Speech and language pathology

Human communication includes speech (articulation, intonation, rate, intensity, voice, resonance, fluency), language (phonology, morphology, syntax, semantics, pragmatics), both receptive and expressive language (including reading and writing)^[1], and non-verbal communication such as facial expression, posture and gesture. Swallowing problems managed under speech therapy are problems in the oral and pharyngeal stages and sometimes esophageal stages of swallowing.

Depending on the nature and severity of the disorder, common treatments may range from physical strengthening exercises, instructive or repetitive practice and drilling, to the use of audio-visual aids and introduction of strategies to facilitate functional communication. Speech therapy may also include sign language and the use of picture symbols or Augmentative and Alternative Communication (AAC).^[2][3]

The practice is called:

• Speech-language pathology (SLP) in the United States and Canada
• Speech and language therapy (SLTs) in the United Kingdom, Ireland and South Africa. Within the United Kingdom a Speech and Language Therapy team is often referred to by clinicians as the "SALT" team.
• Speech pathology in Australia and the Philippines
• Speech-language therapy in New Zealand
• Speech therapy in India, Hong Kong and other Asian countries

Other terms in use include speech therapy, logopaedics and phoniatrics.

The speech and language pathology vocation

Speech and language pathologists provide a wide range of services, mainly on an individual basis, but also as support for individuals families, support groups, and providing information for the general public. From initial screening for the communication and swallowing disorders, to consultations of assessment and diagnosis, and then the provision of advice regarding management, intervention and treatment, and the provision counselling and other follow up services for these disorders.

• cognitive aspects of communication (e.g., attention, memory, problem solving, executive functions).
• speech (i.e., phonation, articulation, fluency, resonance, and voice including aeromechanical components of respiration);
• language (i.e., phonology, morphology, syntax, semantics, and pragmatic/social aspects of communication) including comprehension and expression in oral, written, graphic, and manual modalities; language processing; preliteracy and language-based literacy skills, phonological awareness.
• swallowing or other upper aerodigestive functions such as infant feeding and aeromechanical events (evaluation of esophageal function is for the purpose of referral to medical professionals);
• sensory awareness related to communication, swallowing, or other upper aerodigestive functions.

Administration

Speech-language pathologists act as case managers and service delivery coordinators; as well as managing clinical and academic programs.

Diagnostics

• Screening hearing of individuals who can participate in conventional pure-tone air conduction methods, as well as screening for middle ear pathology through screening tympanometry for the purpose of referral of individuals for further evaluation and management.
• Identify, define, and diagnose disorders of human communication and swallowing (dysphagia) and assist in localization and diagnosis of diseases and conditions.
• Participate in outcome measurement activities and use data to guide clinical decision making and determine the effectiveness of services provided in accordance with the principles of evidence-based practice.
• Provide direct services using a variety of service delivery models to treat and/or address communication, swallowing, or other upper aerodigestive concerns.
• Using instrumentation (e.g., videofluoroscopy, EMG, nasendoscopy, stroboscopy, computer technology) to observe, collect data, and measure parameters of communication and swallowing, or other upper aerodigestive functions in accordance with the principles of evidence-based practice.

Treatment and remediation services

• Providing services to modify or enhance communication performance (e.g. transgendered voice, care and improvement of the professional voice, personal/ professional communication effectiveness).
• Addressing behaviors (e.g. perseverative or disruptive actions) and environments (e.g. seating, positioning for swallowing safety or attention, communication opportunities) that affect communication, swallowing, or other upper aerodigestive functions.
• Selecting, fitting, and establishing effective use of prosthetic/adaptive devices for communication, swallowing, or other upper aerodynamics functions (e.g., tracheoesophageal prostheses, speaking valves, electrolarynges). This does not include sensory devices used by individuals with hearing loss or other auditory perceptual deficits
• Providing services to individuals with hearing loss and their families/caregivers (e.g.,auditory training; speechreading; speech and language intervention secondary to hearing loss; visual inspection and listening checks of amplification devices for the purpose of troubleshooting, including verification of appropriate battery voltage).
• Establishing augmentative and alternative communication (AAC) techniques and strategies including developing, selecting, and prescribing of such systems and devices (e.g., speech generating devices.)

Multi-discipline collaboration

Speech-language pathologists collaborate with other health care professionals often working as part of a multidisciplinary team, Providing referrals and information to audiologists, educators and health professionals as individual needs dictate. In relation to Auditory Processing Disorders^[4] collaborating in the assessment and providing intervention where there is evidence of speech, language, and/or other cognitive-communication disorders.

Speech-language pathologists work closely with others involved with the client; for example, difficulties with eating and drinking may also involve an occupational therapist. Speech and language therapists also work closely with the client, parents and caregivers and other professionals, such as audiologists, teachers, nurses, dietitians and doctors.

Healthcare

• Promote healthy lifestyle practices for the prevention of communication, hearing, swallowing, or other upper aerodigestive disorders.
• Recognizing the need to provide and appropriately accommodate diagnostic and treatment services to individuals from diverse cultural backgrounds and adjust treatment and assessment services accordingly.
• Advocating for individuals through community awareness, education, and training programs to promote and facilitate access to full participation in communication, including the elimination of societal barriers.

Research

• Conduct research related to communication sciences and disorders, swallowing disorders, or other upper aerodigestive functions.

Training

• Educate, supervise, and mentor future speech-language pathologists.
• Educate and provide in-service training to families, caregivers, and other professionals.
• Train, supervise, and manage speech-language pathology assistants and other support personnel.
• Educating and counseling individuals, families, co-workers, educators, and other persons in the community regarding acceptance, adaptation, and decisions about communication and swallowing.

Places of work

Speech and language pathologists can work in a wide range of setting. The clinical environments both public and private hospitals. As part of the support structure in the education system working in both public and private schools, colleges, and universities. And some community support services in community health and day centres, and the judicial and penal services such as courts, prisons, and young offenders' institutions.^[5]

Subsequent to ASHA's 2005 approval of the delivery of speech-language pathology via video conference, or telepractice,^[6] SLPs have begun delivering services via this service delivery method^[7]

Methods of assessment

There are separate standardized assessment tools administered for infants, school-aged children, adolescents and adults. Assessments primarily examine the form, content, understanding and use of language, as well as articulation, and phonology. Oral motor and swallowing assessments often require specialized training. These include the use of bedside examination tools and endoscopic/modified barium radiology procedures.

Individuals may be referred to an SLP for a Augmentative Alternative Communication needs

There are myriad Speech and Language Assessment tools used for children and adults, depending on the area of need.

Clients and patients requiring speech and language pathology services

Speech and language pathologists work with clients and patients who can present a wide range of issues.

Infants and children

• Infants with injuries due to complications at birth, feeding and swallowing difficulties, including dysphagia
• Children with mild, moderate or severe:
  • Genetic disorders that adversely affect speech, language and/or cognitive development including autism and social interaction difficulties including Asperger's, cleft palate
  • Developmental delay
  • Cranial nerve damage
  • Craniofacial anomalies that adversely affect speech, language and/or cognitive development
  • Language delay
  • Specific difficulties in producing sounds (including vocalic /r/ and lisps)

Children and adults

• Cerebral Palsy
• Head Injury (Traumatic brain injury)
• Hearing Loss and Impairments
• Learning Difficulties including Dyslexia, Specific Language Impairment (SLI), Auditory Processing Disorder
• Physical Disabilities
• Speech Disorders
• Stammering (dysfluency)
• Stroke
• Voice Disorders

Adults

• Adults with mild, moderate, or severe eating, feeding and swallowing difficulties, including dysphagia
• Adults with mild, moderate, or severe language difficulties as a result of:
  • Progressive neurological conditions (Alzheimer's disease, dementia, Huntington's disease, Multiple Sclerosis, Motor Neuron Diseases, Parkinson's disease, etc)
  • cancer of the head, neck and throat (including laryngectomy)
  • mental health issues
  • transgender voice therapy (usually for male-to-female individuals)

National approaches to the costs of provision

In the United States, the cost of speech therapy for a child younger than three years old is likely covered by the state early intervention (zero to three) program.

In the United Kingdom, the majority of Speech and Language therapy is funded by the National Health Service (and increasingly, by partners in Education) meaning that initial assessment is available cost-free to all clients at the point of service, regardless of age or presenting problem. The large numbers of referrals contribute to high caseloads and long waiting lists, although this differs from area to area. To meet the needs of many of these clients, it has become necessary for many services to focus heavily on training and consultative models of service provision. The number of hours of direct therapy available to clients varies widely from trust to trust and most areas operate strict guidelines for prioritisation to meet the high clinical demand.

National approaches to qualification

Australia

In Australia, Speech Pathologists either undertake a four year undergraduate degree, or a two year master's degree to qualify. These dual pathways are considered by Speech Pathology Australia to produce equally prepared graduates. To be eligible for optional membership of Speech Pathology Australia, students must study in one of the accredited courses outlined on their website. Speech Pathology degrees in Australia vary in curriculum, but always include streams teaching anatomy and physiology, professional practice, communication and swallowing disorders, and often some elementary psychology and audiology. Most include no or minimal elective subjects. All degrees include a heavy clinical component, and many also include a research component in final year. Once graduated, students become fully qualified Speech Pathologists and are eligible for any Level 1 position, without the need for an internship or general examination. Registration is only required in the state of Queensland, and membership of the professional organization is optional, although it is encouraged.

South Africa

In South Africa, SLTs must complete a four year honours degree in order to qualify as practicing clinicians. Up until very recently, all South African SLTs were also audiologists (also known as otologists), since most universities offering SLT degrees required students to also study towards becoming audiologists. Since about 2002, this situation has changed and today the majority of SLT degrees are unitary. Degree holders are qualified to practice as SLTs only. Upon graduating, therapists must complete a single year of community service in a government hospital. Once this year is complete, therapists must register as independent practitioners with the Health Professions Council of South Africa (HPCSA)before they can begin offering services. This registration must be renewed every year. Membership of professional bodies such as the South African Speech-Language and Hearing Association is not mandatory.

United Kingdom

In the UK, SLTs undertake a three to four year degree course devoted entirely to the study of clinical language sciences and communicative disorders. Alternatively, some universities offer a two year master's or a post graduate diploma. These course options qualify them to work in any of the three main clinical areas. The course, which varies according to university, includes intensive study of core theoretical components underpinning competence to practice [Clinical Phonetics], Linguistics, Psychology and Medical science, in addition to the study of a range of communicative disorders in children and adults. Students are also expected to become familiar with a range of policies, processes and procedures relevant to working in different contexts, including health and education. The course is assessed via coursework, exams and clinical placement. Some universities require students to assess and diagnose an 'unseen client' prior to completing their degree course; all require the completion of a research project related to the field of Speech and Language Therapy. Throughout the course, students undertake a variety of clinical placements in which their ability to practise is continually assessed. All courses require students to complete a certain amount of hours of clinical placement, although the structure of placement differs from course to course.

Upon qualifying SLT's enter the profession as a newly-qualified practitioner. The recommended career course is that they then achieve a number of competencies, which qualify them to work autonomously. The Royal College of Speech and Language Therapists, the professional body representing Speech and Language Therapists in the UK, provides a framework of competencies which therapists are expected to achieve within 12–18 months of beginning clinical practice. Access to supervision during this period varies from trust to trust and setting to setting, and each individual therapist is expected to provide documentary evidence of competencies achieved to a senior colleague (usually a manager) who determines whether a therapist meets the required criteria for admission to the 'full register'.

Speech and Language Therapists in the UK are required by law to register with the Health Professions Council, a regulatory body governing a range of health professions. The Health Professions Council supports the maintenance of high clinical standards and has the power to discipline members who do not meet the rigorous standards for effective and safe clinical practice, and may 'strike off' or deregister members who fail to maintain these standards.

United States of America

In the United States, Speech Language Pathology practice is regulated by the laws of the individual states. However, by 2006, the minimal requirements to be a certified SLP member of the American Speech-Language Hearing Association^[8] were: a graduate degree in Speech-Language Pathology, which typically entails 2 years of post graduate work; a completed clinical fellowship year, which is generally employment for a year while supervised by a practicing SLP who is also ASHA certified; and passing the Praxis Series examination. The graduate degree work to acquire a master's in Speech-Language Pathology requires many hours of supervised clinical practice, and intensive didactic coursework in medical sciences, phonetics, linguistics, phonology, scientific methodology, and other subjects.

Certification by ASHA is noted as carrying one's "C"s. (Certificate of Clinical Competence) It is noted after an SLP's name as: CCC-SLP.

See also

References

Further reading

• Fisher SE, Scharff C (April 2009). "FOXP2 as a molecular window into speech and language". Trends Genet. 25 (4): 166–77. doi:10.1016/j.tig.2009.03.002. PMID 19304338. http://www.sciencedirect.com/science?_ob=ArticleURL&_udi=B6TCY-4VWGVG8-1&_user=10&_coverDate=04%2F30%2F2009&_rdoc=1&_fmt=high&_orig=search&_sort=d&_docanchor=&view=c&_acct=C000050221&_version=1&_urlVersion=0&_userid=10&md5=a40988a1d7dcbe434bf39246fae802af. 
• Nelson HD, Nygren P, Walker M, Panoscha R (February 2006). "Screening for speech and language delay in preschool children: systematic evidence review for the US Preventive Services Task Force". Pediatrics 117 (2): e298–319. doi:10.1542/peds.2005-1467. PMID 16452337. http://pediatrics.aappublications.org/cgi/content/full/117/2/e298#R8. 

External links

• American Speech-Language-Hearing Association
• Royal College of Speech and Language Therapists. (UK)
• Irish Association of Speech & Language Therapists
• The National Student Speech Language and Hearing Association
• Association of Speech Language Pathologists Malta
• Canadian Association of Speech-Language Pathologists and Audiologists
• Indian Speech and Hearing Association
• South African Speech Language Hearing Association
• Speech Pathology Australia
• The Hong Kong association of Speech Therapists