Advantages of Home Speech Therapy

Many families have met a similar situation. In the therapy room the patient manages the exercises asked of them, but once back at home, in real conversation and at the dining table, the patient cannot use them. The success of speech and swallowing therapy often does not depend on performance in the therapy room. It depends on whether skills can be generalised to daily life at home. This article looks at how home speech therapy gains from generalisation, and at swallowing safety at home, immediate involvement of family members, and the practical differences between home and clinic speech therapy.

How home speech therapy helps patients apply what they have learned to daily life

In short, the core value of home therapy is to put training back where the skills are finally used, which is the patient's own living room, kitchen and dining table. When the place of learning is the place of use, the skills learned more easily take root in daily life.

What generalisation is, and how it affects the results of treatment

Generalisation is an important concept in speech therapy. It refers to whether an ability learned in the therapy room extends to words, communication partners and settings that were not trained. It is at the heart of making therapy useful in practice, but it is often wrongly assumed to appear naturally.

The scientific basis for speech therapy in a familiar environment

Since generalisation needs to be arranged deliberately, the most direct approach is to train in the setting where the skills are actually used. Home is where the patient is really “tested” every day: talking with family, eating at the table, answering the phone. When training moves into the home, there is no longer a gap between learning and use.

Data on the effect of tailored training and home practice

This point has large-scale evidence behind it. An individual participant data network meta-analysis of speech therapy for aphasia showed that the programme giving the best language recovery combines “a mix of receptive and expressive work, tailored to function, with prescribed home practice”. The largest gains in overall language ability were generally linked to a cumulative 20–50 hours of therapy (RELEASE Collaborators, 2022).

The dose and intensity of training have to be adjusted to the individual, and the flexibility of home therapy suits this well. It can fit in with the times when the patient is at their best, and build up hours steadily over the long term, so that prescribed practice fits naturally into every day.

Putting swallowing safety into practice at the everyday dining table

For patients with swallowing difficulty the idea of generalisation is just as important, and it bears directly on safety. Whether swallowing compensation strategies and texture modification are safe finally depends on whether every meal at home is carried out accurately. A successful demonstration once in the clinic does not mean that every meal at home will be safe.

Three factors that affect how swallowing safety advice is carried out at home

Whether dietary advice for swallowing works depends mainly on adherence, which is shaped by three interacting levels (Nagshabandi et al., 2023). A home visit lets the therapist work on all three directly, and not rely on handing out an instruction sheet.

Specific steps to carry out safe eating at home

Behavioural swallowing therapy (which includes compensation strategies, safe eating advice and texture modification) has evidence in patients with swallowing difficulty after acute stroke. Compared with usual care, it greatly lowered the risk of chest infection (risk ratio 0.56, 95% CI 0.4–0.8) and raised the rate of return to a normal diet within six months (Carnaby et al., 2006). When carried out at home, the therapist demonstrates and supervises the steps below.

1. 1
   Check the level of food and drinks

   Following the IDDSI standard, check whether the food texture and the drink thickness at home match the level set, and correct the common problem of not being thick enough.
2. 2
   Adjust eating position and surroundings

   Make sure the patient's sitting position, alertness and eating environment are suitable for eating, and reduce distraction and the chance of choking.
3. 3
   Demonstrate compensation strategies

   While the patient is actually eating, demonstrate safe eating techniques, such as slowing down the pace of eating and alternating food and drink.
4. 4
   Put prompting and swallow checks into practice

   For the two steps that are hardest to do consistently, giving prompts and making sure each mouthful is swallowed before the next, the therapist supervises on site and lets the carer practise on the spot.
5. 5
   Hand over to the carer to repeat

   The carer feeds the patient through a whole meal once in front of the therapist, to make sure every meal afterwards can be done safely in the same way, and not only when the therapist is demonstrating.

How family members take part in treatment and build practice into daily conversation

The therapist visits for only a few hours a week, so who supports the patient the rest of the time? The “dose” of training needed in speech rehabilitation is far more than the hours a therapist is present. A big benefit of home therapy is that it lets the therapist train family members on the spot, in real conversation, to become effective “communication partners”, turning the countless family interactions of every day into actual practice.

The benefit of communication partner training is well supported: all 25 studies included in the latest systematic review reported positive effects (Simmons-Mackie et al., 2016). A visiting therapist teaches family members these things on the spot.

• Demonstrating skills in real conversation—The therapist guides on the spot from the actual conversation taking place, so that family members see for themselves how to slow down their speech, give the patient time to respond and check understanding, instead of relying only on abstract explanation.
• Turning home interaction into practice—Everyday chatting, eating and watching television can all become practice with a purpose. Even after the therapist has left, the patient's practice hours can keep building up (RELEASE Collaborators, 2022).
• Answers and corrections straight away—If family members have questions, they can ask the therapist on the spot and be corrected, which avoids using the wrong method for a long time.
• Building lasting support—After communication partner training, there are positive effects for both the patient and the family members themselves (Simmons-Mackie et al., 2016), and rehabilitation support can fit naturally into daily life.

Home speech therapy compared with clinic speech therapy

In comparing the two models, the focus should not be only on equipment or fees. It should be on which model better reaches the basic goal of therapy: making the skills learned useful in daily life, and making every meal safe to eat.

It must be stressed that the two models are not opposed. The effect of speech therapy itself has evidence behind it (Brady et al., 2016), and the choice of setting should depend on the patient's needs. If the patient urgently needs to apply skills in daily life, or every meal at home has to be made safe, the advantage of home therapy is especially clear.

Who is suited to home speech therapy

Not all patients need home therapy equally, but the groups below suit it especially, because they most need to bring their rehabilitation progress directly into daily life, or to stay at home and keep building up enough training.

Other factors to consider in choosing a service (fees, equipment, district)

Home therapy has clear advantages, but there are some practical factors to weigh. Home visit fees are generally higher than clinic fees, some instrumental assessments can only be done in a clinic, and remote districts or bad weather may affect the journey. A better approach is to combine home therapy with follow-up by video, adjusting the dose and intensity of training to the patient, and putting resources where they are most effective.

Checklist of key points for a home speech therapy plan

A speech therapy plan that really makes use of the strengths of the home should have the features below. You can use them to review the present or planned arrangement of therapy.

Frequently asked questions

To make full use of the advantages of home speech therapy, it often has to be combined with specific specialist services. You can also read more about therapy for swallowing difficulty and how it handles eating problems safely, therapy for language disorders and how it deals with aphasia and communication difficulty, and carer support and how it trains family members to be capable communication and home training partners.