Speech and language pathology

Speech-Language Pathology specializes in communication disorders.

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. The main components of language include: phonology, the manipulation of sound according to the rules of the language; morphology, the understanding and use of the minimal units of meaning; syntax, the grammar or 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 to 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, Canada and in the Philippines
• Speech and language therapy (SLTs) in the United Kingdom, Ireland and South Africa. Within the United Kingdom a Speech and Language Therapy team is sometimes referred to as the "SALT" team, to avoid confusion with Senior Leadership Team. S&LT is preferable however, and closer to the official abbreviation SLT used by RCSLT (Royal College of Speech and Language Therapists).
• 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 Pathologist in the Netherlands, it is title for graduates form University they can participate in research.
• Speech and Language Therapist (Logopedist) are educated to give therapy in the Netherlands.

Speech and Language Pathology is also known as logopaedics.

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". First, the individual must obtain an undergraduate degree, which may be in a field related to speech-language-hearing sciences. Second, the individual must graduate from an accredited master's program in speech language pathology. Many graduate programs will allow coursework not done in undergraduate years to be completed during graduate study. Various states have different regulations regarding licensure. The Certificate of Clinical Competence (CCC) is granted after the clinical fellowship year (CFY) when the individual provides services under the supervision of an experienced SLP. 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. A Ph.D. in speech language pathology is currently optional for clinicians wishing to serve the public.

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.

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 to audiologists and other medical consultants; providing information to health care professionals (including doctors, nurses, occupational therapist, and dietitians), educators, and parents 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.

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

Administration

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

Healthcare

• Promote healthly lifestyle practices for the preservation 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 include both public and private hospitals and home health care. 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, and use of language, as well as reading, writing, and some cognitive functions.

Swallowing assessments often require specialized training. These include formal assessments of Fiberoptic Endoscopic Evaluation of Swallowing (FEES) or Modified Barium Swallow Study (MBS). Informal oral motor assessments review the strength, co-ordination, range of movement, symmetry and speed of cranial nerves V, VII, IX, X and XII. The Australian National Guidelines for Stroke Management state that the presence or absence of a gag reflex in an oro-motor examination is not sufficient evidence to determine if someone has a swallowing disorder.

Individuals may be referred to a speech pathologist 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
  • Hearing loss
  • Craniofacial anomalies that adversely affect speech, language and/or cognitive development
  • Language delay
  • Specific difficulties in producing sounds, called articulation disorders, (including vocalic /r/ and lisps)
  • Some infants with injuries due to paralysis of brain.

Some children are eligible to receive speech therapy services, including assessment and lessons through the 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. 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.

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, Stuttering (dysfluency)
• Stroke
• Voice Disorders (dysphonia)
• Language disorders (dysphasia)
• Motor speech disorders (dysarthria or dyspraxia)
• Naming difficulties (anomia)
• Dysgraphia,agraphia
• Cognitive communication disorders
• Pragmatics
• Laryngectomies
• Tracheostomies
• Oncology (Ear, nose or throat cancer)

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:
  • Stroke
  • 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
• Motor theory of speech perception
• Neurolinguistics
• Oral myology
• Phonation
• Specific language impairment
• Speech and language pathology in school settings
• Speech perception
• Speech processing
• Speech repetition

References

• 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

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