Speech-Language Pathology

Speech-language pathology is a field of expertise practiced by a clinician known as a Speech-language pathologist (SLP), also called speech and language therapist,^[1] or speech therapist, who specializes in the evaluation and treatment of communication disorders and swallowing disorders.

The components of speech production include: phonation, producing sound; resonance; fluency; intonation, variance of pitch; and voice, including aeromechanical components of respiration. The components of language include: phonology, manipulating sound according to the rules of a language; morphology, understanding and using minimal units of meaning; syntax, constructing sentences by using languages' grammar rules; semantics, interpreting signs or symbols of communication to construct meaning; and pragmatics, social aspects of communication.^[2]

Swallowing disorders includes oropharyngeal and functional dysphagia in adults and children and feeding disorders in children and infants.

The Speech-Language Pathology profession

Speech-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. Speech-language pathologists (SLPs) work to prevent, assess, diagnose, and treat speech, language, social communication, cognitive-communication, and swallowing disorders in children and adults.^[3] Speech services begin with initial screening for communication and swallowing disorders and continue with assessment and diagnosis, consultation for the provision of advice regarding management, intervention and treatment, and provision counseling and other follow up services for these disorders. Services are provided in the following areas:

• cognitive aspects of communication (e.g., attention, memory, problem solving, executive functions).
• speech (phonation, articulation, fluency, resonance, and voice including aeromechanical components of respiration);
• language (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);
• voice (hoarseness (dysphonia), poor vocal volume (hypophonia), abnormal (e.g. rough, breathy, strained) vocal quality. Research demonstrates voice therapy to be especially helpful with certain patient populations; individuals with Parkinson's Disease often develop voice issues as a result of their disease.
• sensory awareness related to communication, swallowing, or other upper aerodigestive functions.

Speech, language, and swallowing disorders result from a variety of causes, such as a stroke, brain injury, hearing loss, developmental delay, a cleft palate, cerebral palsy, or emotional issues.

Multi-discipline collaboration

Speech-Language Pathologists collaborate with other health care professionals often working as part of a multidisciplinary team, providing referrals to audiologists and others; providing information to health care professionals (including physicians, dentists, nurse practitioners, nurses, occupational therapists, dietitians), educators, behavior consultants (applied behavior analysis) and parents as dictated by the individual client's needs.

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.

The treatment for patients with cleft lip and palate has an obvious interdisciplinary character. The speech therapy outcome is even better when the surgical treatment is performed earlier.^[5]

Working environments

Speech-Language Pathologists work in a variety of clinical and educational settings. SLPs work in public and private hospitals, skilled nursing facilities (SNFs), long-term acute care (LTAC) facilities, hospice,^[6] and home healthcare. SLPs may also work as part of the support structure in the education system, working in both public and private schools, colleges, and universities.^[7] Some speech-language pathologists also work in community health, providing services at prisons and young offenders' institutions or providing expert testimony in applicable court cases.^[8]

Subsequent to the American Speech-Language-Hearing Association's (ASHA's) 2005 approval of the delivery of Speech-Language Pathology services via video conference, or telepractice,^[9] SLPs have begun delivering services via this service delivery method.

Research

Speech-language pathologists conduct research related to communication sciences and disorders, swallowing disorders, or other upper aerodigestive functions.

Education and training

United States

In the United States, Speech-Language Pathology is a Master's entry-level professional degree field. Clinicians must hold a master's degree in Speech-Language Pathology (e.g. M.A., M.S., or M.Ed.) that is from a university that holds regional accreditation and from a communicative sciences and disorders program that is accredited by the American Speech-Language-Hearing Association (ASHA), the profession's governing body. Programs that offer the M.Ed. degree are often housed within a university's College of education, but offer the same education and training as programs with a M.A. or M.S. degree. Beyond the master's degree, some SLPs may choose to earn a clinical doctorate in Speech Language Pathology (e.g. CScD or SLP.D), or a doctoral degree that has a research and/or professional focus (e.g., Ph.D., or Ed.D.). All degrees must be from a university that holds regional accreditation, but only the master's degree is accredited by the American Speech-Language-Hearing Association (ASHA).

All clinicians are required to complete 400 clinical hours (25 observation hours often completed during the undergraduate degree and 375 hours of graduate Clinical Practicum).^[10] They must pass multiple comprehensive exams also called Knowledge and Skills Acquisition (KASA) exams.

After all the above requirements have been met during the SLP’s path to earning the graduate degree:

• Passing score on the National Speech-Language Pathology board exam (Praxis).
• Successful completion of a clinical fellowship year (CFY) as a clinical fellow (CF). The CFY is no less than 36 weeks of full-time experience, totaling a minimum of 1260 hours. During the CFY, the CF cannot earn CFY hours unless they work more than 5 hours in a week and cannot earn any CFY hours beyond 35 hours in a week.^[11]
• American Speech-Language-Hearing Association (ASHA) Certificate of Clinical Competence (CCC) and full state licensure to practice, following successful completion of clinical fellowship year(CFY).

Maintaining Licensure Through Continuing Education:

• To maintain licensure, SLPs participate in periodic earning of Continuing Educational Units (CEU).

Continuing Education and Training Obligations:

• Educate, supervise, and mentor future Speech-Language Pathologists.^[12]
• Participate in continuing education.
• 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.^[13]

Professional Suffix:

• Credentials of a clinical fellow typically read as: MA, MS, or M.Ed, CF-SLP (e.g., Jane Doe, MA, CF-SLP).
• Credentials of a fully licensed SLP commonly read as: MA, MS, or M.Ed, CCC-SLP (e.g., Jane Doe, MA, CCC-SLP), indicating a practitioner's graduate degree and successful completion of the fellowship year/board exams to obtain the "three Cs" the Certification of Clinical Competence, in speech-language pathology.

Salary Information

Salaries of SLP's depend on a variety of factors. These include: educational background, work experience, and location. According to the ASHA 2014 Schools Survey, the median salary was $61,000. However, salaries can range from $40,000-90,000.

Methods of assessment

Clients and patients requiring speech and language pathology services

Speech-Language Pathologists work with clients and patients who may be present with 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 cleft palate, Down syndrome, DiGeorge syndrome
  • Attention deficit hyperactivity disorder^[14][15]
  • Autism spectrum disorders,^[16] including Asperger syndrome^[17]
  • Developmental delay
  • Feeding disorders, including oral motor deficits
  • Cranial nerve damage
  • Hearing loss
  • Craniofacial anomalies that adversely affect speech, language and/or cognitive development
  • Language delay
  • Specific language impairment
  • Specific difficulties in producing sounds, called articulation disorders, (including vocalic /r/ and lisps)
  • Pediatric traumatic brain injury
  • Developmental verbal dyspraxia

In the US, some children are eligible to receive speech therapy services, including assessment and lessons through the public school system. If not, private therapy is readily available through personal lessons with a qualified Speech-Language Pathologist or the growing field of telepractice.^[18] Teleconferencing tools such as Skype are being used more commonly as a means to access remote locations in private therapy practice, such as in the geographically diverse southern New Zealand.^[19] More at-home or combination treatments have become readily available to address specific types of articulation disorders. The use of mobile applications in speech therapy is also growing as an avenue to bring treatment into the home.

In the UK, children are entitled to an assessment by local NHS Speech and Language Therapy teams, usually after referral by health visitors or education settings, but parents are also entitled to request an assessment directly.^[20] If treatment is appropriate, a care plan will be drawn up. Speech therapists often play a role in multi-disciplinary teams where a child has speech delay or disorder as part of a wider health condition.

Children and adults

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:
  • Motor Neuron Diseases,
  • Alzheimer's disease,
  • dementia,
  • Huntington's disease,
  • Multiple Sclerosis,
  • Parkinson's disease,
  • Traumatic brain injury,
  • mental health issues
  • Stroke
  • Progressive neurological conditions such as cancer of the head, neck and throat (including laryngectomy)
• Adults desiring transgender voice therapy (usually for male-to-female individuals)

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. 
• "Discussion Meeting Issue 'Language in developmental and acquired disorders: converging evidence for models of language representation in the brain' - Table of Contents". Royal Society Publishing. 2014. Retrieved 31 December 2013. 
• 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. 
• Howell, Peter (2011). Recovery from stuttering. New York: Psychology Press/Taylor Francis Group. ISBN 978-1-84872-916-2. OCLC 814245820. 

External links

• Many voice and Speech disorders videos both before and after speech therapy by Speech Language Pathologist at you tube
• American Speech-Language-Hearing Association (ASHA) - Communication for a Lifetime
• Glossary of Speech-Language Pathology / Speech and Language Therapy Terminology
• National Institutes of Health - Voice, Speech, and Language
• Free Speech Therapy advice in the UK.
• iCliniq: Ask a Speech Therapist Online

Topics related to Speech-Language Pathology Symptoms and signs: Speech and voice / Symptoms involving head and neck (R47–R49, 784) Aphasias Acute Aphasias Expressive aphasia Receptive aphasia Conduction aphasia Anomic aphasia Global aphasia Transcortical sensory aphasia Transcortical motor aphasia Mixed transcortical aphasia Progressive Aphasias Progressive nonfluent aphasia Semantic dementia Logopenic progressive aphasia Speech disturbances Speech disorder Developmental verbal dyspraxia/‎Apraxia of speech Auditory verbal agnosia Dysarthria Schizophasia Aprosodia/Dysprosody Specific language impairment Thought disorder Pressure of speech Derailment Clanging Circumstantiality Communication disorders Developmental dyslexia/Alexia Agnosia Astereognosis Prosopagnosia Visual agnosia Gerstmann syndrome Developmental coordination disorder/Apraxia Ideomotor apraxia Dyscalculia/Acalculia Agraphia Voice disturbances Dysphonia/Aphonia Bogart–Bacall syndrome Nose Post-nasal drip Epistaxis Mouth Orofacial pain Toothache Galvanic pain Barodontalgia Fremitus Tooth mobility Bruxism Trismus Ageusia Hypogeusia Dysgeusia Parageusia Hypergeusia Xerostomia Halitosis Drooling Hypersalivation Neck Neck mass Cervical lymphadenopathy Other Headache Auditory processing disorder Otalgia Velopharyngeal inadequacy Velopharyngeal insufficiency Hypersensitive gag reflex Jaw claudication Pathology of the nervous system, primarily CNS (G04–G47, 323–349) Inflammation Brain Encephalitis Viral encephalitis Herpesviral encephalitis Limbic encephalitis Encephalitis lethargica Cavernous sinus thrombosis Brain abscess Amoebic Spinal cord Myelitis: Poliomyelitis Demyelinating disease Transverse myelitis Tropical spastic paraparesis Epidural abscess Both/either Encephalomyelitis Acute disseminated Myalgic Meningoencephalitis Brain/ encephalopathy Degenerative Extrapyramidal and movement disorders Basal ganglia disease Parkinsonism PD Postencephalitic NMS PKAN Tauopathy PSP Striatonigral degeneration Hemiballismus HD OA Dyskinesia Dystonia Status dystonicus Spasmodic torticollis Meige's Blepharospasm Athetosis Chorea Choreoathetosis Myoclonus Myoclonic epilepsy Akathisia Tremor Essential tremor Intention tremor Restless legs Stiff person Dementia Tauopathy Alzheimer's Early-onset Primary progressive aphasia Frontotemporal dementia/Frontotemporal lobar degeneration Pick's Dementia with Lewy bodies Posterior cortical atrophy Vascular dementia Mitochondrial disease Leigh's disease Demyelinating autoimmune Multiple sclerosis Neuromyelitis optica Schilder's disease hereditary Adrenoleukodystrophy Alexander Canavan Krabbe ML PMD VWM MFC CAMFAK syndrome Central pontine myelinolysis Marchiafava-Bignami disease Alpers' disease Episodic/ paroxysmal Seizure/epilepsy Focal Generalised Status epilepticus Myoclonic epilepsy Headache Migraine Familial hemiplegic Cluster Tension Cerebrovascular TIA Amaurosis fugax Transient global amnesia Acute aphasia Stroke MCA ACA PCA Foville's Millard-Gubler Lateral medullary Weber's Lacunar stroke Sleep disorders Insomnia Hypersomnia Sleep apnea Obstructive Ondine's curse Narcolepsy Cataplexy Kleine-Levin Circadian rhythm sleep disorder Advanced sleep phase disorder Delayed sleep phase disorder Non-24-hour sleep–wake disorder Jet lag CSF Intracranial hypertension Hydrocephalus/NPH Choroid plexus papilloma Idiopathic intracranial hypertension Cerebral edema Intracranial hypotension Other Brain herniation Reye's Hepatic encephalopathy Toxic encephalopathy Hashimoto's encephalopathy Spinal cord/ myelopathy Syringomyelia Syringobulbia Morvan's syndrome Vascular myelopathy Foix-Alajouanine syndrome Spinal cord compression Both/either Degenerative SA Friedreich's ataxia Ataxia telangiectasia MND UMN only: Primary lateral sclerosis Pseudobulbar palsy Hereditary spastic paraplegia LMN only: Distal hereditary motor neuropathies Spinal muscular atrophies SMA SMAX1 SMAX2 DSMA1 Congenital DSMA SMA-PCH SMA-LED SMA-PME Progressive muscular atrophy Progressive bulbar palsy Fazio–Londe Infantile progressive bulbar palsy both: Amyotrophic lateral sclerosis Dyslexia and related specific developmental disorders (F80–F83, 315) General conditions Speech and language impairments / communication disorders Expressive language disorder Infantile speech Landau–Kleffner syndrome Language disorder Lisp Mixed receptive-expressive language disorder Specific language impairment Speech and language impairment Speech disorder Speech error Speech sound disorder Stammering Tip of the tongue Scholastic skills/ learning disorder Developmental dyslexia Dyscalculia Dysgraphia (Disorder of written expression) Motor function Developmental coordination disorder Developmental verbal dyspraxia also known as Childhood apraxia of speech Other Auditory processing disorder Scotopic sensitivity syndrome Sensory processing disorder Related topics Dyslexia research Irlen filters Learning Ally Learning problems in childhood cancer Literacy Management of dyslexia/Dyslexia interventions Multisensory integration Neuropsychology Reading acquisition Spelling Writing system Lists Dyslexia in fiction Languages by Writing System People with dyslexia Mental and behavioral disorders (F 290–319)   Neurological/symptomatic Dementia Mild cognitive impairment Alzheimer's disease Vascular dementia Pick's disease Creutzfeldt–Jakob disease Huntington's disease Parkinson's disease AIDS dementia complex Frontotemporal dementia Sundowning Wandering Autism spectrum Autism Asperger syndrome Savant syndrome PDD-NOS High-functioning autism Other Delirium Post-concussion syndrome Organic brain syndrome   Psychoactive substances, substance abuse, drug abuse and substance-related disorders Intoxication/Drug overdose Physical dependence Substance dependence Rebound effect Double rebound Withdrawal   Schizophrenia, schizotypal and delusional Psychosis Schizoaffective disorder Schizophreniform disorder Brief reactive psychosis Schizophrenia Disorganized 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(developmental disabilities) Specific Pervasive Autism spectrum disorders Emotional and behavioral ADHD Conduct disorder (ODD) Emotional/behavioral disorder (Separation anxiety disorder) social functioning (Selective mutism RAD DAD) Tic disorder (Tourette syndrome) Speech (Stuttering Cluttering) Movement disorder (Stereotypic)   Symptoms and uncategorized Catatonia False pregnancy Intermittent explosive disorder Psychomotor agitation Stereotypy Psychogenic non-epileptic seizures Klüver-Bucy syndrome Allied health professions Anesthesia technician Aquatic therapist Athletic trainer Audiologist Dental hygienist Dietitian Cardiac physiologist Emergency medical services Hemodialysis technicians Massage therapist Medical assistants Medical coder Medical physicist Medical technologist Medical transcription Music and Arts Therapist Nutrition (clinical) Occupational Therapist Optometrist Phlebotomist Orthotist / Prosthetist Physical Therapist Clinical Psychologist Public health Radiation 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