Speech therapy

Similarly to physiotherapy and occupational therapy, speech therapy is classed as a therapeutic service. Speech therapists deal with voice, language, speech and swallowing disorders.
Disorders can be in the form of both minor problems such as hoarseness or severe impediments, for example due to brain damage. Such damage can result in an inability to speak or severe swallowing problems.

Speech therapy with a focus on speech or language should restore or improve the ability to communicate. It can use a wide variety of procedures. It is not always possible to achieve normal speech. In some cases, speech therapy is also about how people can get around their problems. Sometimes, certain communication aids are also useful. People can learn to use these in speech therapy sessions.

Voice therapy is about the voice function when talking or even singing. If the voice is impaired following surgery, voice therapy may aim to restore its sound. In some cases, it also focuses on teaching people how to use their vocal organ more healthily.

Therapy for swallowing disorders aims to enable people to eat safely and, ideally, independently. Depending on the underlying illness, this can also include adapting the person’s diet, for example through the use of puréed food, or using a feeding tube.

Speech therapy is provided by various different professionals, for example speech therapists, academic language therapists, patholinguists or breathing, speaking and voice teachers. In this text, “speech therapist” is used as an umbrella term to include all associated professionals.

Language, speech, voice and swallowing disorders can affect children, adolescents and even adults. They have many different causes ranging from congenital conditions, such as cleft lip defects, through language development disorders, hearing impairments or a stutter to diseases such as Parkinson’s or dementia. They can also result from accidents or strokes. Whether for congenital or acquired issues, speech therapy can be useful in many cases.

Language disorders

Children with language development disorders often start to speak far later than other children and only expand their vocabulary extremely slowly. Some struggle to correctly pronounce words or form sentences. 

In some cases, language development problems occur without an obvious cause. In others, they result from another health condition. Such conditions can include hearing disorders, a cleft lip or even genetic disorders. Brain damage, for example due to an accident or a lack of oxygen, can impair children’s language development.

Language disorders in children can impair their ability to learn, their mental health and their social competence. Timely speech therapy is therefore extremely important for children with language disorders to enable them to develop as successfully as possible over the long term and participate in society.

Language disorders in adults are usually caused by brain disorders. They can occur following a stroke or severe head injury or as a result of dementia, for example. In some cases, people become unable to properly understand or sufficiently form words. This can sometimes result in a complete loss of language abilities with regard to understanding, speaking, reading and writing. In other cases, only some of these abilities are affected. This is known as aphasia.

Speech impediments

With speech impediments, the movement sequences needed for speech are impaired. This results in people speaking unclearly, slowly or with a lack of fluency, for example.

The best-known speech impediments include a lisp and a stutter. In children, speech impediments are often part of the language learning process and have no identifiable cause. However, certain changes such as the misalignment of the teeth or jaw, muscle weakness in the mouth area and palate defects can also cause speech impediments.

Acquired speech impediments are usually caused by damage to the brain, for example due to an accident or a stroke. In such cases, the ability to plan or execute speech movements is impaired, resulting in slurred and slow speech. People can also experience problems with breathing and volume as well as with endurance when speaking. If the palate muscles are paralyzed, a nasal sound can occur (modified vocal sound). 

Voice disorders

Voice disorders persistently change the voice. They are manifested by a change in the sound of the voice, hoarseness or reduced resilience and faster fatigue when speaking, for example.

Voice disorders have multiple different causes. In many cases, they occur when a great deal of strain has been placed on the voice, for example in the case of teachers. Such strain can lead to the development of vocal cord nodules, for example. Larynx, palate and hormonal disorders can also cause voice disorders. Psychological factors can also have an effect on the voice.

Swallowing problems

People who experience swallowing problems are unable to properly transport food or liquid from their mouth to the stomach. They can experience the feeling of a lump or pressure when swallowing, frequent aspiration (miss-swallowing into the lungs or airways) or regurgitation of their food, for example.

Swallowing problems can also have many different causes. For example, they can arise following a stroke, after surgery in the neck area or due to nervous system disorders such as multiple sclerosis or Parkinson’s disease. They can sometimes also be congenital (present at birth).

Swallowing problems can severely impair people’s quality of life and lead to them not getting enough food or liquid. Frequent aspiration can also increase the risk of pneumonia.

Speech therapy can involve the use of many different methods. The methods used on a case-by-case basis differ greatly and depend on several factors, such as the symptoms, the accompanying illnesses, the patient’s age and the specific treatment goals. Where necessary, relatives and people around the patient are incorporated into the treatment.

Language therapy aims to improve, preserve or restore a person’s ability to communicate.
This can be achieved through exercises to promote language understanding, develop the vocabulary or train the ability to find words as well as on grammar and language usage. Alternative methods for communicating during everyday life can also be learned and practiced. For example, there are signs, symbols and technical aids such as communication boards or speech tablets.

Speech therapy is used to teach patients to speak more loudly and more clearly, for example. It is also possible to train the movement of the muscles required for speaking: the tongue, lips, cheeks, soft palate and diaphragm. In some cases, exercises are performed to influence the breathing, posture or speed of speech.

Voice therapy involves performing special voice exercises and practicing breathing and correct pronunciation, for example. It can also involve improving posture and body tension.
If the larynx has had to be removed, patients can be taught to speak using their esophagus. Patients with a voice prosthesis or who would like to use an electronic voice aid to replace their voice can learn to use these correctly during voice therapy sessions.

Swallowing therapy aims to enable patients to safely eat and drink. This should avoid aspiration-induced problems such as pneumonia. The therapy involves training the interaction between breathing, posture and the muscles needed to swallow. It is not always possible to completely cure swallowing problems. In such cases, the manner in which food is consumed sometimes has to be adapted. This can mean avoiding certain foods or preparing them in certain ways, for example. Sometimes, the use of a feeding tube is required. Speech therapists can also provide advice in this regard.

If a patient requires speech therapy, a doctor or dentist can issue them with a prescription. In such cases, the responsible health insurance provider will usually cover the cost of the treatment.

Speech therapy can also form part of rehabilitation, for example if needed to help people return to their working life. In such cases, sessions can take place in a rehab clinic or medical practice.

Sometimes, children can also receive treatment from speech therapists within the scope of “early intervention”. This is possible in the case of children with development disorders, for example. The first point of call for triggering an early intervention is usually a pediatric doctor.

What are the stages involved in speech therapy?

Speech therapy usually starts with an introductory consultation with the therapist. The treatment aims are then determined and the treatment itself is planned. Such planning gives consideration to the diagnosis and symptoms as well as the patient’s abilities and wishes. Relatives of children, adolescents or adults with a severely impaired ability to communicate can also be involved in the treatment process.

The actual treatment can then begin. Treatment sessions usually last between 30 and 60 minutes. Speech therapy generally involves several treatment sessions over a certain period. In some cases, group treatment can also be useful.

The success of the speech therapy is regularly examined over time so the treatment plan can be adapted if necessary. For speech therapy to be successful, it is important to practice at home independently between sessions.

Speech therapy for children is adapted to their age and often involves the use of play. With children, it is particularly important for parents to support the therapy in order for it to be successful.

A speech therapy prescription is a prerequisite for health insurance providers to cover the costs. The therapeutic services directive (“Heilmittel-Richtlinie”) issued by the Joint Federal Committee (Gemeinsamer Bundesausschuss, G-BA) specifies the precise costs that are covered. 

It should be noted that statutory health insurance (GKV) holders have to make co-payments. These are equivalent to 10% of the cost of speech therapy plus 10 euros per prescription. Children and adolescents under the age of 18 are exempt from the co-payments.

Different rules apply to people with private health insurance. Whether and to what extent the cost of speech therapy is covered by private health insurance depends on the specific policy taken out.

If speech therapy is part of rehabilitation, the health insurance provider will not necessarily cover the costs. Depending on the rehab aim or reason, pension or accident insurance providers may also be responsible. More information on applying for rehab can be found in our “medical rehabilitation” article.

Further information on the precise conditions associated with speech therapy prescriptions can be found in our “therapeutic services” article.

Speech therapy is offered by several places, including:

• Logopedic practices
• Hospitals and rehab clinics
• Early intervention centers
• Social pediatric centers
• Special educational institutions such as kindergartens specializing in speech and language therapy
• Special schools

If medically necessary, speech therapy can also be prescribed in the form of a home visit on exceptions. If necessary, children with an “integration status” can also receive speech therapy in the institution that they attend.

The list of therapeutic service providers created by the National Association of Statutory Health Insurance Funds (GKV-Spitzenverband) provides an overview of logopedic practices.

The therapist directory from the German Association for Academic Speech and Language Therapy (Deutscher Bundesverband für akademische Sprachtherapie und Logopädie e.V.) and the speech therapist search from the German Association for Speech Therapy (Deutscher Bundesverband für Logopädie e.V.) can also be used to find logopedic practices. These can also be filtered by certain treatment specializations or languages.