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Recent Developments in Speech Therapy in Great Britain and the U.S.A.
Speech therapy is a young science. In Britain the first clinic was opened at St. Thomas's Hospital in 1913. Other London hospitals soon followed suit, but the real stimulus to the expansion of the work came from the necessity of treating the speech casualties of the 1914–18 war. Teachers of elocution and voice production were the first speech therapists. Eventually two professional associations were formed—the Society of Speech Therapists and the Association of Speech Therapists. Students who had completed a course of training approved by these bodies were admitted to membership or associateship of the respective society. In 1943 these independent organizations amalgamated to form the College of Speech Therapists, which is now the sole controlling organization and examining body in Britain. A national standard of training and qualification for speech therapists has been instituted by the College. The course leading to the examination for the diploma of Licentiate of the College of Speech Therapists covers a period of three years. Persons holding this qualification may register as medical auxiliaries and in fact are required to do so before holding professional appointments.
The American Speech Correction Association performs a similar function in the U.S.A. to the College of Speech Therapists in Britain. There is one important difference. The licentiate diploma of the College of Speech Therapists is now the only recognized qualification in Britain, whereas in America each university grants its own degrees in speech correction. Certain minimum standards of training and qualification are, however, required for membership of the A.S.C.A., and as this is virtually the trade union of speech therapy in America, most practising speech therapists wish to belong to it. This ensures a certain uniformity in degree syllabuses. In most States an M.A. or Ph.D. in speech is considered an essential qualification for sole-charge or senior positions. The American training is thus longer and in general has a broader scope than the British.
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Therapists in both Britain and the U.S. may work in school clinics, hospital clinics or in private practice. Speech therapy for children follows the same lines overseas as in New Zealand and hence needs no description. Adult work, however, is almost unknown in this country. A feature of wartime and post-war work, in Britain especially, is the treatment of the enormous numbers of aphasias resulting from brain injuries. This comparatively new therapeutic technique has given most promising results. Treatment is based on the re-establishment of lost or impaired associations and much depends on the skill and ingenuity of the therapist and the perseverance of the patient.
Patients suffering from voice disorders form another major group among both civilians and servicemen. Among the latter, direct injuries to the larynx are common and among civilians causes vary from pathologies such as tuberculosis, cancer, vocal nodules and paralysis of the vocal cords resulting from lesions of the laryngeal nerves, to functional aphonias of psychological origin. One of the more spectacular types of vocal re-education is the development of oesophageal voice in laryngectomised patients. The crico-pharyngeus muscle of the oesophagus is trained to produce a vibration, thus acting as substitute for the vocal cords. Voice produced in this way is not entirely natural, but speech is easily intelligible and adequate for all practical purposes. (A recording of the speech of a laryngetomised patient who had mastered the technique of oesophageal voice was played at this point.) In the treatment of aphonias and dysphonias of psychological origin the best results are obtained by the collaboration of psychiatrist and speech therapist.
In Britain the treatment of stammering is based on the principles of relaxation and readjustment of the personality. In America treatment techniques vary considerably from state to state and many theories of causation are promulgated. In America as in Britain the most reliable authorities regard stammering as a psychoneurosis and treat it accordingly. It is generally admitted, however, that no theory of stammering may yet be regarded as the final word on this subject.
One of the latest developments in the work of speech therapy in Britain is the provision of residential treatment for selected children. No permanent residence of this kind was observed in America, but the same idea is embodied in the holiday camps for speech defective children which are organized by the speech-therapy departments of many universities during the long vacation. These camps give intensive treatment under residential conditions.