More than words
Statistics show that 3,663 children have a speech or language difficulty to overcome when communicating. Marika Azzopardi learns more about the Maltese Association of Speech Language Pathologists and the work they carry out with the children who are affected.
Speech and language, feeding and swallowing come naturally for the larger majority of us. However, there is always that small percentage of people who needs the help of professionals to get over what for many of us is part and parcel of everyday life and which, luckily, comes naturally.
Together with 30 European organisations of CPLOL (Standing Liaison Committee of Speech and Language Therapists/Logopedists in the European Union), the Maltese Association of Speech Language Pathologists (ASLP) recently marked the European Day of Speech and Language Therapy with a seminar organised in Malta for the first time. Focusing on neurological conditions in childhood, the event honed in on neurological damage like brain damage, cerebral palsy, dyspraxia and post-traumatic aphasia ‒ conditions occurring due to lesions sustained in the brain during the peri- and/or post-natal period. Difficulties presented include a persistent disorder of movement and/or posture that varies in mode of presentation and severity, from mild to severe, with possible changes occurring over time. Speech language pathologists (SLPs) work on these conditions on the three pillars of the profession - assisting speech and language; helping patients in the process of feeding and swallowing; providing alternative and augmentative means of communication. Early intervention provides better results.
Founded in 1985, ASLP was immediately recognised as a professional association by the Federation of Professional Bodies in Malta. It was set up with four main aims that are still valid today, namely safeguarding the profession, safeguarding the professional code of ethics, keeping up with standards and current developments, and creating public awareness. Over the past 20 years, as the number of qualified SLPs increased, the association has developed to meet current challenges.
ASLP president Gertrude Buttigieg said: "ASLP was affiliated with CPLOL in 2007 - a very important move that will help place Maltese SLPs closer to European standards. Of the 102 registered SLPs, many less may be practising in Malta and this is mainly due to some moving out of the profession or moving on in the profession by seeking opportunities overseas". There are several issues which ASLP is striving to solve, namely the warrant issue. "Therapists who are government employees have recently been automatically warranted, while private therapists have not. Having said that we strongly believe that warrant holders should be accountable for their warrant and its professional upkeep is very important." Being affiliated with CPLOL should help ASLP also on this front and in improving professional training all over Europe. "In Malta we have a high level of training and as SLPs graduate from university they are ready to practise following a four-year degree course that includes theory and practice. In some European countries, training only leads to diploma level and CPLOL is working to iron out these differences and achieve the same standards in all European countries."
Birgitta Rosén Gustafsson is president of CPLOL (Comité Permanent et Liaision des Orthophonistes/Logopèdes de l'Union Européenne) based in Sweden. She has been working as a speech and language therapist for 25 years, mainly with children and young people with different kinds of language impairments or handicaps which affect language and communication as well as patients with dyslexia. Asked about the number of children who are affected with neurological disorders within the EU and whether there is a most common type of disorder manifested throughout, she explained: "If you count children with language impairment, between five and eight per cent of pre-school children are affected. As regards severe language impairment (SLI), one usually calculates one to two per cent of one age group. However, this can vary between different countries. Usually children with language disorders do not have other handicaps, the main symptoms being the difficulties in the development and use of language. And the basis of this is considered to be neurological. However, there are other neurological handicaps like cerebral palsy and these children can have communication disorders which speech language therapists take care of. Neurological disorders are a heterogenic group and to get numbers you also have to consider impairments caused by brain injury from accidents, illness and/or neuropsychiatric diagnoses like Asperger's syndrome, autism, etc."
As president of CPLOL, Rosen Gustafsson can take stock of the general problems encountered by professionals in this field. "A problem in most European countries is that there usually is a lack of professionals, which leads to children (and other patient groups) with communication problems having to wait a long time before they get help. Children with language impairments have to be detected as early as possible to prevent learning disabilities as well as reading and writing problems later in life. If prevention activities and screening tools were available during the first years of life, I mean if you could find these children very early (before three years of age), they would have a much better prognosis."
Locally, the Speech-Language Department offers services under the auspices of primary health care and all members of staff are accountable to the primary health care director. It is responsible for a number of speech language units including those at ENTOP, CDAU, special schools and a number of adult training centres, totally providing services in 33 different locations within Malta and Gozo.
Rita Micallef manages this department and is herself qualified as a clinical speech and language pathologist with a doctorate in education programme. "All members of the speech language pathology staff employed within the health division fall under my responsibility and my aim is to promote a work ethic that strives relentlessly to ensure quality services both in terms of cure and care.
"Naturally part of my work involves liaising with other government departments to ensure the best service that can be offered with the resources available," she said.
Asked how many children are presently registered with the speech language department, Dr Micallef confirms that as per 2007 statistics, the total number amounted to 3,663.
"The department operates on an open referral system, and referral can be made by contacting the speech language department itself or any other outlet of service provision.
Referrals to other professionals are also made directly by the speech language pathologists. We deal with a number of different conditions that involve communications problems associated with hearing, sensory impairment, learning disability or autism.
Then there are also problems in articulation, phonology, grammar, fluency. We also treat voice disorders, speech and language delay. At the other end of the spectrum, there are also severe neurological conditions such as those caused by head injuries, stroke or progressive diseases.
All these conditions may ultimately effect swallowing and create feeding difficulties which our pathologists assist patients in resolving."
• More details on the ASLP may be found online at www.aslpmalta.org or by phone on 2131 2888.
Two children, two stories
Jonathan * is 12 and was born with cerebral palsy. He started speech therapy early as his mother Anna * sought professional assistance immediately and did all in her power to help Jonathan speak. "I always hoped he would speak spontaneously. Both speech therapists who saw him (government and private) used various methods like teaching vowels, massaging the tongue, placing ice against his lips to teach him to purse his lips or teaching him how to blow through a straw. The therapy also helped him control his dribbling. He doesn't speak with his mouth, but his eyes speak volumes and we communicate fully just by looking at each other. I was told early on, that it's a huge advantage because he knows what he wants and he can let others who understand his system of communication, know."
Anna explains Jonathan is using low-tech communication aids such as the E-tran frame as well as flash cards but that the most extraordinary aid is the high-tech laptop which has a cursor attached to his nose. "He can communicate fully through this laptop as it speaks for him. He can even send text messages. However, now he needs a specialised wheelchair to complement the apparatus and thanks to his school, this will soon be arriving in Malta." Anna recounts how Jonathan's school organised a marathon for the AAC which is being bought from the UK. "The children in his school made it all possible as they raised enough money to purchase it - I would never have managed on my own. That is one major problem with these children - expenses. For instance, we have to make an annual trip to the UK to adjust his walker to fit his growing stature. We just stay there for two days and fly back. The walker allows him to play ball for an hour a day with the rest of his classmates."
*Names have been changed to protect identities
Mika Zammit is five and thankfully practically back to normal. Emma, his mum, talks of the terrible experience of seeing her three-and-a-half-year-old suffering severe skull fractures after a merry-go-round accident. "He spent a long period in intensive care and then had to be re-operated on due to the leakage of cerebro spinal fluid. Mika emerged from the whole trauma with his face half-paralysed, something which should be fixed in another operation happening soon. In the meantime he required speech therapy as cheek movement needed to be stimulated."
Speech therapy was just one of the whole process to bring Mika back in step - he had become incontinent again and had to re-learn basic skills like re-tying shoe laces. However, today he is back at school in Year One, catching up with his peers. "The therapists had great charisma and loads of patience. They helped him through specialised games. We attended speech therapy both at St Luke's Hospital and at the speech therapy clinic at the health centre. Surely Mika would never have come back to normality had he not been assisted in this way."
Together with 30 European organisations of CPLOL (Standing Liaison Committee of Speech and Language Therapists/Logopedists in the European Union), the Maltese Association of Speech Language Pathologists (ASLP) recently marked the European Day of Speech and Language Therapy with a seminar organised in Malta for the first time. Focusing on neurological conditions in childhood, the event honed in on neurological damage like brain damage, cerebral palsy, dyspraxia and post-traumatic aphasia ‒ conditions occurring due to lesions sustained in the brain during the peri- and/or post-natal period. Difficulties presented include a persistent disorder of movement and/or posture that varies in mode of presentation and severity, from mild to severe, with possible changes occurring over time. Speech language pathologists (SLPs) work on these conditions on the three pillars of the profession - assisting speech and language; helping patients in the process of feeding and swallowing; providing alternative and augmentative means of communication. Early intervention provides better results.
Founded in 1985, ASLP was immediately recognised as a professional association by the Federation of Professional Bodies in Malta. It was set up with four main aims that are still valid today, namely safeguarding the profession, safeguarding the professional code of ethics, keeping up with standards and current developments, and creating public awareness. Over the past 20 years, as the number of qualified SLPs increased, the association has developed to meet current challenges.
ASLP president Gertrude Buttigieg said: "ASLP was affiliated with CPLOL in 2007 - a very important move that will help place Maltese SLPs closer to European standards. Of the 102 registered SLPs, many less may be practising in Malta and this is mainly due to some moving out of the profession or moving on in the profession by seeking opportunities overseas". There are several issues which ASLP is striving to solve, namely the warrant issue. "Therapists who are government employees have recently been automatically warranted, while private therapists have not. Having said that we strongly believe that warrant holders should be accountable for their warrant and its professional upkeep is very important." Being affiliated with CPLOL should help ASLP also on this front and in improving professional training all over Europe. "In Malta we have a high level of training and as SLPs graduate from university they are ready to practise following a four-year degree course that includes theory and practice. In some European countries, training only leads to diploma level and CPLOL is working to iron out these differences and achieve the same standards in all European countries."
Birgitta Rosén Gustafsson is president of CPLOL (Comité Permanent et Liaision des Orthophonistes/Logopèdes de l'Union Européenne) based in Sweden. She has been working as a speech and language therapist for 25 years, mainly with children and young people with different kinds of language impairments or handicaps which affect language and communication as well as patients with dyslexia. Asked about the number of children who are affected with neurological disorders within the EU and whether there is a most common type of disorder manifested throughout, she explained: "If you count children with language impairment, between five and eight per cent of pre-school children are affected. As regards severe language impairment (SLI), one usually calculates one to two per cent of one age group. However, this can vary between different countries. Usually children with language disorders do not have other handicaps, the main symptoms being the difficulties in the development and use of language. And the basis of this is considered to be neurological. However, there are other neurological handicaps like cerebral palsy and these children can have communication disorders which speech language therapists take care of. Neurological disorders are a heterogenic group and to get numbers you also have to consider impairments caused by brain injury from accidents, illness and/or neuropsychiatric diagnoses like Asperger's syndrome, autism, etc."
As president of CPLOL, Rosen Gustafsson can take stock of the general problems encountered by professionals in this field. "A problem in most European countries is that there usually is a lack of professionals, which leads to children (and other patient groups) with communication problems having to wait a long time before they get help. Children with language impairments have to be detected as early as possible to prevent learning disabilities as well as reading and writing problems later in life. If prevention activities and screening tools were available during the first years of life, I mean if you could find these children very early (before three years of age), they would have a much better prognosis."
Locally, the Speech-Language Department offers services under the auspices of primary health care and all members of staff are accountable to the primary health care director. It is responsible for a number of speech language units including those at ENTOP, CDAU, special schools and a number of adult training centres, totally providing services in 33 different locations within Malta and Gozo.
Rita Micallef manages this department and is herself qualified as a clinical speech and language pathologist with a doctorate in education programme. "All members of the speech language pathology staff employed within the health division fall under my responsibility and my aim is to promote a work ethic that strives relentlessly to ensure quality services both in terms of cure and care.
"Naturally part of my work involves liaising with other government departments to ensure the best service that can be offered with the resources available," she said.
Asked how many children are presently registered with the speech language department, Dr Micallef confirms that as per 2007 statistics, the total number amounted to 3,663.
"The department operates on an open referral system, and referral can be made by contacting the speech language department itself or any other outlet of service provision.
Referrals to other professionals are also made directly by the speech language pathologists. We deal with a number of different conditions that involve communications problems associated with hearing, sensory impairment, learning disability or autism.
Then there are also problems in articulation, phonology, grammar, fluency. We also treat voice disorders, speech and language delay. At the other end of the spectrum, there are also severe neurological conditions such as those caused by head injuries, stroke or progressive diseases.
All these conditions may ultimately effect swallowing and create feeding difficulties which our pathologists assist patients in resolving."
• More details on the ASLP may be found online at www.aslpmalta.org or by phone on 2131 2888.
Two children, two stories
Jonathan * is 12 and was born with cerebral palsy. He started speech therapy early as his mother Anna * sought professional assistance immediately and did all in her power to help Jonathan speak. "I always hoped he would speak spontaneously. Both speech therapists who saw him (government and private) used various methods like teaching vowels, massaging the tongue, placing ice against his lips to teach him to purse his lips or teaching him how to blow through a straw. The therapy also helped him control his dribbling. He doesn't speak with his mouth, but his eyes speak volumes and we communicate fully just by looking at each other. I was told early on, that it's a huge advantage because he knows what he wants and he can let others who understand his system of communication, know."
Anna explains Jonathan is using low-tech communication aids such as the E-tran frame as well as flash cards but that the most extraordinary aid is the high-tech laptop which has a cursor attached to his nose. "He can communicate fully through this laptop as it speaks for him. He can even send text messages. However, now he needs a specialised wheelchair to complement the apparatus and thanks to his school, this will soon be arriving in Malta." Anna recounts how Jonathan's school organised a marathon for the AAC which is being bought from the UK. "The children in his school made it all possible as they raised enough money to purchase it - I would never have managed on my own. That is one major problem with these children - expenses. For instance, we have to make an annual trip to the UK to adjust his walker to fit his growing stature. We just stay there for two days and fly back. The walker allows him to play ball for an hour a day with the rest of his classmates."
*Names have been changed to protect identities
Mika Zammit is five and thankfully practically back to normal. Emma, his mum, talks of the terrible experience of seeing her three-and-a-half-year-old suffering severe skull fractures after a merry-go-round accident. "He spent a long period in intensive care and then had to be re-operated on due to the leakage of cerebro spinal fluid. Mika emerged from the whole trauma with his face half-paralysed, something which should be fixed in another operation happening soon. In the meantime he required speech therapy as cheek movement needed to be stimulated."
Speech therapy was just one of the whole process to bring Mika back in step - he had become incontinent again and had to re-learn basic skills like re-tying shoe laces. However, today he is back at school in Year One, catching up with his peers. "The therapists had great charisma and loads of patience. They helped him through specialised games. We attended speech therapy both at St Luke's Hospital and at the speech therapy clinic at the health centre. Surely Mika would never have come back to normality had he not been assisted in this way."