Speech and language pathology

Background
The practice of speech-language pathology includes prevention, diagnosis, habilitation, and rehabilitation of communication, swallowing, or other upper aerodigestive disorders; elective modification of communication behaviors; and enhancement of communication. This includes services that address the dimensions of body structure and function, activity, and/or participation as proposed by the World Health Organization model.

Speech-language pathology is the study of disorders that affect a person's speech, language, cognition, voice disorders, and swallowing disorders. Speech-language pathologists (SLPs) or Speech and Language Therapists (SLTs) address people's speech production, vocal production, swallowing difficulties and language needs through speech therapy in a variety of different contexts including schools, hospitals, and through private practice.

It is the rehabilitative or corrective treatment of physical and/or cognitive deficits/disorders resulting in difficulty with communication and/or swallowing.

Communication includes speech (articulation, intonation, rate, intensity), language (phonetics, phonology, morphology, syntax, semantics, pragmatics), both receptive and expressive language (including reading and writing), and non-verbal communication such as facial expression and gesture. Swallowing problems managed under speech therapy are problems in the oral, laryngeal, and/or pharyngeal stages of swallowing (not oesophageal).

Depending on the nature and severity of the disorder, common treatments may range from physical strengthening exercises, instructive or repetitive practice and drilling, to the use of audio-visual aids and introduction of strategies to facilitate functional communication. Speech therapy may also include sign language and the use of picture symbols (Diehl 2003).

Speech therapists are also trained to assess, treat and manage swallowing difficulties.

The practice is called:
 * Speech-language pathology (SLP) in the United States and Canada
 * Speech and language therapy (SLT) in the United Kingdom, Ireland and South Africa
 * Speech pathology in Australia
 * Speech-language therapy in New Zealand

Other terms in use include speech therapy, logopaedics and phoniatrics.

It is the medical research and treatment of organs involved with speech production. In general terms, the speech organs are the mouth, throat (larynx), the vocal cords and lungs. Problems treated in phoniatrics include dysfunction of the vocal cords, cancer in the vocal cords or larynx, incapability to control the speech organs properly (speech disorders), and vocal loading related problems.

In the United States, practitioners are trained in Speech Pathology training programs. While the field is an allied health field, the practitioners are not physicians but rather known specifically as speech pathologists. Speech pathologists work with patients with speech disorders from a wide variety of causes and also deal with disorders of swallowing. They also assist in the diagnosis of laryngeal dysfunction including hoarseness, and have helped define and identify the role of esophageal reflux disease in a number of patients. Examples of patients treated by Speech Pathologists include children with speech disorders, adults after laryngectomy, patients with swallowing disorders from neurologic disease, and performers with laryngeal problems.

In the past, stuttering was viewed as a psychological problem, but that view has been discarded.

Scope of Practice
The practice of speech-language pathology involves:


 * Providing prevention, screening, consultation, assessment and diagnosis, treatment, intervention, management, counseling, and follow-up services for disorders of:
 * speech (i.e., 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, including 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);
 * cognitive aspects of communication (e.g., attention, memory, problem solving, executive functions).
 * sensory awareness related to communication, swallowing, or other upper aerodigestive functions.


 * Establishing augmentative and alternative communication (AAC) techniques and strategies including developing, selecting, and prescribing of such systems and devices (e.g., speech generating devices.)


 * 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).


 * 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.


 * Using instrumentation (e.g., videofluoroscopy, 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.


 * Selecting, fitting, and establishing effective use of prosthetic/adaptive devices for communication, swallowing, or other upper aerodigestive 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.


 * Collaborating in the assessment of central auditory processing disorders and providing intervention where there is evidence of speech, language, and/or other cognitivecommunication disorders.


 * Educating and counseling individuals, families, co-workers, educators, and other persons in the community regarding acceptance, adaptation, and decision makes about communication, swallowing, or other upper aerodigestive concerns.


 * 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.


 * Collaborating with and providing referrals and information to audiologists, educators, and health professionals as individual needs dictate.


 * 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., accent modification, transgendered voice, care and improvement of the professional voice, personal/ professional communication effectiveness).


 * Recognizing the need to provide and appropriately accommodate diagnostic and treatment services to individuals from diverse cultural backgrounds and adjust treatment and assessment services according.

Professional Roles and Activities
Speech-language pathologists serve individuals, families, groups, and the general public through a broad range of professional activities. They:
 * Identify, define, and diagnose disorders of human communication and swallowing and assist in localization and diagnosis of diseases and conditions.
 * Provide direct services using a variety of service delivery models to treat and/or address communication, swallowing, or other upper aerodigestive concerns.
 * Conduct research related to communication sciences and disorders, swallowing, or other upper aerodigestive functions.
 * Educate, supervise, and mentor future speech-language pathologists.
 * Serve as case managers and service delivery coordinators.
 * Administer and manage clinical and academic programs.
 * Educate and provide in-service training to families, caregivers, and other professionals.
 * Participate in outcomes 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.
 * Train, supervise, and manage speechlanguage pathology assistants and other support personnel.
 * Promote healthy lifestyle practices for the prevention of communication, hearing, swallowing, or other upper aerodigestive disorders.

Education
In the UK, SLTs undertake a three to four year degree course devoted entirely to the study of clinical language sciences and communicative disorders. This qualifies 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 very demanding, and 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 pilot study 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 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 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.

In the United States, Speech Language Pathology practice is regulated by the laws of the individual states. However, by 2006, minimal requirement to be a certified SLP member of the American Speech-Language Hearing Association were: a graduate degree in Speech-Language Pathology, which typically entails 2 years of post graduate work; a completed clinical fellowship year, which is generally employment for a year while supervised by a practicing SLP who is also ASHA certified; and passing the Praxis Series examination. The graduate degree work to acquire a Master's in Speech-Language Pathology is rigorous and demanding, requiring many hours of supervised clinical practica, and intensive didactic coursework in medical sciences, phonetics, linguistics, phonology, scientific methodology, and other subjects.

Certification by ASHA is noted as carrying one's "C"s. ( Clinical Competency Certification) It is noted after an SLP's name as: CCC-SLP.

Main Branches of Speech & Language Therapy (UK)
In the UK SLTs choose one or a mixture of three main clinical areas to work in, these are with adults, children or adults with learning disabilities. Adult work mainly involves rehabilitation after a traumatic event, such as a stroke, which may leave the person with a disorder such as aphasia, dysarthria or dyspraxia. Work with children mainly involves attempting to bring the child's speech or language skills up to the level of their peers. Working with adults with learning disabilities mainly involves educating their direct staff in communicating with the person so that they can reach their communicative potential. Jobs often fall outside the remit of these categories including special education, working with physical disabilities and working with people with autism.

If a person is planning on becoming a speech-language therapist, a 4 year (sometimes 3 years) undergraduate course or a 2 year Msc or PgDip course is available. The RSCLT has details of this. Courses include a number of clinical placement as well as covering areas such as phonetics, linguistics, anatomy, speech and language disorders, professional skills, psychology and child development. The courses are known for being very intensive and competition is often high to get onto the course, especially the post-graduate ones.

Methods of 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 which includes the use of bedside examination tools and endoscopic/modified barium radiology procedures.

Individuals may be referred to an SLP for the following: Traumatic Brain Injury, Stroke, Alzheimers disease and dementia, Cranial nerve damage, Progressive neurological conditions (Parkinson, ALS, etc, Developmental Delay,L Learning disability (speaking and listening), Autism Spectrum Disorders (including Asperger Syndrome), Genetic disorders that adversely affect speech, language and/or cognitive development, Injuries due to complications at birth, Feeding and swallowing concerns, Craniofacial anamolies that adversely affect speech, language and/or cognitive development,and Augmentative Alternative Communication needs.

There are a myriad of Speech-Language Assessment tools used for chidren and adults, depending on the area of need.

Speech therapists
Speech Therapists, Speech and Language Therapists (SLTs), or Speech-Language Pathologists (SLPs) are allied health professionals. Health Services employ most SLTs. Other therapists work for education services or charities. Some therapists work independently and treat patients privately. Speech therapists hold certificates to practice following a degree course and clinical training.

Patients/clients
Speech and language therapists work with:


 * Babies with feeding and swallowing difficulties
 * Children with mild, moderate or severe:
 * learning difficulties
 * physical disabilities, language delay
 * specific language impairment
 * specific difficulties in producing sounds (including vocalic r and lisps)
 * hearing impairment
 * cleft palate
 * stammering
 * autism/social interaction difficulties
 * dyslexia
 * voice disorders
 * Adults with eating and swallowing and/or communication problems following
 * stroke
 * head injury (Traumatic brain injury)
 * Parkinson's disease
 * motor neuron disease
 * multiple sclerosis
 * Huntington's disease
 * dementia
 * cancer of the head, neck and throat (including laryngectomy)
 * voice problems
 * mental health issues
 * learning difficulties, physical disabilities
 * stammering (dysfluency)
 * hearing impairment
 * transsexual women seeking voice therapy

In USA, If a child is younger than three years old, then the cost of speech therapy is likely covered by the state early intervention (zero to three) program.

In Britain, 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.

Place of work
Speech and language therapists work in community health centres, hospital wards and outpatient departments, mainstream and special schools, further education colleges, day centers and in their clients' homes. Some now work in courtrooms, prisons and young offenders' institutions.

Some speech and language therapists who work independently will see children and adults in their own homes, and may offer appointments on a Saturday.

Job Prospects
According to the United States Bureau of Labor Statistics, jobs for SLPs are expected to grow to compensate for the aging Baby Boomer generation. Jobs are also expected to grow generally in the health and education fields, especially for pathologists who are bilingual.

Colleagues
SLTs/SLPs work closely with others involved with the client, for example difficulties with eating and drinking may also involve an occupational therapist. Speech and language therapists also work closely with parents and caregivers and other professionals, such as teachers, nurses, dietitians, physiotherapists, and doctors.