Speech therapist: when to consult? Why ? recipes? supported?

The speech therapist is a paramedical professional, which deals with oral and written language disorders of children, but also of adults. It can cause “dys-disorders”, but also disorders in speech, language, communication, learning, swallowing, etc. How is the treatment going? Are the sessions reimbursed? Answers from Anne Dehêtre, speech therapist and president of the National Federation of Speech Therapists (FNO).

What is the role of the speech therapist?

The role of the speech therapist is to: prevent, assess and manage difficulties or disorders related to:

  • oral and written language and communication,
  • oro-myo-facial functions (all motor, sensory and secretory activities concentrated in the skull and face),
  • and to other cognitive activities such as phonation, speech, oral and written language, or mathematical cognition.

This professional is also responsible for: preserve the functions of communication and orality in the context of degenerative and neurodegenerative pathologies and hand out learning other forms of non-verbal communication to supplement or supplement verbal functions.

“The speech therapist intervenes on doctor’s prescriptionusually a general practitioner, a pediatrician, an ENT, a neurologist or a geriatrician”, specifies Anne Dehêtre. They can collaborate with these specialists, but also with other paramedical professionals: orthodontists, orthoptists, nursing assistants, etc.

Where can I find a speech therapist?

Speech therapists generally practice as a liberal, within a company. But they can also be employed in the public or private sector, in different structures: in a crèche, in a PMI (mother and child protection center), in a walk-in center, in a CMP (medical-psychological center), in a retirement home or in a hospital center.

Speech therapists are not doctors, but holders of an a certificate of professional competence in speech therapy (CCO), obtained after five years of study (Master 2 level) in a training center, usually linked to a UFR of medicine. On the program? A transversal education on anatomy, acoustic physics, phonation, linguistics and psychology.

Good to know: the social security financing account for 2022 plans to test access to speech therapy consultations without a prescription. Professionals will beauthorized to provide care without a medical prescription“, provided that they are practiced in coordinated care structures (for example, a medical center or a health center). They only need to send “an initial assessment and report of the care provided” to the attending physician, as well as to report these elements specify in a “shared medical record” the texts of the amendments voted in October 2021. The experiment would be conducted “for a period of three years, in six divisions

Indications: why go to a speech therapist?

The speech therapist determines a specific program for each patient, depending on their problems. “We think too often of speech therapy when written language disorders (dyslexia, dysorthography, dysgraphia) and logical-mathematical reasoning (dyscalculia). But the latter only represent 25% of healthcare,” emphasizes the chairman of the FNO. Many other situations may require speech therapy:

  • the neurodevelopmental disordersTND
  • the speech disorders (difficulties in sucking, swallowing problems) that sometimes appear from the first weeks of life;
  • the disorders related to neurodegenerative pathologies (Parkinson’s disease, multiple sclerosis, Charcot’s disease, Alzheimer’s disease, stroke, etc.) affecting language (aphasia), speech (dysarthria) and swallowing (dyshpagia);
  • the stutters
  • the voice disorders (dysphonia);
  • the pervasive developmental pathologies (eg, autism spectrum disorders);
  • the birth defects of the face (cleft velo lip palate);
  • problems placing the tongue (dysfunctional swallowing), often related to orthodontic conditions;
  • the congenital deafness and presbycusis (deafness related to aging).

“Patients who are victims of Covid-19 may also require speech therapy to compensate for the consequences particularly related to intubation,” specifies Anne Dehêtre.

First test: the speech therapy assessment

Speech-language pathology care starts with determining the speech-language pathology assessment. It takes place in two stages:

  • an interview with the patient and his family (if it is a child) or his helpers (if he is disabled or has serious consequences). Goal ? Collect as much information as possible about the patient, about his difficulties, the context in which his problems appeared, the impact on his daily life, etc.
  • thereafter a series of tests and games intended to identify oral, written, motor and developmental disorders, as well as pre-existing compensatory strategies.

Two types of speech therapy assessments can be performed, depending on the original recipe:

  • A research report : where the aim is to trace the patient’s condition(s) according to his difficulties, to assess their importance to (or not) set up a program to correct them. The prescribing physician will then have to validate or not the program proposed by the speech therapist.
  • A balance with rehabilitation : if the prescribing doctor considers the child’s conditions important and the prescription says “with rehabilitation”, then the speech therapist can immediately start rehabilitation, without waiting for the validation of the prescribing doctor.

Who can benefit from a speech therapy assessment?

“The speech therapist can intervene from the first days of life, and until the last”, says the chairman of the FNO. Speech therapy is recommended for both children and adults. no age limit

  • Babies with swallowing problems;
  • children whose parents or school, social or medical environment question their abilities;
  • children whose development of oral or written language seems difficult;
  • children, adolescents and adults whose disabilities (trisomy, deafness, etc.) interfere with the installation or development of language
  • children, adolescents or adults impaired in their communication (oral or written) after consequences of previous conditions such as an accident, trauma, post-operative consequences, brain aging, etc.

Depending on the results of the speech therapy examination, the professional sets a speech therapy diagnosis (additional to the initial medical diagnosis) and an action plan that may include: speech therapy sessionsbut also by prescribing additional examinationssupport of other (para)medical professionals or specific care for the patient at school level.

The number of sessions is programmed from the start and can change (usually from 10 to 50 sessions, or even more). The duration of each session depends on the condition to be rehabilitated : from 30 minutes, for articulation, to 40 minutes for written language disorders, or even an hour in case of a disability such as deafness.

“Some of the work is done in session, but rehabilitation also requires a daily investment, from the patient, the parents, the entourage, the carers, etc. We work a lot according to the ecosystem that surrounds the patient,” emphasizes Anne Dehêtre. And to explain: “We cannot deal with communication and language disorders without considering the environment: it is important to teach people with aphasia to reconnect with communication of course, but it is also necessary for the people to teach him to communicate with them”.

How much does a session cost? Supported?

Speech therapists are contracted, therefore their rates are fixed and overruns are rare. The price of the check-ups and sessions varies according to the quote of the acts of the AMO (Acte Médical Orthophonique), it is necessary to calculate on average between 20 and 39 euros per session with a refund of 60% CPAM† Many mutual companies cover the remaining delta.

Please note: in the case of long-term illness (ADL): the sessions are fully reimbursed by the basic health insurance fund.

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