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Speech Therapy-‘Mrs Chitra Manohar’ – April 1st, 2003

Mrs Chitra Manohar
A Speech Language Pathologist or Therapist is a professional who helps people communicate better. Communication is more than words

Communication is an essential part of being a person. We communicate to express our basic needs, feelings, understand and relate to others and to our environment. We communicate in many ways; using body language, facial expression, tone of voice, speech, gestures and writing.

Problems with communication can occur at any age. It can arise

present at birth (e.g. cleft palate, Down syndrome) or
happen gradually (voice disorders, hearing loss, some medical conditions) or
Suddenly (stroke, head injury).
from many different conditions and can be

Whatever the age or the cause, a communication difficulty can be very debilitating and can result in much frustration and anxiety to the individual and family. Speech-language therapists assess, diagnose and treat communication difficulties and help prevent and reduce such emotional stresses.

Speech Language Therapists may help people with


The person may experience difficulties in understanding and /or using words and sentences (written or spoken) to express themselves.Strokes, head injury, developmental disorders such as Autism, are examples of conditions that may result in language difficulties. Therapy may focus not only on the language skills but also on the social interaction which is an integral part of communication. This includes the body language, tone of voice, gestures etc.


Some people have difficulty producing sounds correctly. This could be the result of a

structural defect (e.g. cleft lip/ palate) or
brain damage (e.g. stroke, tumours), or
muscular weakness (e.g. cerebral palsy) or
Developmental delay (some children continue to have incorrect sound substitutions) or heavy accent.


This is an interruption to the flow of speech by the repetition of sounds, words or complete blocks in speech. Stuttering or stammering often starts about 2-4 years of age. It is not a psychological/ emotional problem as commonly perceived. It can be treated more easily early on and much of the psycho-social difficulties can be prevented.


The quality of the voice can be affected by misuse, overuse, tension, surgery and disease. These conditions can alter the pitch or volume of the voice and cause a very husky or nasal voice. Teachers and young children who are screamers are prone to voice problems. Proper voice care, education on vocal exercises and behavioral management (for the little screamers) can help alleviate this problem.

Hearing Loss

A hearing impairment of any degree can interfere with communication in children or adults. The child who is hearing impaired at or near birth needs help acquiring speech and language. Many children may have fluctuating hearing losses due to middle ear infections during coughs and colds. These kids may present with poor pronunciation and difficulties understanding instructions. Adults who become hearing impaired may require help adjusting to their communication difficulties.


Good language skills are essential to children’s academic development. Hence conditions that result in language difficulties may also cause learning difficulties. Some children may have learning difficulties due to attention problems (e.g. Attention Deficit Disorders +/- Hyperactivity). Others may have a specific learning disability such as Dyslexia (problems reading) or Dysgraphia (problems writing). Many of these children have a specific problem that requires specialist skills and not just extra tuition. It is important to intervene early as academic failure can result in many secondary problems in addition to poor self-esteem.

Swallowing and Feeding

In addition to communication difficulties a speech-language therapist may also assess, diagnose and treat children and adults who have difficulties chewing and swallowing. Infants with difficulty sucking and swallowing can also be helped.

Speech Language Therapists work to reduce/ prevent communication disabilities

Speech therapists routinely counsel, advice and train caregivers as part of the treatment. Links are made with support groups and the relevant community services. Many speech therapists also work closely with professionals in schools, health care and community social services.

Speech Therapists may work in

Rehabilitation centers or nursing homes
Services for people with a specific disability such as Down syndrome, cerebral palsy, autism or a hearing loss.
Preschools, childcares
Community health centers
Private practice

To become a Speech Therapist:

Speech Pathology is a degree course offered at tertiary institutions. Currently it is not available in Singapore and one has to go abroad if interested. Courses cover a wide range of theoretical and practical subjects including:

Language development
Communication Disorders
Anatomy and physiology
To ensure clinical competency, throughout the course students are required to undertake clinical observations and supervised practice of clinical skills. To graduate students must have accumulated a minimum number of hours of clinical practice and must have passed a variety of clinical placements.

Attending Speech Therapy


As soon as a problem is detected or if you are concerned about a communication problem, it is appropriate to see a Speech Therapist. Do Not Wait! Early intervention can prevent a problem from becoming more serious and can prevent other secondary problems.


Restructured Hospitals
Private Speech Language Therapy Services

Many centres may require a doctors referral. A referral may be obtained from your family doctor, GPs or the polyclinic.

What to expect?

The first visit usually involves taking a case history or interview, and assessment of the communication problem. This may take a number if visits. Following assessment the Speech Therapist will review the findings with the family and recommend an intervention program if therapy is required. The treatment program may consist of regular individual therapy, group therapy, reviews at various intervals, home programs or a combination of the above. The duration of each session and frequency will depend on the needs of individual. It may be as often as thrice weekly or as little as 4 monthly. It depends on the nature and severity of the communication difficulty. Family participation is often encouraged and may sometimes be essential to the success of the treatment program. Hence each therapy program is tailored to meet individual needs.

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