Speech and language pathology

Speech and language pathology is concerned with issues surrounding human speech and language communication disorders. There are multiple methods of human communication using all human senses both nonverbal communication (such as facial expression, posture and gesture), and verbal communication. Speech and language pathology is primarily concerned with disorders of verbal communication, including expressive language (the production of effective communication) and receptive language (the understanding of presented communication). Speech results from voice production, and the manipulation of speech sounds creates language.

Depending on the nature and severity of the disorder, common treatments may include exercises, instructive or repetitive practice and drilling, and the use of assistive technology aids and introduction of strategies to facilitate functional communication. Speech therapy may also include the use of sign language and the use of picture symbols or Augmentative and Alternative Communication (AAC) from the iconic PECS System.

Speech

See also: Speech disorder

The main components of speech production include: phonation, the process of sound production; resonance, opening and closing of the vocal folds; intonation, the variation of pitch; and voice, including aeromechanical components of respiration. With variations in the articulation of speech and fluency of speech.

Language

See also: Language disorder

The main components of language include: phonology, the manipulation of sound; morphology, the identification, analysis and description of the structure of morphemes and other units of meaning in a language; syntax, the principles and rules for constructing sentences in language; semantics, the interpretation of meaning from the signs or symbols of communication; and pragmatics the social aspects of communication.

National approaches speech and language pathology

Speech and Language pathology is known by a variety of names in various countries around the world:

• 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.

Speech and Language Pathology is also known as logopaedics and phoniatrics.

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

Prior to 2006, speech and language pathology in the United States was regulated by the individual states. Since January 2006, the 2005 "Standards and Implementation Procedures for the Certificate of Clinical Competence in Speech-Language Pathology" guidelines as set out by The American Speech-Language-Hearing Association (ASHA) have determined the qualification requirements to obtain "Speech-Language Pathology Clinical Fellowship". The first step is a speech and language related degree followed by post graduate academic and practical studies to acquire the knowledge and skills to the standard of clinical competence. After a Certificate of Clinical Competence in Speech-Language Pathology is acquired, there is a mandatory 3 year "maintenance" or renewal required to demonstrate continued professional development. Post graduate work for a speech pathologist will include both academic study and practical work supervised by a practicing speech and language pathologist.

National approaches to the costs of provision

In the United States, the cost of speech therapy for children ages birth-three years old is usually covered by a state early- intervention 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.

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. 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 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.

Multi-discipline collaboration

Speech-language pathologists collaborate with other health care professionals often working as part of a multidisciplinary team, providing referrals audiologists, medical consultants, and information to parents, educators and health care professionals including doctors, nurses, occupational therapist, and dietitians; as dictated by the individual client's needs. In relation to Auditory Processing Disorders collaborating in the assessment and providing intervention where there is evidence of speech, language, and/or other cognitive-communication disorders.

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, Electromyography (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 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.)
• 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
• 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.
• Providing services to modify or enhance communication performance (e.g. transgendered voice, care and improvement of the professional voice, personal/ professional communication effectiveness).

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.

Working environments

Speech and language pathologists can work in a wide range of settings. 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 centers, and the judicial and penal services such as courts, prisons, and young offenders' institutions.

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

Methods of assessment

For more details on this topic, see Speech and language 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 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)
    • some infants with injuries due to paralysis of brain.

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)

See also

• Applied linguistics
• Auditory Processing Disorder
• Augmentative and alternative communication
• Esophageal speech
• Language delay
• List of university speech-language pathology departments
• List of voice disorders
• Oral myology
• Neurolinguistics
• Phonation
• Specific language impairment
• Speech and language pathology in school settings
• Speech perception
• Speech processing
• Speech repetition

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

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