When to refer to Speech Pathology

Speech Pathologists are experts in assessing and treating difficulties with swallowing and communication. Our team of Speech Pathologists provide support for adults, with various conditions that may impact their communication, swallowing or both.

Examples of underlying medical conditions that we can provide specialised and individualised support to include (but not limited to): Intellectual Disability (E.g., Autism, Down Syndrome), Traumatic Brain Injury, Progressive Neurological Conditions (Parkinson’s Disease, Motor Neurone Disease, Huntington’s Disease, Multiple Sclerosis), Stroke, Mental Health Conditions (including Schizophrenia, Bipolar, Anxiety).

If you notice any of the following signs/indicators, please refer for Speech Pathology:


  • Signs of aspiration/choking (food/drinks going the wrong way into the lungs). Signs may include coughing, throat clearing and/or wet voice when eating and drinking or directly after oral intake, as well as increased temperature and/or reduced chest status)
  • Recurrent chest infections (even if not showing overt signs of aspiration e.g. coughing when eating and drinking, if someone is having recurrent chest infections it may be related to swallowing difficulties with potential silent aspiration i.e. no coughing/throat clearing when food/drink goes the wrong way into the lungs)
  • There are also more subtle changes in swallowing function that should be taken just as seriously as signs of aspiration when eating/drinking. These may include:
    • Increased time required for meals and related &/or unexplained weight loss (refer to dietitian and also consider speech pathology referral as weight loss may be related to texture diet restrictions and/or increased difficulty swallowing).
    • Increased chewing difficulty
    • Increased oral residue (food/fluids remaining in mouth after eating/drinking)
    • Difficulty with managing secretions/saliva (which may include increased drooling, pooling of saliva in mouth or coughing on saliva)
    • Pain when swallowing
    • Complaints of food getting stuck (or any complaints/concerns raised by person around changes in swallowing)
    • Increased work of breath when eating and drinking
    • Fast pace of eating and drinking.
    • Diet upgrade requested by person or family.


The following areas are examples of changes or difficulties that often become a barrier to someone being able to participate in various activities including basic rights of a person.

Language Difficulties (Language involves the ability to understand what others are saying to you as well as expressing yourself), language skills vary person to person and language extends beyond just what is spoken but also using body language/gesture to communicate your needs and wants.

  • Word finding difficulties
  • Difficulty with understanding speech that is spoken to them (e.g. difficulty following instructions, not responding to questions appropriately, no able to understand yes/no questions).
  • Difficulty understanding complex information (e.g. when provided multiple steps or complex questions, no response or difficulty completing task)
  • Difficulty expressing oneself and communicating one’s needs and wants
  • Spelling/Writing/Reading difficulties

Other areas of communication that can impact how a person is understood and being able to be heard includes:

  1. Voice (use of voice box to achieve clear voice quality)
    a. Unclear voice e.g. hoarse, husky, breathy or strained voice quality (similar to what someone sounds like when they are sick)
    b. Frequent voice loss or difficulty being able to speak for long periods due to voice discomfort
    c. Difficulty projecting voice
    d. Nasal voice or nasal emissions (air coming out of nose when speaking)
    e. Difficulty in appropriate volume/loudness
    f. Voice patterns that sound unusual oruncoordinated(e.g. shaky voice)

  2. Speech (ability to produce speech sounds clearly to create intelligible speech)
    a. Slurred Speech (Dysarthria)
    b. Difficulty being understood by others (intelligibility) due to unclear speech sounds particularly when speaking in conversation
    c. Fast speech rate that makes it difficult to understand the person
    d. Uncoordinated speech (oral apraxia)
    e. Difficulty managing breath when speaking e.g. become breathless when talking

  3. Fluency (be able to speak with steady flow i.e. without stuttering)
    a. Stuttering (e.g. repeating word, sound or freezing when speaking)

  4. Cognitive-Communication Skills (any difficulties in cognitive skills e.g. attention, memory, problem solving; will impact on someone’s ability to communicate in a meaningful way with others).
    a. Difficulties with sequencing information and completing the task
    b. Difficulties in safety awareness (in particular understanding the risk and outcome of various activities)
    c. Difficulties with behaviours due to cognitive functioning e.g. inappropriate responses in social settings, unable to regulate their self and behaviours that impact their interactions
    d. Difficulty with problem solving and reasoning
    e. Difficulty with orientation (understanding time, place, person)

  5. Pragmatics (Social Communication Skills)
    a. Difficulty with eye contact, greetings (e.g. saying hello/goodbye and introduce self)
    b. Difficulty in understanding the underlying meaning of conversation (particularly understanding metaphors, humour)
    c. Difficulty in changing language formality depending on who they are speaking to e.g. to familiar or unfamiliar people
    d. Inappropriate level of sharing personal information (e.g., over-sharing)
    e. Difficulty with taking turns in conversation (difficulty responding to others in conversations, staying on topic, dominating or taking over the whole conversation)
    f. Verbosity (talking a lot)
    g. Difficulty using gestures and facial expressions in conversation and being able to understand another’s non-verbal communication (e.g. the communication partner’s gestures/body language/facial expressions.

We can also trial and set up alternative means of communicating, also known as AAC – Alternative Augmentative Communication (e.g., use of picture aids, iPad/technology based device to communicate) if necessary.

Health Journey Partner has fully qualified and experienced Speech Pathologists that can work together with you to achieve your goals. Contact us for a comprehensive assessment followed by collaborative therapy.