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, diagnosis, and treatment of communication disorders, cognition, voice disorders, and swallowing disorders.

A common misconception is that speech-language pathology is restricted to correcting pronunciation difficulties, such as helping English speaking individuals enunciate their "s" and "r" sounds, and helping people who stutter to speak more fluently. In fact, speech-language pathology is concerned with a broad scope of speech, language, swallowing, and voice issues involving communication,^[2] some of which are:

• Word-finding issues, either as a result of a specific language problem such as a language delay or a more general issue such as dementia.
• Social communication difficulties involving how people communicate ideas with others (pragmatics).
• Structural language impairments, including difficulties creating sentences that are grammatical (syntax) and meaningful (semantics).
• Literacy impairments (reading and writing) related to the letter-to-sound relationship (phonics), the word-to-meaning relationship (semantics), and understanding the ideas presented in a text (reading comprehension).
• Voice difficulties, such as a raspy voice, a voice that is too soft, or other voice difficulties that negatively impact a person's social or professional performance.
• Cognitive impairments (e.g., attention, memory, executive function) to the extent that they interfere with communication.

The components of speech production include:

• phonation (producing sound);
• resonance;
• fluency;
• Intonation,
• Pitch variance;
• 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 according to languages' grammar rules);
• semantics (interpreting signs or symbols of communication to construct meaning);
• pragmatics (social aspects of communication).^[3]

Primary pediatric speech and language disorders include receptive and expressive language disorders, speech sound disorders, childhood apraxia of speech, stuttering, and language-based learning disabilities.^[4]

Swallowing disorders include difficulties in any system of the swallowing process (i.e. oral, pharyngeal, esophageal), as well as functional dysphagia and feeding disorders. Swallowing disorders can occur at any age and can stem from multiple causes.^[5]

The profession

Speech-language pathologists (SLPs) 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 work to prevent, assess, diagnose, and treat speech, language, social communication, cognitive-communication, and swallowing disorders in children and adults.^[6] 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.^[7]
• 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,^[8] brain injury,^[9] hearing loss,^[10] developmental delay,^[11] a cleft palate,^[12] cerebral palsy,^[13] or emotional issues.^[14]

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,^[15] 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.^[16]

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,^[17] and home healthcare. Speech-language pathologists may also work as part of the support structure in the education system, working in both public and private schools, colleges, and universities.^[18] 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.^[19]

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,^[20] 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 Communicative Disorders/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 national governing body as well as individual state's governing board. 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).^[21] 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:

• State licensure and national certification by:
• Passing score on the National Speech-Language Pathology board exam (Praxis).
• Successful completion of a clinical fellowship year (CFY) as a clinical fellow (CF) under the mentorship of a fully licensed mentor clinician. 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.^[22]
• 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).
• States are responsible for licensure of clinicians and other professionals and, as far as the new SLP, these requirements are often similar of that of the CFY. Following the state licensure procedures and national certification requirements are usually done simultaneously.

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.^[23]
• 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.^[24]

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 SLPs depend on a variety of factors. These include educational background, work experience, and location. According to the ASHA 2014 Schools Survey, the median salary for a speech-language pathologist working during the academic year at a school was $61,000.^[25] However, salaries can range from $40,000–90,000. In Australia, it has been found that the basic salary that a speech pathologist/therapist would earn in Australia is an estimate of $59,500 Australian dollars.^[26]

Methods of assessment

For many parents, the decision of whether or not to enroll students into school-based speech therapy or privately practiced therapy is challenging. Because school-based speech therapy is run under state guidelines and funds, the process of assessment and qualification is more strict. To qualify for in-school speech therapy, students must meet the state's criteria on language testing and speech standardization. Due to such requirements, some students may not be assessed in an efficient time frame or their needs may be undermined by criteria. For a private clinic, students are more likely to qualify for therapy because it is a paid service with more availability.

Clients and patients

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^[27][28]
  • Autism spectrum disorders,^[29] including Asperger syndrome^[30]
  • 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
  • Cleft palate^[31]

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.^[32] 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 south island of New Zealand.^[33] 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.^[34] 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,^[39]
  • Huntington's disease,
  • Multiple sclerosis,
  • Parkinson's disease,^[40]
  • Traumatic brain injury,
  • Mental health issues
  • Stroke
  • Progressive neurological conditions such as cancer of the head, neck and throat (including laryngectomy)
  • Aphasic^[41]
• 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. PMID 19304338. doi:10.1016/j.tig.2009.03.002. 
• "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. PMID 16452337. doi:10.1542/peds.2005-1467. 
• 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.
• SLP Teaching Techniques - Angie Sterling-Orth MS, CCC-SLP, Director