The relevance of cooperation between a speech therapist and a doctor

Автор: Панкратова Виолетта Сергеевна

Организация: БелГУ

Населенный пункт: Белгородская область, г. Белгород

Abstract: The article discusses the need for close cooperation between speech therapists and medical specialists (neurologists, psychiatrists, and otorhinolaryngologists) in the diagnosis and correction of speech disorders. It is argued that isolated speech therapy work without considering the medical component reduces the effectiveness of correction and increases the time required to achieve sustainable results.

Key words: speech therapist, neurologist, interdisciplinary interaction, speech disorders, etiopathogenetic approach, primary and secondary speech pathology.

In recent decades, there has been a steady increase in the number of children and adults with speech disorders. According to the World Health Organization, up to 25% of preschool-aged children have some form of speech disorder, and the number of adults with aphasia after strokes and traumatic brain injuries is also on the rise. In this context, the isolated work of a speech therapist focused solely on external manifestations (such as incorrect pronunciation, limited vocabulary, and grammatical errors) is often insufficient. Interdisciplinary collaboration between a speech therapist and a medical professional becomes crucial.

Speech is a complex mental function that is supported by a variety of brain structures, including the frontal lobes (programming of speech), the temporal regions (phonemic perception), the parietal regions (kinesthetic basis of speech), and the subcortical nodes and cranial nerves.

Every year, the number of children with an undefined brain dominant increases, that is, it is unclear by the age of seven which hand is the leading one. This leads to spatial perception distortions, and in writing it results in optical dysgraphia. If the named problem is not resolved at least during the period of preparation for schooling, it causes serious difficulties in learning.

Every year, during consultations with future first-graders, 4-5 people are identified who have defects in their sonor (R, L) due to untreated adenoid growths. Otolaryngologists do not take into account the consequences of speech disorders in cases where adenoids are not treated in a timely manner.

A defective sound leads to a defective perception, which in turn leads to difficulties with the Russian language and reading. This can result in academic underachievement and mental stress. In many cases, pronunciation defects are associated with underdevelopment or abnormal jaw development.

Progenia and prognathia are now common phenomena: with this defect, the sibilant and hissing sounds will surely be defective.

Any speech disorder can have an organic, functional, or mixed nature. Without a medical report, a speech therapist runs the risk of:

l missing a serious medical condition (such as epilepsy with atypical seizures or a brain tumor);

l choosing the wrong correction approach (for example, trying to "correct sounds" in the presence of progressive neurodegeneration);

l overloading a child or adult with activities that do not take into account their actual neurophysiological status.

 Areas of cooperation between a speech therapist and doctors.

Neurologist. The neurologist establishes a diagnosis (dysarthria, alalia, aphasia, delayed speech development of organic genesis), prescribes drug support (nootropics, vascular drugs, B vitamins), evaluates the dynamics against the background of correction. Together with the speech therapist, the neurologist interprets the data of EEG, MRI, ultrasound of the vessels of the neck.

Otorhinolaryngologist. Hearing loss (even slight hearing impairment) is a common cause of mispronunciation and limited vocabulary. A speech therapist should have an audiogram and an ENT specialist's report on the condition of the eardrum, adenoids, and auditory ossicles. Only after the ENT organs are treated can speech therapy be effective.

Psychiatrist / medical psychologist. In cases of autism spectrum disorders (ASD), intellectual disability, and selective mutism, the speech therapist works closely with a psychiatrist who prescribes basic therapy (antipsychotics, antidepressants, and tranquilizers) and provides recommendations for the patient's daily routine.

Dentist / Orthodontist. Malocclusion, a short frenulum, and cleft palate (rhinophonia) require surgical or orthodontic intervention before intensive speech therapy begins.

In advanced clinics and rehabilitation centers, the following have already been implemented:

Joint consultations (speech therapist + neurologist + psychologist) upon admission and after 3-6 months.

A unified medical record where the speech therapist records the dynamics of verbal functions.

Supervision of speech therapy sessions by a doctor (especially for aphasias and dysarthrias).

Parent training at the intersection of two disciplines: what doctors can do and what speech therapy exercises can do.

Barriers and ways to overcome them

Despite the obvious benefits, cooperation faces difficulties:

Disparity of institutions (speech therapist in the polyclinic, neurologist in another building, ENT in the third).

Lack of regulations for information exchange (speech therapist does not always have access to medical diagnoses, and the doctor does not have access to the speech card).

Overloaded specialists (insufficient time for consultations).

Solutions: implementation of telemedicine consultations, mandatory inclusion of speech therapists in neurology departments and early development centers, and creation of interdisciplinary protocols for managing patients with speech disorders at the regional level.

The relevance of cooperation between a speech therapist and a doctor is dictated by the very nature of speech disorders, which in most cases have a biological basis. Isolated speech therapy is a correction of the consequence, not the cause. Only by combining knowledge about the brain, sensory systems, medical support, and speech techniques can we achieve stable and functional speech in patients of all ages.

Recommendation: Each speech therapist should have a neurologist and an ENT specialist in their team for prompt consultation, and each doctor working with children and adults with speech disorders should view the speech therapist as an equal partner in the rehabilitation team.

References

1. Lopatina, L.V., and Serebryakova, N.V.Logopedic Work with Children with Dysarthria.Moscow, 2018.
2. Wiesel T.G. Neuropsychological Examination of Patients with Aphasia. Moscow, 2020.
3. Clinical guidelines of the Russian Ministry of Health for managing patients with delayed speech development (2022).