Speech Therapy

Swallowing is a coordinated interplay of 50 pairs of muscles and five cerebral nerves in four swallowing phases. This interplay guarantees the safe transport of saliva, liquids and solid food, and can be affected in isolation or in combination with a disorder.

Serious swallowing disorders many result in both pulmonary inflammation due to aspiration (when saliva, liquids or food enter the airway) and malnutrition. As eating and drinking play a central role in numerous social interactions, swallowing disorders may lead to social withdrawal or even social isolation.

Therapy is adapted to individual difficulties on a case-by-case basis and always aims to enable patients to be able to eat and drink again without complications as soon as possible. A comprehensive diagnosis provides an important foundation for this. During the clinical swallowing investigation, a patient’s medical history is taken into account and, if required, a further imaging investigation recommended. In the SPC, both endoscopic evaluations of swallowing (FEES) and radiological evaluations of swallowing are performed in close interprofessional cooperation. The functional dysphagia therapy approach is used in speech therapy. Functional dysphagia therapy (FDT) has three main points of focus: 

• Restitution → These therapeutic procedures can be characterised as sensorimotor training of the swallowing muscles. The aim is to restore disturbed functions or to enable maximum use of any maintained residual functions. Key individual movements and movement patterns are first practised separately from the swallowing process and, as soon as the movement goal has been achieved, integrated into the swallowing process.
• Compensation → These therapeutic procedures include changes to the position of the head and special swallowing techniques, including cleaning techniques, that are applied directly during swallowing. The aim is to allow efficient and aspiration-free swallowing, even when the physiological sequence of movement can no longer or only partially be restored.
• Adaptation → These therapeutic procedures consist of external adaptation. The aim is to try and reduce the requirements of the act of swallowing or its preparation in order to do justice to the reduced ability to swallow. Here, there is a choice of dietary measures, the suitable placement of food, special eating and drinking aids, and support during meals.

Inserting a tracheal cannula may be necessary if there are serious problems with breathing and/or swallowing. Such issues have an impact on breathing, swallowing and speaking.
To achieve the optimal preconditions for therapy in these three areas, the way that tracheal cannulas are selected and handled must be adapted on a case-by-case basis to the needs of the individual patient. For successful tracheal cannula management, we place great value on close interprofessional cooperation with all the experts involved.
Once a tracheal cannula has been inserted, speech therapy deals with both swallowing and verbal communication. As the tracheal cannula affects the swallowing function, speech therapy within the tracheal cannula management team serves as a specialist discipline for swallowing disorders for saliva and for all other consistencies that need to be swallowed. Regular swallowing function checks are performed and therapeutic measures taken if necessary.
One goal in terms of communication is to enable patients to speak and thus to be able to express desires and needs as soon as possible – irrespective of whether they are still dependent on a ventilator or not. As a centre of competence for respiratory medicine, Nottwil Weaning^® promotes the early use of ventilator-compatible speaking valves in the Intensive Care Unit.

Normal speech is only possible if respiration (breathing), phonation (sound production) and articulation (pronunciation) are precisely coordinated. If this key functional system is affected by a stroke or neurological disease, speech disorders ensue. Speech becomes unclear and slurred, which results in considerable limitations in oral communication abilities. As the areas of respiration, phonation and articulation may be impaired in different combinations and to varying degrees, individual points of focus are set in therapy following a detailed investigation.

Voice disorders may develop due to organic changes in the area of the vocal folds, paralysis of the larynx muscles, or unphysiological use of the voice when speaking or singing. The voice becomes hoarse, which can take on extremely different forms. Treatment may involve voice therapy, surgery or a combination of both. Imaging (endoscopic) and clinical investigations provide the basis for therapy. Voice therapy tries to achieve physiological use of the voice where possible and to avoid overstraining and overcompensating.

Acquired language disorders are often the consequence of a stroke or brain injury. All language modalities – i.e. language production (speaking, writing) and language comprehension (understanding of spoken language, reading) – may be affected. Various test procedures are used to identify the affected areas and the degree of severity.
The aim of speech therapy is to achieve the best possible ability to communicate in day-to-day life. Therapy works on all language modalities.

Facial nerve paralysis can occur due to neurological disease, an external injury to the nerve, or without detectable cause. Facial muscle paralysis usually affects just one side of the face and can take on different forms (from a crooked mouth to total unilateral paralysis, including an inability to close the eye).

Therapy uses different methods to try and stimulate the facial nerve and thus muscle recovery and to counteract secondary dysfunction. If the preceding investigations reveal an indication, targeted motor exercises are also introduced.