Patient information

Speech therapy (from the Greek: “speech training”) covers the areas of diagnostics, therapy and counseling of language, speech, voice and swallowing disorders, as well as auditory perception disorders in children, adolescents, adults and their relatives.

If you have the impression that you need speech therapy or that your child is having difficulties with speech development/pronunciation, you should first discuss this with your doctor. For adults, the specialist areas are, for example, general medicine, neurology or ENT. For children, the pediatrician, ENT doctor or orthodontist is usually responsible. The doctor has the option of issuing a prescription for medicinal products if speech therapy diagnosis or therapy is necessary.

Speech therapy should begin as early as possible! If you are unsure whether therapy is necessary, your doctor may initially prescribe 2-3 therapy sessions to assess the condition.

We treat both children and adults in our practice. The reasons for treating adults are language/speech/voice/swallowing disorders after a neurological event, e.g. a stroke or progressive diseases, e.g. Parkinson's disease, multiple sclerosis (MS). But we also treat patients with voice disorders, weaknesses in the tongue and facial muscles, e.g. after tumor treatments in the head/neck area, stuttering/cluttering or facial paralysis.

Insured persons of the German statutory health insurance funds The statutory health insurance companies cover the costs of speech therapy. Co-payment : Children and young people under 18 are exempt from co-payment. All other people pay a co-payment. According to the current medicinal product guidelines, the co-payment is 10% of the treatment costs plus a 10 euro prescription fee. For patients who are exempt from co-payment, your health insurance company will cover the costs. Insured persons of private health insurance companies Private health insurance companies cover the costs of the therapy as agreed in your contract. We would be happy to provide you with a cost estimate in advance so that you can clarify the cost coverage with your private health insurance company.

We work by appointment from Monday to Friday. If you would like to register in person at the practice and no one is there, we are out and about and make home visits to our patients.

You can contact us in our practice for an initial appointment or if you have any questions beforehand by phone or email. If you are unsure whether speech therapy would be useful for you or your child, please do not hesitate to contact us by phone. Our office staff's telephone consultation hours are usually Mondays, Wednesdays and Fridays from 8 a.m. to 10 a.m. So that we can give each patient our full attention, an answering machine is switched on during our ongoing treatments and during home or house visits. Please be sure to leave your name and telephone number here. We will call you back as soon as possible to take your request. You can also fill out the contact form on the homepage under “Contact and Directions” for inquiries.

At the first appointment in our practice, an initial conversation (anamnesis interview) takes place. With adults, we first get an idea of the current difficulties and ask for individual information that we think is important for diagnosis and possible therapy planning. With children, for example, we ask the parents about early childhood development in various developmental areas and the difficulties that arise. We then carry out an initial diagnosis with the patient to get an impression of their language skills. Children usually experience this as a "game" and not as a "test". We try to make our work transparent for both the patient and their relatives. In child therapy, the parents are given a comprehensive consultation to explain the current state of language development and the options for speech therapy are shown. Close cooperation with the parents is particularly important to us, as this is crucial for comprehensive therapy success. As part of the therapy, we are happy to offer detailed consultations for parents in which support options at home and more comprehensive questions can be discussed. Our therapy concept includes a holistic view of the disorder, which is why interdisciplinary exchange with other professional groups is also very important to us.

For children, a prescription usually includes 10 treatments, each of which usually lasts 45 minutes. They are carried out as individual therapy, but in rare cases group therapy can also be useful. In adults, the duration of therapy is 30, 45 or 60 minutes, this is decided by the prescribing doctor. After each prescription (treatment phase), a detailed therapy report is sent to the treating physician and, if necessary, a follow-up prescription is requested. Basically, we try to treat as briefly as possible, but as long as necessary.

Our practice is an appointment-only practice, which means that in order to avoid unnecessary waiting times, we arrange individual, fixed treatment appointments with you. These treatment appointments are reserved exclusively for you. By handing over the prescription, you enter into a service contract with us for medical services, the services provided of which are covered by the health insurance companies for those with statutory insurance. If you miss an appointment - for whatever reason - or if you do not cancel it at least 24 hours in advance, we will not be able to reassign the time you have already reserved. We therefore expressly ask you to cancel appointments in good time. Otherwise, we are obliged to invoice you for the missed appointments according to the valid treatment fees of the statutory or private health insurance companies (according to §611 SGB and §615 BGB). We ask for your understanding.

If you have a corresponding doctor’s prescription, we will also be happy to come to your home, nursing home or other therapeutic and social facilities. However, this only applies to the Wilhelmsburg district.

Every child develops individually. Some children start speaking as early as ten or eleven months, while others wait until they are 18 months old. Some pronunciation problems can also occur, which the child can overcome on their own. However, there are milestones that every child should reach by a certain age. If the age limit is exceeded by three months, a pediatrician examination or speech therapy diagnosis and, if necessary, therapy is recommended. LAUTERWERB ACCORDING TO ANNETTE FOX-BOYER (cf. Fox-Boyer, A. 2003. Speech disorders in children. Idstein: Schulz-Kirchner Verlag) Age (years; months) Acquired sounds up to 1;11 m, p, d up to 2;5 n, b up to 2;11 w, f, l, t, ng, ch (as in book), h, k, s (as in ice) up to 3;5 j, r, g, pf up to 3;11 s (as in sun) up to 4;5 ch (as in I) up to 4;11 sch GRAMMAR ACQUISITION ACCORDING TO CLAHSEN (cf. Clahsen, H. 1986. Profile analysis. Berlin: Marhold.) PHASE I (UP TO 1 1⁄2 YEARS): One-word utterancesPHASE II (1 1⁄2 – 2 YEARS): Two-word sentences, occasionally three-word sentences Only content words (nouns, verbs, adjectives, adverbs, personal pronouns and occasionally demonstrative pronouns) Verbs mostly in the basic form (infinitive), occasionally with the ending -t Negation of a sentence by preceding it with “No” PHASE III (2 – 3 YEARS): Two-word sentences, occasionally three-word sentences Only content words (nouns, verbs, adjectives, adverbs, personal pronouns and occasionally demonstrative pronouns) Verbs mostly in the basic form (infinitive), occasionally with the ending -t Negation of a sentence by preceding it with “No” PHASE IV (3 – 3 1⁄2 YEARS): Verb position in main and subordinate clauses mostly correct•Subject-verb agreement exists Separable verbs are now split (e.g. “falls over”) Sentence structure is complete Occasional use of accusative marking PHASE V (FROM 3 1⁄2 YEARS): Complex sentence structures, statements are divided into several clauses Correct formation of W-questions and indirect questions Accusative is used stably (from 3 1⁄2 years) Dative is used stably (from 4 1⁄2 years)•Genitive is used stably (from 6 years) Use of passive sentences only from 9 – 10 years Recent studies show that the age limits for case acquisition have shifted: Accusative (3-4 years), dative (7 1⁄2 years) and genitive (10 years). (cf. Motsch, H.-J. 2010. Context optimization. Evidence-based intervention for grammatical disorders in therapy and teaching. Munich: Ernst Reinhardt.)

For several years now, primary schools in Hamburg have been carrying out the so-called "four-and-a-half-year examination," in which all children who will be required to attend school in the year after next are examined. If the teachers determine that the child does not yet speak sufficient German to successfully complete the first grade, the child receives language support at the primary school. Here, vocabulary, grammar, sentence structure and formulation are practiced in a playful way. This applies to children who are not sufficiently exposed to a German-speaking environment (for example, do not attend a daycare center). In speech therapy , there are medical reasons why children cannot speak so well (e.g. impairments in auditory processing, auditory memory, oral motor skills, phonetics or even in pre-linguistic skills such as eye contact, imitation).

In the case of language development disorders, language acquisition usually begins late and/or does not proceed at an age-appropriate rate. Usually one or more of the following areas are affected: pronunciation, vocabulary, grammar and language comprehension. Language development disorders can become apparent very early, as early as the age of 2 (a child should be able to speak at least 50 words by the age of 2). In addition to communication behavior, children's play behavior is often also noticeable. You can also find further tips/information under “Patient information” or late-talker-so-erkennen-parents-unable-to-know-whether-your-child-is-at-risk-for-a-speech-disorder

Every child develops at their own individual pace. However, there are certain “milestones” by which a child should have completed a developmental step. An important milestone in vocabulary acquisition is that a child should speak at least 50 words by the age of 2. You can also find further tips under “Patient information” – children’s language development or on the homepage of the University of Konstanz https://www.ling.uni-konstanz.de/bsl/spracherwerb/meilensteine/

There have been studies that show that bilingualism/multilingualism is not the reason for a delay in language development. Especially when two languages are learned at the same time (father's language "A", mother's language "B" or family language "A", in daycare language "B"), the baby/toddler initially speaks fewer words in both languages. When counting words (so-called "milestones"), the words from both languages are added together. A stable mother tongue is important for language development: speak to your child in your mother tongue as consistently as possible during the first three years of life – this way your child can build up a strong linguistic “framework” into which new languages can be more easily integrated.

Please do not put pressure on your child to speak "properly". If they could speak better, they would. If you overwhelm them, you risk your child losing the joy of speaking. After each treatment, you will usually receive material/ideas on how you can practice at home and thus support the therapy. You can also find more tips under "Patient information".

Parent information on language support Do you have a child who doesn’t speak or speaks very little? You are probably experiencing that you are mostly alone in conversations and/or that your child is barely responding to your offers to talk. Every child is different and there are children who do not seem to learn to speak on their own - they need our support. How can you help your child to discover the importance of language as a means to an end? First things first: you are the expert on your child. No one knows your child better. You are the most important person in your child's life and you spend most of your time with them. Learning to speak takes place in the many everyday situations that you experience together: playing, shopping, getting dressed, bathing, etc. In these everyday situations and when you play together, your child can learn that communicating is not only fun, but also meaningful. Reasons to share Observe your child’s attempts to communicate! Long before children speak their first words, they begin to communicate. Whether the way they look, reach out for something, or the sounds a child makes when interacting with you or objects are messages is up to you! Consciously investigate all of your child's statements, no matter how random they may seem or not directed at you, and give them meaning. An example: Your child reaches for the ball, which he cannot reach alone, and makes whining noises. You look at him and ask: "Ball? Do you want the ball?" Because this is the message you suspect is behind his statements: your child wants the ball. Perhaps your child will now give you some kind of signal that shows you that you were right. The whining is interrupted for a brief moment by a quick look or a smile from your child. Now say as you give him the ball: "Yes, ball! Here is the ball." "Look there!" Create shared attention! Every conversation needs a shared focus of attention. This can be an object that is perceived together or a shared action. In small children, shared attention is usually associated with "oscillating" eye contact, ie the gaze switches back and forth between the conversation partner and the object of the conversation. This oscillating gaze can be observed particularly well in situations in which your child needs help. In the ball example, a child would look at the ball out of reach, then look at you, and then ask for your help by looking at the ball, extending their arm, and making a whining noise. Many children who are having difficulty learning to speak have difficulty establishing divided attention. When interacting with your child, pay attention to where their attention is, seek their gaze, and use everyday opportunities to encourage divided attention. An example: Your child wants to drink, you pour just a small sip into their cup and then eagerly await their look that signals to you that they want more. Make sure you are at eye level and fairly close to your child to make that look more likely. Ask "more?" and pour the next sip while commenting "drink more." “Get to the point!” The right word at the right time! Whenever you and your child focus your attention on an object or situation that you have perceived together, your child's ability to absorb new words is particularly high. Because children can only maintain shared attention for a few seconds at first, the language they offer should be adapted accordingly. Less is more! Choose a word that describes the situation accurately and, if possible, say it at the exact moment when your child is paying maximum attention. Make yourself and your language more interesting for your child by emphasizing the key words more and exaggerating the intonation of the language. An example: Your child observes a bird, makes a hissing sound and claps his hands. You pick up on what your child says and clap your hands as well. As you do so, call out: "VVBirdI". Pay close attention to your child's reaction: he may look at you briefly and/or he may try to imitate you. Reinforce each reaction by repeating: "a VVBird". If your child's attention then remains focused on the bird, you can expand the topic: "Beep, beep - the VVBird goes beep, beep". "It's your turn!" Learn to take turns In every game and in every conversation, you have to take turns. One time me, one time you: many children who have difficulty learning to speak don't yet know this rule. But the back and forth between two partners is the key to conversation. Help your child to contribute. Encourage the passive or shy child to respond by looking at them expectantly, waiting long enough for their contribution, perhaps offering help and, above all, considering every statement - even looks count! - as a full contribution and responding in turn. The boisterous child with their own plan can become a conversation partner if you get involved in their activities and demand your part. An example: Your child taps the spoon on the table. You imitate this and look at your child with anticipation. Your child may look at you with amusement or surprise. You respond to this reaction by tapping again and then signaling to your child that it is their turn now. For some children, it is enough to look at them expectantly, for others the request "now it's your turn". Some children can be supported at first by holding their hand. Keep at it as long as your child is having fun and add language (eg "boing"). Source: Forum Logopädie Issue 1, Schulz-Kirchner-Verlag (20) January 2006 Page 20-25 , Author: Delia Möller

If the muscles in the mouth, lips or face are not strong enough, the child cannot close his mouth properly, the tongue can slip forward, saliva is not swallowed regularly and may drip out. There can be many reasons for this: from difficulty breathing through the nose due to allergies/polyps to complications during breastfeeding in infancy or whole-body muscle weakness (such as Down syndrome). You can determine the reasons for your child's muscle weakness in a diagnosis with your doctor or in a "anamnesis/diagnosis appointment" at a speech therapist. After this diagnosis, the speech therapist will then work out exercises with you/your child to strengthen the muscles involved in swallowing. These should then be repeated regularly at home.

In a "myofunctional disorder" the swallowing process is altered. In this case the tongue does not press upwards against the palate when swallowing - as with physiological ("normal") swallowing - but usually forwards against the teeth. The causes for this are often a combination of weak mouth and tongue muscles and remaining in an early childhood swallowing pattern. In speech therapy, the muscles involved in the swallowing process are then strengthened and the correct swallowing pattern is initiated. This means that after orthodontic treatment the tongue does not push the teeth back into the wrong position.

Children who have had pronunciation errors during their language development may have difficulties learning to read/write as schoolchildren. The reason for this is that various skills are needed to learn to read/write well. On the one hand, this is the ability to distinguish between different sounds by hearing them. But more extensive skills such as segmenting syllables, forming rhymes, hearing rhythm... ("phonological awareness") are also prerequisites for unhindered literacy acquisition. You should discuss with your doctor whether this applies to your child and if so, whether he or she should order a speech therapy diagnosis. However, the reason may also lie in other perception channels, or there may be a family predisposition to reading and writing disorders. In this case, further diagnosis is necessary.

In children's language development, the speed of "what can I say" (vocabulary, grammar) and "what do I want to say" (intellectual development) is not always the same. It can happen that children want to say much more than they are able to verbally. If, for example, excitement or time pressure is added to the mix, stuttering can occur. However, this is usually quite relaxed and consists mainly of repetitions ("and then and then and then Santa Claus came to kindergarten"). This phase is usually overcome when the child has improved their language skills and usually only lasts a few days or weeks. You should seek advice from a pediatrician or speech therapist if tensions/blockages arise, if the child develops distress or avoids situations in which he or she has to speak. Even if you as a parent are very worried, an informational conversation can help. Through a conversation we can try to reduce these fears, which you could pass on to your child and which could then act as a maintaining factor for the child's stuttering.

With a swallowing disorder (dysphagia), swallowing is difficult or almost impossible. Swallowing of food, liquids or saliva often occurs. Swallowing disorders can occur as a result of surgery, as part of a degenerative disease such as multiple sclerosis (MS) or Parkinson's disease, or after brain damage such as strokes.

Voice disorders can arise due to incorrect use of the voice or changes in breathing (functional voice disorders) or due to an organic cause (e.g. after operations on the larynx/thyroid gland or changes to the larynx, for example due to tumors). The voice can sound rough, hoarse, strained, quiet, brittle or even creaky; other symptoms often include a need to clear the throat and rapid voice fatigue. Speech therapy can help to improve these symptoms.

Facial paralysis (facial paresis) can occur in neurological diseases (e.g. strokes) = central facial paresis. There is also peripheral facial paralysis. This occurs in cases of inflammation, after tick bites, with erysipelas, or after tumors/operations in the facial area. This can lead to difficulties in closing or opening an eye, drooping of the corner of the mouth, relaxation of the facial muscles and occasionally difficulty swallowing. During therapy, a technique is developed in which the course of the affected muscle is discussed in order to then improve access to the affected muscles using targeted measures. This can improve functions and reduce restrictions.

Aphasia is a partial or complete loss of previously existing language skills. The causes are usually strokes, cerebral hemorrhages and traumatic brain injuries. Those affected often have word-finding and sentence-forming difficulties and frequently also have difficulty understanding language. Other linguistic levels such as reading and writing can also be affected. Dysarthria is a speech disorder caused by paralysis, weakness or coordination disorders of the speech muscles. Pronunciation then usually sounds slurred and unclear. Understanding language, word finding and reading comprehension are not affected. Illnesses that are often associated with dysarthria include Parkinson's disease, amyotrophic lateral sclerosis (ALS), multiple sclerosis (MS) or traumatic brain injuries following accidents and strokes. Speech apraxia is an impairment of the ability to specifically control speech movements, i.e. to "program" them in the brain. In pure speech apraxia, the speech muscles are fully functional. For all of these symptoms, speech therapists can help you improve/compensate for the limitations.

Patients in a vegetative state are often fitted with a tracheostomy tube, meaning that inhalation and exhalation occur through an "opening" in the throat. This means that no more breathing occurs through the mouth or nose. The consequences of this are not only that the patient can no longer smell, but also that the lack of airflow means that there is no sensitive feedback in the upper throat area. This means that the patient does not notice saliva in the throat, for example, and the swallowing disorder becomes more severe. On the one hand, speech therapy attempts to improve perception in the upper throat by exhaling through the mouth and nose in phases. At the same time, measures are taken to improve swallowing and swallowing stimulation.