The speech therapist is a paramedical professional, which deals with oral and written language disorders of children, but also adults. It can take care of “dys disorders”, but also disorders of 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).
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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:
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- 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.
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This professional is also responsible for maintain the functions of communication and orality in the context of degenerative and neuro-degenerative pathologies and dispense learning other forms of non-verbal communication to complement or supplement verbal functions.
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“The speech therapist intervenes on doctor’s prescriptionmost often a general practitioner, a pediatrician, an ENT, a neurologist or a geriatrician”, specifies Anne Dehêtre. They can work together with these specialists, but also with other paramedical professionals: orthodontists, orthoptists, nursing assistants, etc.
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Where can I find a speech therapist?
Speech therapists generally practice as a liberal, within a firm. But they can also be salaried in the public or private sector, in various structures: in a crèche, in a PMI (maternal and child protection centre), in a drop-in centre, in a CMP (medico-psychological centre), in a retirement home or in a hospital center.
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Speech therapists are not doctors, but holders of a certificate of competence in speech therapy (CCO), obtained after five years of study (Master 2 level) in a training center, most often attached to a UFR of medicine. In the program ? A transversal training covering anatomy, acoustic physics, phonation, linguistics and psychology.
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Good to know: the social security financing bill for 2022 plans to test access to speech therapy consultations without a prescription. Professionals will beauthorized to deliver care without a medical prescription“, provided they are practiced in coordinated care structures (a medical center or a health center for example). They will only have to send “an initial assessment and report of the care provided” to the attending physician, as well as report these elements in a “shared medical file”, specify the texts of the amendments voted in October 2021. The experiment would be carried out “for a period of three years, in six departments“.
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Indications: why go to see a speech therapist?
The speech therapist establishes a specific program for each patient, according to their problems. “We too often think of speech therapy in case of written language disorders (dyslexia, dysortography, dysgraphia) and logical-mathematical reasoning (dyscalculia). But the latter only represent 25% of care, “insists the president of the FNO. Many other situations may require speech therapy:
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- the neurodevelopmental disorders (TND) ;
- the speech disorders (difficulties suckling, swallowing problems) which sometimes appear from the first weeks of life;
- the disorders related to neuro-degenerative pathologies (Parkinson’s disease, multiple sclerosis, Charcot’s disease, Alzheimer’s disease, stroke, etc.) which affect 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);
- tongue placement problems (dysfunctional swallowing), often related to orthodontic disorders;
- the congenital deafness and presbycusis (deafness related to aging).
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“Patients who are victims of Covid-19 may also need speech therapy to compensate for the sequelae linked, in particular, to intubation”, specifies Anne Dehêtre.
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First test: the speech therapy assessment
Speech therapy care begins with the establishment of the speech therapy assessment. It takes place in two stages:
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- an interview with the patient and his family (if he is a child) or his helpers (if he is disabled or suffers from serious sequelae). Goal ? Gather as much information as possible about the patient, about his difficulties, the context in which his troubles appeared, the impact on his daily life, etc.
- then a series of tests and games intended to identify oral, written, motor and developmental disorders, but also the compensation strategies already in place.
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Two types of speech therapy assessments can be carried out, depending on the initial prescription:
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- An investigation report : where the goal is to detect the disorder(s) of the patient according to his difficulties, to judge their importance in order to set up (or not) a program to correct them. The prescribing doctor will then have to validate (or not) the program proposed by the speech therapist.
- A balance sheet with rehabilitation : if the child’s disorders are considered important by the prescribing doctor and the prescription mentions “with rehabilitation”, then the speech therapist can begin rehabilitation immediately, without waiting for the prescribing doctor’s validation.
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Who can benefit from a speech therapy assessment?
“The speech therapist can intervene from the first days of life, and until the last”, indicates the president of the FNO. Speech therapy is recommended for both children and adults. no age limit.
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- Babies with swallowing disorders;
- 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 disability (trisomy, deafness, etc.) disrupts the installation or development of language
- children, adolescents or adults disturbed in their communication (oral or written) after sequelae of previous disorders such as an accident, trauma, post-operative consequences, brain aging, etc.
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Depending on the results of the speech therapy assessment, the professional will draw up a speech therapy diagnosis (complementary to the initial medical diagnosis) and an action plan which may include speech therapy sessionsbut also by prescription of additional examinationssupport from other medical or paramedical professionals, or specific care for the patient at school level.
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The number of sessions is programmed from the start, and may change (generally from 10 to 50 sessions, or even more). The duration of each session varies according to the disorder to be rehabilitated : from 30 minutes, for articulation, to 40 minutes for written language disorders, or even an hour in the event of a disability such as deafness.
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“Part of the work is done in session, but rehabilitation also requires a daily investment, on the part of the patient, the parents, the entourage, caregivers, etc. We work a lot according to the ecosystem that surrounds the patient”, insists Anne Dehêtre. And to explain: “We cannot deal with communication and language disorders without taking into account the environment: it is important to teach people with aphasia to reconnect with communication, of course, but it is necessary also that those around him learn to communicate with them”.
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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 quotation of the acts of the AMO (Acte Médical Orthophonique), it is necessary to count on average between 20 and 39 euros per session with a refund of CPAM of 60%. Many mutuals cover the remaining delta.
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Note: in the case of long-term illnesses (ADL): the sessions are fully covered by the primary health insurance fund.
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