5 is made on each domain, where a score of 0 is profound, 3 is moderate and 5 is considered normal for the age, sex, and culture of the individual ( 25 ). A score of 0.5 or ½ a point may be used to indicate if the person is slightly better or worse than the descriptor ( 23 – 26 ).

The ROOT is opt-in (i.e., it is not mandatory for all SLT services to contribute to) and currently comprises data from a range of service types including NHS, independent and third-sector funded services. Timing of data entry is not regulated and is dependent on the SLTs or support staff to input information either “live” or periodically.

To examine the impact on service provision , the number and proportion of episodes of care from every area of SLT, and those of the 5 most frequently recorded neurological disorders (in the 2019 period) were extracted from the ROOT data and are compared with 2020 data descriptively.

To evaluate the impact of COVID-19 on therapy outcomes , initial and final TOM ratings were extracted for episodes of care from every area of SLT, and those of the most frequently recorded neurological disorder for the same 2019 and 2020 period as detailed earlier. Average changes in the TOM were calculated and are presented descriptively.

Finally, to inform on the contribution of SLT in COVID-19 management , data from the ROOT on patients who were recorded as positive for COVID-19 was extracted. This was interrogated to explore the overall numbers of patients presenting to SLT services (within the services that were contributing data), with a diagnosis of COVID-19 (by age and gender) and the focus of SLT intervention for these patients. The SLT role in neurorehabilitation of COVID-19 patients was specifically examined by analyzing the change in the ‘impairment' TOM before and after an episode of care of patients with a SLT diagnosis of dysphagia secondary to COVID-19. These are reported in categories which reflect the goal of intervention of these patients (i.e., whether the impairment is expected to improve, maintain at the same level, or if intervention is part of a managed decline). The average change in the TOM ratings was calculated and are presented descriptively.

Ethical Considerations

This project involved use of anonymised audit data to evaluate current services as part of a service evaluation. SLTs provided minimal de-personalized data on all referred patients e.g., age, gender, diagnoses, and TOM ratings at the beginning and end of an episode of care to the ROOT database, and thorough information governance procedures were adhered to. Participants in the survey were anonymous and there were no inducements to take part.

Surveys of RCSLT members conducted in April 2020 and August-September 2020 received 544 and 413 responses, respectively. At the time of reporting, the ROOT contains data on 45,174 episodes of care from 39,534 patients, which are from 34 SLT services across the UK. Here, both sources of data are combined to answer the specific research questions.

The Impact of COVID-19 on SLT Referral Rates

Table 1 shows the number of referrals received for speech, language and communication needs (SLCN) (from 68 SLT services) and dysphagia (from 52 SLT services) and the change in referral rate between the two time periods prior to and during the pandemic, as reported by participants of survey 2. It indicates a substantial reduction in referrals for SLCN (−31.10% change) although a relatively stable rate of dysphagia referrals (−1.29% change).

Number of referrals received for speech, language and communication needs (SLCN) (from 68 SLT services) and dysphagia (from 52 SLT services).

The Impact of COVID-19 on SLT Service Provision

95.6% of respondents (520/544) to the first survey said that the pandemic was having an impact on their professional roles, responsibilities and duties. They reported changes including use of different methods of service delivery, and a reduction in clinical caseload (referrals and serviced current caseload) being most commonly cited.

Table 2 shows several common changes to service delivery experienced by SLTs during the acute COVID-19 period (April 2020), with nearly two-thirds of respondents identifying that an altered method of service delivery occurred in this period (63.1%), and almost half reporting that they were no longer seeing patients directly (face-to-face) (48.9%).

Frequently reported changes experienced by SLTs in April 2020, and number and percentage of respondents identifying these.

Table 3 explores the service provision changes in more detail but focuses on the provision for patients who were continuing to receive intervention in April 2020. The most commonly reported change to provision was more therapy being delivered remotely via telephone consultations (60.7%), with a high volume of respondents also citing the following changes: patients seen less frequently (44.5%), more video consultations (43.6%), more advice given to others (41.2%), alternative delivery of care due to PPE considerations (38.2%) and providing information via leaflets (28.3%).

Six commonly reported changes in service provision for patients on routine caseloads who were continuing to receive intervention in April 2020, and number and percentage of respondents identifying these.

Respondents reported that a significant proportion of patients were not receiving intervention, when in normal circumstances they would, for the both the acute COVID-19 period (April 2020) and later in August-September (2020). This demonstrates a negative shift over time, in that 74.6% responded that they did have patients who should be receiving intervention but who were not in April, which increased to 83.5% in the second survey in August-September. See Table 4 .

Number of respondents reporting whether they had patients on their caseload who were not receiving intervention but would usually do so.

The barriers to providing these patients with services are given in more detail ( Table 5 ), across the two time points. The most frequently cited barrier in April was that services could not be provided due to national guidance or local policy (37.3%). This was still a common issue in August-September (42.7%) but moreover, there was an additional issue that teletherapy was not appropriate for some of these patients in the August-September survey (53.3%).

Number of respondents reporting common barriers to accessing services for patients on their caseload who were not receiving intervention.

N.b respondents could select more than one option, therefore, the percentages do not total 100 .

The second survey sought to explore these changes in service provision in more detail, such as the use of remote consultations by the profession. Respondents estimated that, on average, 46.2% of individuals on SLT caseloads were receiving services virtually (e.g., via teletherapy) which had been unusual before and at an earlier stage in the pandemic.

Data from the ROOT on completed episodes of care is presented in Table 6 detailing episodes recorded for patients with any of the 5 most common neurological disorders referred for SLT in the 2019 and 2020 periods. The number of episodes is also expressed as a percentage change across the 2 years. This illustrates a distinct reduction (of 1,523) in episodes of care either recorded or entered into the ROOT in the 2020 period compared with the 2019 period.

Completed episodes of care recorded in ROOT, for whole database and broken down for the 5 most common neurological disorders, in the 2019 and 2020 periods, and expressed as a percentage change across the 2 years.

The Impact of COVID-19 on SLT Outcomes

Table 7 shows the mean and median change in the TOM for all the ROOT data for both time periods in 2019 and 2020, as well specifically for stroke patients. The tables indicate that outcomes were largely positive and consistent in both cohorts. Interestingly, the data suggests that stroke patients made greater progress in their therapy in 2020 than in 2019.

The average change in TOM scores for all ROOT data and specifically stroke data for both time periods in 2019 and 2020.

The Contribution of SLT in COVID-19 Management

The data on 163 individuals with a confirmed COVID-19 diagnosis ( Figure 1 ) indicates that more males than females were referred, and a greater proportion of people from the older age group required SLT services, which is in line with the reported gender and severity differences related to COVID-19 requiring hospitalization ( 28 ).

Proportion of 163 patients with confirmed COVID-19 diagnosis at the point of referral to speech and language therapy, by gender (A) and age group (B) .

The data in Table 8 describes the SLT management required for the patients referred with a positive diagnosis of COVID-19, and the average change in the TOM. These individuals were treated for dysphonia, dysphagia, dysarthria and cognitive communication disorder. Some patients were orally intubated and/or had a tracheostomy as part of their management requiring assistance with oral hygiene. This shows some variability in the degree of change for different conditions, however clinically significant changes were reported for most.

The number and average change in TOM “impairment” ratings from multiple TOM scales for COVID-19 positive patients being treated by SLT services.

NB. Individuals may have more than one SLT requirement .

Where possible, COVID-19 patients were coded for the objective of their SLT intervention: whether their impairment was anticipated to “improve,” “sustain,” or where they may have a “managed decline,” depending on the underlying medical condition causing the speech, language, communication or swallowing disorder. Table 9 provides data on the respective average outcomes of COVID-19 patients with dysphagia, within each intervention objective. The highly significant positive change in impairment rating of those on the “improve” track may be associated with the role that SLTs have in dysphagia management of COVID-19 patients, forming a crucial part of the multi-disciplinary team (MDT) ( 29 ).

The number of patients with dysphagia and COVID-19, with identified specific intervention objectives (improvement, sustain, manage decline), with the corresponding median impairment scores at the start and end of treatment, and median change over time.

Despite the challenges posed on the UK healthcare system resulting from the COVID-19 pandemic, speech and language therapists have been able to adapt their ways of working, develop specialist skills and innovate strategies to manage the consequences of a new disease. On the other hand, speech and language therapy services in the UK have, for several reasons, reduced over the acute-stage of the pandemic, and it is probable that a large proportion of patients have not received the provision they would have normally been offered. The findings we present here provide a broad insight into the ways in which this has occurred from a national perspective, which appear very much in line with reports from other UK-based allied health professions ( 30 ).

Investigating such changes, and thus assessing the impact of the pandemic, is challenging. One of the advantages of a dedicated and flexible national database, such as the ROOT, is that it provides information which can be interrogated when there is a major unanticipated disruption, such as a pandemic. This allows for analysis of the impact on services and patients exposing negative and positive effects. By comparing information gathered during the first wave of the COVID-19 crisis in the UK, with that from an identical time-period in 2019, we have been able to illustrate some of the impacts of the outbreak on usual care. The survey of professionals provides further information explaining and complementing that gathered on the database and assisting with its interpretation. Whilst we acknowledge that we cannot generalize the findings from our investigations too widely due to the opt-in and non-stratified methodologies used, it can nonetheless offer a unique perspective on UK SLT provision both before and after the onset of the COVID-19 pandemic. In so doing, we have been able to investigate specific questions posed, regarding its impact.

Changes to Referrals to and Service Delivery of Speech and Language Therapy

Overall, the data presented here suggests that SLTs have observed substantial changes to the number of referrals to SLT, and the amount and process of therapy that they have delivered, following the UK's COVID-19 response. This is perhaps not surprising given the national restrictions and is in line with reports on the general landscape of non-COVID-19 NHS care during the pandemic ( 31 ). Indeed, it is clear from both datasets that, similar to other services ( 30 ), there has been a reduction in routine SLT caseloads. This may in part be caused by fewer new referrals for the assessment and treatment of speech, language and communication disorders. Additionally, it is likely to be an effect of SLTs being unable to provide intervention to individuals on existing caseloads following the closure of settings during lockdown, and patients opting not to access services at this time. The findings from the survey provide insight into these changes, specifically the 2019/20 year-on-year referrals, but also the finding relating to the high proportion of services which had to adopt different methods of service delivery. There has been an increase in the provision of services in different settings delivering therapy remotely using a variety of technologies, which is likely to have disadvantaged those from socially deprived areas ( 32 ) or the very elderly ( 33 ). The “switchover” to telehealth has been one of the widest reported changes to healthcare in this period ( 34 , 35 ), despite its subsequent problematizing with regard to how this approach may exclude many patients without access to technology ( 36 ). These issues are likely to underpin the reduction in treatment episodes recorded on the ROOT for the pandemic.

Impact on Neurorehabilitation Speech and Language Therapy Services

It is possible that some neurorehabilitation patient groups have been more severely affected by the pandemic, in terms of receiving therapy. We found that not only had the number of episodes of care for stroke patients reduced substantially between the 2019 and 2020 periods (619–147), the proportion of episodes of care for stroke in the 2020 period was 10% less than the year before. Whilst it is possible that over time, as more data is imported into ROOT, this pattern adjusts, it is plausible that given the COVID-19 healthcare response, these patients are simply not being referred to SLT. Early assessment and management of stroke-related dysphagia and language difficulties by SLTs reduces pneumonia and mortality ( 37 ) and there is evidence that persistent aphasia has a more favorable outcome if provided with SLTs at an early stage ( 38 ). Therefore, this finding of reduction in referrals is of concern. One explanation could be that it is simply not safe for SLTs to deliver care to these groups in the COVID-19 context ( 39 ), or these patient groups may be less able to rapidly adapt or adhere to tele-therapy ( 40 ), leading to less engagement in this period. However, the reduction observed in stroke cases from SLTs is in line with other reports showing a concerning reduction in stroke admissions across the UK throughout the lockdown period ( 41 ). Similarly, the data shows a reduction in episodes of care for dementia patients, but relatively consistent representation of patients with Motor Neuron Disease (Amyotrophic Lateral Sclerosis), Parkinson's disease and those with brain tumors. This could potentially indicate where SLT services were particularly affected, for example, with limited access to care homes to see patients with dementia, or reduced capacity in acute hospital care for those with strokes, in comparison to the likely domiciliary care for other neurorehabilitation patients with chronic or progressive diseases.

Impact of the Pandemic on Routine Therapy Outcomes

The findings also show, interestingly and perhaps surprisingly, that the average improvement on the TOM from 2019 is indeed maintained, and in some cases, bettered, in 2020. It is clear that SLTs continue to make an impact for patients, regardless of the challenging circumstances. For the stroke patients recorded in the ROOT, the comparative average change in outcomes between 2019 and 2020 is notable; the median change in 2019 for impairment, activity and participation was 0.0, which increased to 1.0 in 2020, reflecting a positive gain of 2 half-points which is clinically significant. This is of particular interest and requires further investigation to ascertain the reasons. Yet, it is important to note that those receiving SLT in 2020 during the pandemic may be a subset of those who would do so in usual times. One consideration is that those who received intervention may have been a “less impaired” subset. It is plausible, for example, that patients with more complex needs, co-morbidities and/or those who were subject to the “shielding” regulations may have been less able to engage with services during the immediate period after the UK lockdown. Thus, this may reflect the therapy outcomes from those who were less at risk of the virus in terms of health, i.e., fewer co-morbidities and who may potentially make greater gains anyway, or those who had greater support around them from relatives/carers working at home. Another consideration may be that those from less socially deprived areas were able to access therapy more readily than those in less-affluent areas, using virtual means ( 32 ). Furthermore, some individuals may also have experienced improved access with the extension of remote delivery of services, such as those who would ordinarily find it challenging to attend appointments, due to caring responsibilities, or travel restrictions. Another explanation could be that for those engaging in teletherapy, skills acquired through intervention whilst in the home were more easily practiced and embedded than when therapy is confined to a clinic.

Contribution of Speech and Language Therapists in Managing COVID-19

Our findings illustrate that SLT plays an important and positive role in the treatment and rehabilitation of patients with COVID-19 especially for those presenting with dysphagia, whose impairment can improve—and potentially resolve, for a subset of patients. The survey, similar to other reports ( 42 ), indicates that SLTs have adopted new roles associated with treating particular symptoms of COVID-19, such as communication with tracheostomy, and different expressions of dysphagia. The SLT profession has a growing body of data about the presentation ( Table 8 ) and outcomes ( Table 9 ) of individuals with COVID-19 receiving SLT intervention for the consequences of this new disease, which is further supported in the literature ( 12 – 14 , 43 , 44 ).

Going forward, it would be valuable to be able to gather information on the new ways of working from the perspective of those both receiving and in need of the service. A limitation of the study presented in this paper is the omission of information from those receiving services during this period. The RCSLT are, at the time of writing, conducting a survey to gather the experiences of individuals with speech, language, communication and swallowing needs, and their families, but the findings are not presented in this paper. Nonetheless, charities and patient associations have been collecting information on the impact of COVID-19 on their members. The impact on services was detailed in surveys conducted by the Patients' Association and the Stroke Association. The latter survey ( 45 ) received a response from 1,500 stroke survivors and carers in England, 60% of whom felt that they received less support from health and care services than was usual. Sixty-eight percent of respondents reported that they felt more anxious and depressed and more than three quarters of carers said they were providing more care and support during the pandemic than prior to it. Nine hundred and fifty-three patients responded to the survey conducted by the Patients' Association ( 46 ) which found that 67% of respondents reported that they were not seeking medical advice or intervention either because primary care services were more difficult to access or because they were avoiding contact with healthcare professionals due to anxiety related to the pandemic. These findings were not surprising given what the survey reported in this paper along with what the ROOT data indicates.

There are additional limitations to our study that should be considered when interpreting the results presented in this paper. As with all surveys, we must be cautious in our assumption that these respondents are representative of the experiences of the SLT profession within the UK. Furthermore, even though the ROOT is intended to be used by SLTs for routine data collection, it is likely that the disruption experienced by services has impacted on the ability to record outcomes data for all individuals receiving SLT compared with usual times, which may be affecting the completeness of the data in the national database. It will be important to repeat this analysis in future to explore any changes to the retrospective data. The nature of the data in the ROOT also may impede its generalizability, not least with respect to the specific UK context, but also across services within the UK, since it captures a subset of speech and language therapy services.

Despite this, we have presented an overview of the impact of COVID-19 on the role and clinical practice of SLTs in the UK, providing evidence of consequences of the pandemic, both positive and negative. The outcomes of SLT patients both prior to and during the pandemic present some interesting issues and areas for further exploration, in addition to highlighting the contribution of SLTs in COVID-19 rehabilitation. The recovery of the provision of health services once the pandemic wains will need to consider how to support those who did not receive SLT support for their speech, language, communication and swallowing needs or for their rehabilitation in a timely manner along with incorporating the new ways of working into care pathways.

Data Availability Statement

Author contributions.

KM and KC: data collection and analysis. PE, KM, and KC: preparation of manuscript. All authors: contributed to the article and approved the submitted version.

Conflict of Interest

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Acknowledgments

We thank the members of the RCSLT who have contributed data to the ROOT and responded to the survey and colleagues Mark Bedwell and Patrick Guest from Different Class Solutions Ltd. for the production and ongoing development of the ROOT database. We would like to thank Alexandra John for her expertise and input in reviewing the manuscript.

Funding. The Royal College of Speech and Language Therapists funded the development of the ROOT.

Supplementary Material

The Supplementary Material for this article can be found online at: https://www.frontiersin.org/articles/10.3389/fneur.2021.629190/full#supplementary-material

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Brittany Cartwright Cauchi/Instagram

Brittany Cartwright and  Jax Taylor want the best for their son.

On Tuesday’s episode of The Valley , Brittany, 35, and Jax, 44, had their son Cruz, 2, meet with a speech therapist named Dory because the Kentucky native said the toddler seemed to “regress” when it came to talking.

“He stopped talking altogether and now we are going to put him in speech therapy just to make sure that he has all the help that he needs,” Brittany said in a confessional interview.

Jax called Cruz a “smart kid” and told his wife of four years , “I feel like I’ve been researching everything and I feel like I’m doing everything I’m supposed to be doing.”

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Jax Taylor/Instagram

Brittany said she hoped they “were giving him all the right tools and everything that he needs.”

Jax and Brittany sat in on the session as Cruz played with Miss Dory.

“He’s trying,” Brittany observed.

But in an on-camera interview, Brittany owned up to feeling a bit worried about her son. “It can make you really, really sad sometimes because you just want your kid to be so perfect and whenever things go a little bit different than you planned it can be a lot of pressure for a mom,” she said. “I don’t ever want to see him struggle with anything.”

Jax admitted he often measures Cruz’s progress against that of other children.

“I compare my child to other kids and that’s pretty much Parenting 101, you should not do that,” the  Vanderpump Rules  alum said.

The couple announced their separation  after The Valley wrapped filming, but they continue to prioritize co-parenting Cruz .

"We're doing a really good job going back and forth," Brittany recently told PEOPLE. "And I'll also take him to the house and play and we'll swim one day or have him play on his play set and we'll do different things."

Felix Kunze/Bravo

Brittany has been living in various Airbnbs since the split and will go back to the Los Angeles home she shared with Jax and Cruz whenever the former model isn’t home. "Trust me, I told him he could stay in the Airbnb that I pay for," she said. "But he doesn't want to leave the house. So, it's tough. But I still go back to the house whenever [Taylor isn't] there."

The Bravo stars spent Easter together with Cruz in March and will celebrate his third birthday with a dinosaur-themed party at Sky Zone trampoline park later this month.

“Cruz just absolutely loves that trampoline park, so it's going to be cute,” Brittany said. “He loves dinosaurs, so I want it to be very jungle-like.”

The former SUR server described Cruz as “very athletic” these days. “He loves to climb, jump, run and play on swing sets,” she said. “He's just got energy, nonstop. But he has got the sweetest soul. He got it from me, of course.”

Ultimately, Cartwright finds Cruz to be “a perfect mixture” of her and Taylor: “He's my baby.”

The Valley  airs Wednesdays at 9 p.m. ET on Bravo.

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