I. What is a speech therapist?
Since speech therapists in China currently do not have a professional license, there are various channels for the development and education of speech therapists. The Audiology and Linguistics Society of the Republic of China is working to obtain legislation that will allow all speech therapy professionals in China to have a national professional license to enhance the quality and image of the profession. The following are brief descriptions of the four different training pathways.
(a) Domestic and foreign university and graduate school undergraduate graduates: Currently, domestic audiology-related departments include the Department of Speech Therapy and Audiology at Sun Yat-sen University of Medical Sciences, the Institute of Hearing and Speech Disorders Science at the National Taipei College of Nursing, and the Institute of Communication Disorders Education at Kaohsiung Normal University. The training at these schools includes over 40 credits of courses in audiology anatomy, audiology physiology, audiology pathology, audiology acoustics, speech and swallowing assessment, speech and swallowing therapy, and over 375 hours of clinical practice training under clinical supervision. The scope of clinical practice training includes the treatment of dysarthria, voice disorders, speech disorders, childhood speech disorders, neurological speech disorders, and swallowing disorders. These universities and institutes can train approximately 70 audiologists each year.
(ii) Graduates of related departments (such as nursing, psychology, health education, special education, and linguistics institutes) from a college or university who have completed six months of specialized training in audiology at the Medical Center.
(3) Graduates from a related department (e.g. nursing, psychology, health education, special education, and linguistics) with a certificate from the Reserve Course.
(4) Those who have graduated from a college or university and have completed more than 20 credits of speech therapy-related professional courses, completed more than six months of speech therapy pre-vocational training or on-the-job training under the supervision of an instructor qualified by the Audiology and Linguistics Society of the Republic of China, passed the Society’s written exam and clinical practice exam, and obtained a Certificate of Accreditation from the Society.
The professional work of speech therapists includes: assessment, diagnosis and treatment of communication disorders in children; assessment, diagnosis and treatment of communication disorders in adults; assessment, diagnosis and treatment of swallowing disorders; and design and use of communication aids. Speech therapists often use a variety of tests and instruments to assess communication and swallowing problems and provide treatment after completing the diagnosis of communication and swallowing disorders. In addition, speech therapists provide consultation services on medical and social resources related to speech, communication, and swallowing problems. In schools, speech therapists can assist teachers in assessing students’ communication or swallowing problems and recommend effective strategies for teachers to include in students’ IEPs and implement in their regular instruction.
II. What are the services of a speech therapist?
When a teacher identifies a student with suspected swallowing or communication problems and refers him/her to a speech therapist, the speech therapist will conduct a detailed diagnostic assessment. For swallowing disorders, the assessment will include swallowing difficulties, past medical history, the structure and function of the swallowing organs, and the appropriate eating style and type of food. For communication disorders, the assessment includes all factors that affect the communication disorder, such as speaking ability, language ability, cognitive ability, and social and family environment. After the assessment, the speech therapist identifies interventions and training strategies and provides the results to the teacher as a reference for the development of the individualized education plan and curriculum, as well as to let parents know what rehabilitation activities can be done at home.
The speech therapist’s rehabilitative interventions can be divided into pull-out individual training and group training. If needed, they can also enter the classroom and participate in the teacher’s instruction. The speech therapist will use skillful behavior change techniques to gradually improve the habitual communication behaviors of the client. For example, the student is skillfully elicited to respond to the correct communication behavior by modeling the correct response through situations that can trigger the communication behavior and recording the student’s improvement. The students are then allowed to apply it continuously in a variety of different situations.
The advantages of having a speech therapist on campus are numerous. The therapist is able to observe and assess students in their learning situation, and can provide semester-by-semester advice on language training goals and methods to assist teachers in designing individualized education plans to address specific student issues. For example, “improving language comprehension,” “improving language expression,” “improving writing and reading skills,” “using communication aids,” and “designing language materials” can be the focus of speech therapy recommendations. Students with speech disorders (e.g., unclear pronunciation, hoarseness, stuttering, etc.) that are more difficult to train in a group classroom can be referred to a medical facility for one-on-one assessment and treatment. Nevertheless, students with speech difficulties need encouragement and support from the classroom teacher, who can give appropriate explanations to the class if necessary, so that the case will not be subjected to strange looks from classmates.
Which students can teachers refer to speech therapists?
In schools, speech therapists work with students who have swallowing disorders and communication disorders. The following further describes the signs that may be present when these two types of disorders arise.
(i) Swallowing disorders.
Broadly speaking, all behaviors related to swallowing food (e.g., sitting position to help swallow food, etc.), sensory messaging (e.g., integration and coordination of visual, gustatory, tactile, and olfactory messages, etc.), neuromuscular functions (e.g., effective chewing, keeping food from spilling out of the mouth, etc.), cognitive abilities (e.g., appropriate performance in meal situations, ability to accept food being brought to the mouth by others, etc.), and physiological responses (e.g., salivation, Swallowing disorders are considered to occur when there are various problems in the areas of swallowing (e.g., salivation, swallowing reflex, etc.). In the case of students with cerebral palsy, for example, they have difficulty swallowing because they have to chew food after it is delivered to their mouths due to poor motor oral function, and their tongues keep pushing outward, making it impossible to form a food mass and swallow it smoothly.
Since swallowing disorders can directly affect the growth rate and health of students, the earlier they are treated, the better. For severe swallowing disorders, parents usually already seek the assistance of a speech therapist from a medical unit and may only need a speech therapist to visit the school to advise the student on how to eat at school. However, for students with less pronounced swallowing problems, teacher referral is key when parents may not be sure if their child is having difficulty with this. The following is a brief explanation of the behavioral signs of swallowing disorders. A teacher may refer a student to a speech therapist when he or she notices the following conditions.
Frequent coughing (e.g., chronic bronchitis), recurrent pneumonia, uncontrollable shortness of breath, frequent or persistent prolonged upper respiratory infections.
Eating food that often falls out of the mouth or drools a lot.
Eats only a certain type of food (e.g., liquid, paste, or dry rice).
Coughing and choking immediately after feeding or swallowing food.
Physical mobility or wakefulness is significantly reduced when eating.
After eating, the voice may become muffled, or there may be labored breathing.
There is often an unexplained fever, or a combination of the above.
When eating, if dysphagia occurs more frequently, there is a greater chance of evolving into a long-term swallowing disorder. Therefore, the usual teacher’s observation or knowledge of the student’s health during eating can help to make early referral for swallowing disorder assessment to improve their swallowing difficulties or sequelae.
(ii) Communication barriers.
Throughout the process of communication, it is important to hear and understand what others are saying, followed by the ability to express oneself and for others to understand what one is saying. In such a seemingly simple communication situation, there are many automated neurophysiological, perceptual, and message processing processes going on. Problems with any one of these processes can cause communication difficulties. Some students with physical and mental disabilities may even have multiple communication problems at the same time. For example, students with intellectual disabilities who have hearing loss not only cannot hear others’ words clearly, but also cannot understand the meaning of the messages they hear.
Because the causes and consequences of communication disorders often interact, it is not easy to identify them without a formal assessment. In school, students with communication disorders can have a direct impact on their academic performance. The following are examples of conditions in which communication disorders affect learning. A teacher may refer a student to a speech therapist if he/she detects
Has hearing difficulties: cannot hear clearly what the teacher or classmates are saying, or often needs to be repeated by the person speaking. These students may be able to read normally and understand language normally, but their hearing status may be affected by a change in seating distance in class (e.g., closer or farther away), so that their academic performance may vary.
They may have auditory memory problems: They may understand the teacher’s lecture, but they may forget it immediately and may not be able to participate in classroom discussions.
Problems with language comprehension: Problems with understanding language. For example, you do not understand or fully comprehend abstract phrases, complex syntax, or conjunctions with several transitions.
Speech problems: Although the student understands the teacher’s words and knows the answers, he or she does not speak clearly, has a hoarse voice, or has a stutter that makes it difficult for the teacher and classmates to understand what he or she is saying or to ask him or her to repeat himself or herself many times.
He has speech problems: he can’t speak very well, he can only make a few sounds or say a few words, or he often says the wrong thing. For example, the word “gutter” may be “gutter water”; or if you know the answer, you may not be able to remember which words to use.
Difficulty in reading or writing: Although they understand the teacher’s lecture, they cannot write down the content correctly; they often write wrong words, opposite radicals or innovative words; they cannot read written materials or visual symbols such as sketches; or they have obvious difficulties in comparing pictures and words.
Communication problems due to physiological factors: Here, communication problems accompanying congenital or acquired physiological disorders (such as intellectual disability, autism, attention deficit, facial disability, cleft lip and palate, cerebral palsy, etc.) may cause problems with language comprehension, expression, and speaking ability. In addition, cognitive and language learning may also be affected in students with physical disabilities (e.g., blood cancer, heart disease, progeria, etc.) because they often need to stay in the hospital for treatment and have less contact with the outside environment.
All of these communication disorders can have different effects on learning depending on the severity of the disorder. These students often have difficulty learning in general classroom contexts and require specific instructional approaches to reach their maximum potential. In addition, in addition to directly causing poor learning outcomes, these barriers are often accompanied by distractibility, lack of confidence, deviant behavior, negative emotions, and poor peer relationships, making it more difficult for teachers to deal with them. Sometimes the milder cases are easily masked by other superficial behaviors, leading teachers to believe that the student is simply underachieving academically or having poor peer relationships. For example, children with mild language comprehension difficulties are unpopular with their peers because they often mishear or react inappropriately to only part of what is said, and they often perform poorly academically because they cannot understand the teacher’s verbal instructions and directions. Therefore, if a teacher suspects that a student’s low academic performance is the result of a communication problem, the best course of action is to refer the student to a speech therapist for a diagnostic evaluation to identify the student’s communication problems and to develop an individualized education plan.