Abstract
Dear Editor:
Speech therapy (ST) is a specific area of health that is empirically associated with the development of verbal communication, commonly following a primary disturbance of the language (such as articulatory difficulties during childhood) or secondary to some pathological condition (the most common example being dysphasia or aphasia after a stroke).
In fact, as the name suggests, most health professionals are unaware of functions other than improvement in communication (especially with regard to recovery or development of speech).
In its first definition, ST targeted the “development activities within the (…) human communication, encompassing not only all the functions associated with understanding and expression of oral and written language, but also other forms of nonverbal communication.”
The field has been progressively expanded, and hence its definition reformulated. Currently, ST is defined as the “profession responsible for the prevention, assessment, intervention and scientific study of disorders of human communication, encompassing not only all the functions associated with understanding and expression of oral and written language but also other forms of non-verbal communication; (…) intervenes, even at the level of swallowing (safe passage of food and drink through the oropharynx in order to ensure adequate nutrition); (…) evaluates and intervenes in individuals of all ages (…) with the general objective of optimizing communication capabilities and/or individual swallowing, thus improving their quality of life.”
The main areas of intervention can thus be divided into seven—communication, oral language, written language, verbal articulation, voice, fluency, swallowing, and motor orofacial.
Speech therapists, in conjunction with other healthcare providers, are able to exercise their technical expertise in various institutions. As one of the main objectives is to improve quality of life related to the mentioned difficulties, it is reasonable to conclude that these professionals play an important role in palliative care (PC), an interdisciplinary field of active and total care for patients with incurable chronic disease and inexorable evolution.
Rehabilitation work will contribute to the improvement or resolution of symptoms that can arise in advanced stages of the disease. Therefore, it is possible to invest in improving the functional state of the patient and reduce anxiety states or other psychological disorders arising from feelings of worthlessness and hopelessness often associated with a terminal phase of life.
In PC, speech therapists, within their technical skills, can develop verbal and nonverbal communication strategies that allow the preservation of social relations and communication between the patient and the caregiving team, to improve relevant information transmission, such as their decisions and desires. Speech therapists can direct exercises to train the patient in the performance of daily life tasks, thus encouraging independence, ensuring a higher own satisfaction level, and the sense of preserving their autonomy and dignity, not only for patients but for their families or other caregivers as well. Speech therapists also have an important role in the optimization of swallowing, which increases the patient's well-being and facilitates positive relationships during the meal. A crucial aspect considering is not only the physical/nutritional issues but also the psychological and social impact that food takes on.
In Portugal the statistical data regarding the introduction of a speech therapist in the PC team reveal a discouraging scenario. In 2014, each team consisted of an averaged number of 7.5 professionals, of which the lowest number corresponded to the rehabilitation area—0.32 rehabilitation nurses, 0.41 physiotherapists, 0.03 physiatrists, ST, and occupational therapists. It is estimated that 86.4% of these teams do not resort to a physiatrist or ST.
In conclusion, there is still a long way to go before a paradigm shift can occur. This shows that more research is needed in this area to invest in the structure, organization, and interpersonal coordination and rehabilitation programs in CP. There is also a need to sensitize teams and health managers and to show their importance in terms of gains in quality-of-life patients and their families/caregivers.