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Speech–language pathology

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Speech-Language Pathology
MeSHD013066
Disability
Theory and models
Education
Therapy
Societal implications
Personal assistance
Socioeconomic assistance
  • Groups
  • Organizations
Parasports
Culture

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.[4]
  • 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,[5] brain injury,[6] hearing loss,[7] developmental delay,[8] a cleft palate,[9] cerebral palsy,[10] or emotional issues.[11]

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[12] 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.[13]

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,[14] 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.[15] 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.[16]

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,[17] 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).[18] 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.[19]
  • 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.[20]
  • 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.[21]

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

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 states 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's a paid service with more availability.

Further information: Speech and language 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

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.[26] 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.[27] 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.[28] 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

See also

References

  1. ^ Brady, MC; Kelly, H; Godwin, J; Enderby, P (May 16, 2012). "Speech and language therapy for aphasia following stroke". The Cochrane database of systematic reviews. 5: CD000425. doi:10.1002/14651858.CD000425.pub3. PMID 22592672.
  2. ^ Block, Frances K.; Amie Amiot; Cheryl Deconde Johnson; Gina E. Nimmo; Peggy G. Von Almen; Deborah W. White; Sara Hodge Zeno (1993), "Definitions of Communication Disorders and Variations", Ad Hoc Committee on Service Delivery in the Schools, ASHA, doi:10.1044/policy.RP1993-00208, retrieved 2010-08-07
  3. ^ "Speech-Language Pathologists". American Speech-Language-Hearing Association. Retrieved 6 April 2015.
  4. ^ Factor, Stewart; Weiner, William (2008). Parkinson's disease: Diagnosis & clinical management : Second edition (2nd, rev. and updat;2; ed.). ed.). U.S.: Demos Medical Publishing. pp. 77–83. ISBN 9781933864006.
  5. ^ Richards, Emma (June 2012). "Communication and swallowing problems after stroke". Nursing and Residential Care. 14 (6): 282–286. doi:10.12968/nrec.2012.14.6.282. {{cite journal}}: |access-date= requires |url= (help)
  6. ^ Editors, Nathan D. Zasler, Douglas I. Katz, Ross D. Zafonte, Associate Editors, David B. Arciniegas, M. Ross Bullock, Jeffrey S. Kreutzer (2013). Brain injury medicine principles and practice (2nd ed. ed.). New York: Demos Medical. pp. 1086–1104, 1111–1117. ISBN 9781617050572. {{cite book}}: |access-date= requires |url= (help); |edition= has extra text (help); |last1= has generic name (help)CS1 maint: multiple names: authors list (link)
  7. ^ Ching, Teresa Y. C. (2015). "Is early intervention effective in improving spoken language outcomes of children with congenital hearing loss?". American Journal of Audiology (Online). 24 (3): 345–348. {{cite journal}}: |access-date= requires |url= (help)
  8. ^ The Royal Children's Hospital, Melbourne. "Developmental Delay: An Information Guide for Parents" (PDF). The Royal Children's Hospital Melbourne. The Royal Children's Hospital Melbourne. Retrieved 2 May 2016.
  9. ^ Bauman-Waengler, Jacqueline (2011). Articulatory and phonological impairments : a clinical focus (4th ed., International ed. ed.). Harlow: Pearson Education. pp. 378–385. ISBN 9780132719957. {{cite book}}: |edition= has extra text (help)
  10. ^ "Speech and Language Therapy". My Child at cerebralpalsy.org. Retrieved 2 May 2016.
  11. ^ Cross, Melanie (2011). Children with social, emotional and behavioural difficulties and communication problems: there is always a reason (2nd ed.). London: Jessica Kingsley Publishers.
  12. ^ DeBonis DA, Moncrieff D (February 2008). "Auditory processing disorders: an update for speech-language pathologists". Am J Speech Lang Pathol. 17 (1): 4–18. doi:10.1044/1058-0360(2008/002). PMID 18230810.
  13. ^ Mihaela Frățilă, Emil Urtilă, Maria Ștefănescu (Oct 2011). "Speech therapy — criteria for determining the time of the surgical operation in surgery of labio-palato-velars cleft". Rev. chir. oro-maxilo-fac. implantol. (in Romanian). 2 (2): 21–23. ISSN 2069-3850. 33. Retrieved 2012-06-06.{{cite journal}}: CS1 maint: multiple names: authors list (link)(webpage has a translation button)
  14. ^ Pollens R (October 2004). "Role of the speech-language pathologist in palliative hospice care". J Palliat Med. 7 (5): 694–702. doi:10.1089/jpm.2004.7.694. PMID 15588361.
  15. ^ "Speech and language therapist - NHS Careers".
  16. ^ "What is speech and language therapy?".
  17. ^ "ASHA Telepractice Position Statement". Asha.org. Retrieved 2010-04-15.
  18. ^ http://www.asha.org/uploadedFiles/Accreditation-Standards-Graduate-Programs.pdf
  19. ^ ""Speech-Language Pathology Clinical Fellowship"". www.asha.org.
  20. ^ "Professional Profile of the Speech and Language Therapist".
  21. ^ "Roles and Responsibilities of Speech-Language Pathologists in Schools".
  22. ^ Bellani, M.; Moretti, A.; Perlini, C.; Brambilla, P. (Dec 2011). "Language disturbances in ADHD". Epidemiol Psychiatr Sci. 20 (4): 311–5. doi:10.1017/S2045796011000527. PMID 22201208.
  23. ^ "International Statistical Classification of Diseases and Related Health Problems 10th Revision (ICD-10) Version for 2010". World Health Organisation. 2010.
  24. ^ https://www.nidcd.nih.gov/health/voice/pages/autism.aspx
  25. ^ http://www.ninds.nih.gov/disorders/asperger/detail_asperger.htm
  26. ^ http://asha.org/telepractice/
  27. ^ http://vocalsaints.co.nz/
  28. ^ http://www.nhs.uk/Conditions/pregnancy-and-baby/pages/helping-your-childs-speech.aspx#close
  29. ^ Ritter, Michaela J. (June 2009). "The Speech-Language Pathologist and Reading: Opportunities to Extend Services for the Children We Serve". Perspectives on School-Based Issues. 10 (2): 38–44. doi:10.1044/sbi10.2.38. Retrieved 2012-04-15.
  30. ^ "The Role of the Speech-Language Pathologist | DyslexiaHelp at the University of Michigan".
  31. ^ Richard GJ (July 2011). "The role of the speech-language pathologist in identifying and treating children with auditory processing disorder". Lang Speech Hear Serv Sch. 42 (3): 241–5. doi:10.1044/0161-1461(2011/09-0090). PMID 21757563.
  32. ^ "Language Delay in Children Under Five Years".

Further reading


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