Speech therapy (from ancient Greek λόγος lógos , German 'word' and παιδεύειν paideuein , German 'educate' ; literally 'speech training') is the medical discipline that deals with speech , speech , voice , swallowing or hearing impairment . It deals with prevention , counseling, diagnostics, therapy and rehabilitation , teaching and research in the fields of voice, voice disorders and voice therapy , speaking, speech disorder and speech therapy, language, language disorder and speech therapy, swallowing , swallowing disorder and swallowing therapy, and communication and hearing. The term was first used in 1913 and introduced in 1924 by the Viennese doctor Emil Fröschels for medical speech medicine.
History of speech therapy
The first four-week courses for "speech therapists" were held in Potsdam in 1886 . Five years later, 115 course participants were trained, and the Berlin outpatient clinic for language patients was one of the first to open, offering courses for linguistically ill children. These courses with eight to ten children lasted about three to four months with one to two hours a day. After 1918, the field of speech medicine was significantly expanded and speech medicine became an academic subject. Results of psychoanalysis and individual psychology led to new methods. After the term speech therapy was first used in 1913, the official introduction to medical terminology took place in 1924 by Emil Fröschels in Vienna. He organized the first international congress for speech therapy and phoniatrics in Vienna, which called for the introduction of a scientific-based training with an academic final examination. Until 1945, however, there was no independent training.
In 1949 Hermann Gutzmann jr. after his departure from the Charité his privately run language clinic in Berlin-Dahlem and called it "Central Office for Voice and Language Sufferers". The job title of speech therapist was officially introduced in 1957, five years later Gutzmann opened the first speech therapist training institute. With the completion of this course - after long negotiations with the Senate Administration - state recognition was granted. In 1974 the health insurance companies were obliged by the Rehabilitation Adjustment Act to assume the costs of speech therapy. At the same time, the pension insurance institutions created a new framework for rehabilitation. This made neurological rehabilitation a large area of work in speech therapy. In 1977 training and examination regulations were drawn up. On this basis, the law on the profession of speech therapist was passed on October 1, 1980.
The beginnings of speech therapy in Austria were strongly influenced by Emil Fröschels (1886–1972). In 1909 there was a separate speech clinic in Vienna, the term speech therapy has been used since 1913, but this has made a name for itself over a period of more than 100 years. In 1924 the IALP founding congress took place in Vienna. The training to become a speech therapist initially had no fixed framework. Later it was organized in schools under the Nursing Act. The first school opened in Linz in 1968, followed by Innsbruck and Vienna, Graz, Ried and Klagenfurt. The first speech therapy associations were founded in the 1970s. In 1981 the Federal Association of Certified Speech Therapists was founded. The federal association was later restructured into logopädieaustria . From 1992 the three-year training according to MTD law took place in academies for the speech therapy-phoniatric-audiological service. The MTD law regulates the rights and obligations of the health profession speech therapy. The professional titles “speech therapist” and “speech therapist” are protected in Austria by § 10 (1) Z6 MTD-G. The profession itself is anchored in § 2 (6) MTD-G as follows: “The speech therapy-phoniatric-audiological service includes the independent logopedic assessment and treatment of speech, speech, voice, swallowing and hearing disorders as well as audiometric examinations according to medical doctors or a dental prescription ”. With the amendments 31/1973 and BGBl. 676/1991 the range of services of the ASVG was expanded. Speech therapy services were equated with medical services. Since 2005 the training has taken place at universities of applied sciences and concludes with a "Bachelor of Science in Health Studies". In 2009 the first master's degree in speech therapy was implemented at the Danube University in Krems. In 2013, speech therapy was recorded in the systematics of the sciences (Manual de Frascati) in the 3rd main group (human medicine, health sciences, human medicine, health sciences) with the number 302 042. Since a change in the legal basis in February 2015, speech therapists have been allowed to use others Hire speech therapists.
Johann Konrad Ammann (1669–1724), a Swiss doctor and teacher for the deaf and dumb, who lives in the Netherlands, is considered to be one of the first to write instructions for the education of the deaf and dumb and the most influential deaf teacher of his time. He taught lip reading, the use of the larynx mirror and made the larynx vibrations felt. He emphasized the importance of speaking as the most essential human characteristic and thus provided the philosophical basis for the oralists . His books Surdus loquens (The speaking dove) and his dissertation from 1700 ( Dissertatio de loquela ) were translated into several languages and had great relevance for the development of deaf education in Germany.
The pastor and teacher of the deaf and dumb Heinrich Keller (1728–1802) founded the first small deaf and dumb school in his rectory in Schlieren in 1777, where he taught spoken language. In 1786 his textbook for the deaf and dumb instruction attempt on the best way of teaching the deaf and dumb appeared .
The doctor Rudolf Schulthess (1802–1833) published his book The Stammering and Stuttering in 1830 , in which he made the first exact distinction between stammering and stuttering.
The doctor Otto Laubi (1861–1925) was the first ENT specialist to practice in Zurich from 1889 . As a former doctor in the Rheinau psychiatric institution, he favored - like Emil Fröschels later - the psychogenic view of stuttering. From 1893 he carried out regular ear examinations on schoolchildren in Zurich. In 1918 he voluntarily introduced the first public consultation hour for voice and language disorders at the ENT clinic in Zurich, combined with reading lessons for the hard of hearing.
1928–1932 Arnold Karl Kistler took over the phoniatric consultation at the ENT clinic in Zurich. In 1934 he founded the Schwyzerhüsli, the first speech therapy home in Zurich.
In 1942, the Swiss Working Group for Linguistic Disorders (SAS) (from 1960: Swiss Working Group for Speech Therapy SAL ) was founded in Zurich as a professional association of Pro Infirmis . Founding members were Karl Kistler, Hans Petersen, Hedwig Sulser, Hans Ammann, Ernst Bieri, Melanie Scheit as well as members from French-speaking Switzerland and Ticino . Karl Kistler served as the first president from 1942 to 1962.
In 1947, the SAS began to systematically train speech therapists as the first institution in Switzerland. The deaf-mute teacher and speech therapist Hans Petersen was training director from 1947–1973. The primary and speech therapy teacher / speech therapist Hedwig Sulser-Bachmann founded the first speech therapy kindergarten on the Egg in Zurich- Wollishofen in 1947 . 1979–1984 she led the SAS courses she designed for group leaders at speech therapy kindergartens.
In 1949, the curative education institute of the Université de Friborg started its first course for academic speech therapist training.
The interdisciplinary society for phoniatrics, speech therapy and audiology was founded in 1953. In 1960, the also interdisciplinary Société Romande d'Audiophonie de Pathologie du Language (today Société Romande d'Audiologie, de Phoniatrie et de Logopédie SRAPL ) was founded.
In 1961, a speech therapy training was started at the Institute for Special Education and Psychology in Basel and in 1973 at the Curative Education Seminar in Zurich (today the Intercantonal University for Curative Education HfH ).
In 1967, the Department of Speech and Voice Disorders at the University Ear Clinic in Zurich, which was founded in 1917 by Felix R. Nager, opened a three-year advanced training course to acquire a diploma in clinical speech therapy, based on the three-year basic speech therapy training. Speech therapy and pedoadiology was established in 1971 by Christian Heldstab at the Children's Hospital in Zurich.
In 1971, the speech therapy center (specialist unit) of the city of Zurich was founded with the primary school teacher and speech therapist Eva Guldenschuh as the educational director. She gave lectures for speech therapists and organized the speech therapist training at the Curative Education Seminar (HPS), which began in 1973.
The Swiss Professional Association of Speech Therapists (SBL) was established in 1978, and SAL played a key role in its founding. In 1985, the SBL was divided into the regional language groups, Professional Associations of the German-Swiss Speech Therapists Association (DLV) , Association Romande des Logopédistes Diplomés (ARLD) , Associazione Logopedisti della Svizzera Italiana (ALOSI) .
In 1979 the conference of heads of speech therapy schools was founded with the aim of being a point of contact for the authorities and regulating questions relating to interns and the further training and education of teachers in speech therapy classes. In 1980 the journal Logopädie was published in Zurich for the first time and in 1981 the first framework for the training of speech therapists in Switzerland was created. The German-speaking Swiss speech therapist association DLV was founded in 1998.
Training in Germany
The training is regulated by the law on the profession of speech therapist and the training and examination regulations for speech therapists . It is a school education at a state-recognized school and lasts three years. It comprises 1,740 hours of theoretical and 2,100 hours of practical lessons, most of which are to be completed externally in therapeutic facilities such as practices, rehabilitation clinics or hospitals. At various universities and colleges, including in other European countries, courses in speech therapy are offered as a Bachelor course, sometimes as a dual course .
Training in Austria
In Austria, speech therapists are trained at universities of applied sciences (degree: Bachelor of Science in Health Studies). Details are regulated in the MTD Act .
Professions in voice, speech and speech therapy
Speech therapists as well as clinical speech scientists (clinical speech science ), breathing, speech and voice teachers , clinical linguists ( clinical linguistics ) and certified speech therapists as well as certified speech therapists work in therapy . However, the difference between these last two professional groups is largely unknown. Specialists in voice, speech and children's hearing disorders (formerly: specialists in phoniatrics and pediatric audiology ) have a certain special status . In addition to medical diagnostics, therapy is also part of the specialist training. The working area of conventional therapy for all of the above-mentioned professional groups is almost identical. For members of the non-medical health professions, the activities in the independent practices extend to diagnostics, therapy and advice for voice, speech, language, hearing and swallowing disorders in patients of all age groups.
There are various associations in the Federal Republic of Germany. The German Federal Association for Speech Therapy , founded in 1964, is the largest professional association for speech therapists in Germany. He represents the interests of freelance and salaried speech therapists in relation to politics, administration, health insurance companies and other stakeholders in the health sector. The association also works to disseminate specialist knowledge. The German-speaking Society for Speech and Voice Medicine represents interdisciplinary professional groups (speech and language studies, medicine, musicology, speech therapy, pedagogy, psychology) in scientific, diagnostic and therapeutic matters as an umbrella organization. In March 2014, Germany's first interdisciplinary interest group in the field of therapeutic products, the Association of United Therapists, was founded in Hagen. Speech therapists, occupational therapists, podiatrists, physiotherapists and masseurs are all represented here. After the relaunch in May 2018, now known as United Therapists . On November 29, 2014, around 170 therapists founded the LOGO-Germany association in Frankfurt am Main . He declares that he only represents the interests of independent speech therapists and speech therapists. According to its own information, however, the association also keeps an eye on appropriate remuneration for employees. In February 2017, the Association of German Speech Therapists and Speech Therapy Professions e. V. (VDLS) founded in Cologne. He advocates for the self-employed and employees alike and advocates, among other things, income adjustments in order to enable a secure existence and the development of an adequate pension. The association sees itself as grassroots democracy and uses almost exclusively electronic media. In Austria, the professional association logopädieaustria represents the interests of speech therapists in public. It is organized as an association and is one of the seven professional associations for high-level medical-technical services (MTD) in the umbrella organization MTD-Austria . This was founded in 1984 and is based in Vienna. In Switzerland, no distinction is made between speech therapists and speech therapists. The job profile of Swiss speech therapists roughly corresponds to that of German speech therapists.
Speech therapy as an action science or therapy
The interest of speech therapy is directed towards concrete action (prevention, advice, recording, treatment). The clientele includes all age groups.
In early childhood, treatment of disorders of language development predominates on the linguistic levels of vocabulary, grammar and phonology . In addition to expressive abnormalities, disorders of speech understanding are also treated in particular. During the kindergarten and pre-school age, one often finds problems in the context of a language development delay or disorder. These include, for example, dysgrammatism (disorders of sentence structure and disorders of word inflection, e.g. use of the plural), dyslalia (pure articulation disorder), omissions, replacements and changes to individual sounds and sound connections (phonological disorder). Speech therapists also treat balbuties (stuttering), rumbling , myofunctional muscle imbalance, and voice disorders. Speech therapists also treat patients
- Dysarthria (impaired execution of articulatory movements due to a neurological impairment, e.g. damage to a nerve; usually more precisely referred to as dysarthropneumophonia, since speech breathing and / or the sound of the voice are usually also affected)
- Difficulty swallowing
- Speech disorders after a stroke or other neurological impairments or consequences of an accident ( aphasia )
- Speech apraxia (impaired planning of the articulation movement without damage to the facial nerve ).
Also becoming more common recently, treat speech therapists children of school age, the result of an earlier language disorder as a result of difficulties symptoms acquisition of written language development (acquisition of written language disorder; formerly called dyslexia, dyslexia, dyslexia or Dysgrafie).
The speech therapy measures include diagnosis , counseling and therapy for disorders of speech comprehension, spoken and written language, speaking , breathing , voice , oral function , hearing, swallowing and perception . In addition, preventive measures are also offered, especially in the area of the voice. Regular and detailed advice to relatives (parents, partners, children) is part of the field of activity, especially for children and severely disturbed adults, as this is the only way to change the ability to communicate in everyday life.
Application fields (selection)
- Aphasia (e.g. after a stroke, accidents / traumatic brain injury)
- Dysarthria : impaired coordination of voice, articulation, breathing and tone (e.g. in infantile cerebral palsy, Parkinson's disease, ALS (amyothrophic lateral sclerosis), multiple sclerosis , strokes and traumatic brain injury)
- Dysgrammatism (impaired grammatical skills)
- Dyslalia (phonetic): speech and articulation errors, lisp
- Dysphagia (swallowing therapy): neurological swallowing disorders (e.g. after a stroke or in infantile cerebral palsy ), postoperative swallowing disorders (e.g. after removal of parts of the throat or tongue due to tumors)
- Dysphonia : voice disorders
- limited vocabulary , both active and passive
- Myofunctional disorder (orofacial)
- Phonological disturbances: disturbance of the correct use of sounds (e.g. swaps, omissions, additions)
- Fluency disorders: stuttering , rumbling
- Selective Mutism , Mutism, and Autism
- Speech and speech disorders in the context of dementia (e.g. Alzheimer's)
- Language development disorders and delays in children ( SES , specific language development disorder )
- Change of speaking tone as part of gender reassignment treatments (see also transsexuality )
- Disorders of hearing and auditory perception
- Supported communication (diagnostics, counseling and therapy in the sense of expanding the communicative possibilities for people with missing or severely restricted spoken language)
Course of treatment
Articulation , vocabulary , language comprehension, writing, reading and computing power, breathing, vocal or swallowing function are tested as required . Together with the medical findings, the results of this diagnosis form the basis for the selection of treatment methods. The disorder-specific methods are applied in a patient-oriented manner in order to achieve the therapy goals set together with the patient and / or their caregivers. The treatment consists of specific exercises, discussions about the course of treatment and instructions for independent practice.
- Thomas Brauer, Jürgen Tesak: Speech therapy - what is it? with 2 audio CDs, 5th revised edition, Schulz-Kirchner, Idstein 2014, ISBN 978-3-8248-0364-4 .
- Julia Siegmueller, Susanne Bartke; Henner Barthel (Ed.): Guide Language - Speaking - Voice - Swallowing . Urban and Fischer at Elsevier, Munich 2006, ISBN 978-3-437-47780-5 .
- Ulrike Franke: Logopädisches Handlexikon, with 27 tables , UTB / Reinhardt, Munich / Basel 2008, ISBN 978-3-8252-0771-7 (UTB) / ISBN 978-3-497-01992-2 (Reinhardt).
- Manfred Grohnfeldt (Ed.): Lexicon of Speech Therapy , Kohlhammer, Stuttgart 2007 / ISBN 978-3-17-018665-1 .
- LOGOS. The specialist journal for academic speech therapy and speech therapy. ProLog, Cologne / ISSN 0944-405X F 20923, www.logos-fachzeitschrift.de
- Logo Germany - Representation of the interests of independent speech therapists and speech therapists in Germany V.
- German Federal Association for Speech Therapy (dbl)
- Professional association logopädie austria
- German-Swiss Association of Speech Therapists, DLV
- Federal Association of German Speech Therapy Schools
- Technical college education in Austria
- Speech therapy database with specialist articles
- Condorcet Blog 03/2020: Speech therapy - successful integrating therapy
- MTD Law (MTD-G). In: jusline.at. Retrieved July 7, 2018 .
- Hans Petersen: The Swiss Working Group for Speech Therapy . Pro Infirmis 1962/1963
- Law on the profession of speech therapist (LogopG). In: gesetze-im-internet.de. Retrieved October 16, 2018 .
- Training and examination regulations for speech therapists (LogAPrO). Date of issue October 1, 1980. In: gesetze-im-internet.de. Retrieved April 30, 2019 .
- training. In: logopaedieaustria.at. Retrieved December 15, 2018 .
- § 23 MTD-G Training for the speech therapy-phoniatric-audiological service. In: jusline.at. Retrieved December 5, 2018 .
- Manfred Herbst: Annual Review 2017. In: vdls-ev.de. Retrieved January 9, 2020 .