Speech-language pathology
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Speech-language pathology professionals (speech-language pathologists (SLPs), or informally speech therapists) specialize in communication disorders as well as swallowing disorders.
The main components of speech production include: phonation, the process of sound production; resonance; 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 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.[1]
National approaches to speech and language pathology
Speech-language pathology is known by a variety of names in various countries around the world:
- Speech-language pathology (SLP) in the United States [1], Canada [2], Malta [3], Italy [4], and in the Philippines
- Speech and language therapy (SLT) in the United Kingdom, Ireland [5], and South Africa [6]. 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< is preferable however, and closer to the official abbreviation SLT used by RCSLT (Royal College of Speech and Language Therapists) [7].
- Speech pathology in Australia [8], and the Philippines
- Speech-language therapy in New Zealand
- Speech therapy in India [9], Hong Kong [10] and other Asian countries.
- Speech and language pathologist in the Netherlands, the title for graduates from University who can participate in research.
- Speech and language therapist (logopedist) are educated to give therapy in the Netherlands.
Prior to 2006, the practice of Speech-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 and licensed SLP. After a Certificate of Clinical Competence in Speech-Language Pathology is awarded. Continuing education is required for maintenance of the Certificate of Clinical Competence, every three years.[2] Post master's graduate study for a Speech-Language Pathologist may consist of academic, research, and clinical practice . A doctoral degree (Ph.D or Speech-Language Pathology Doctorate) is currently optional for clinicians wishing to serve the public.
The Speech-Language Pathology vocation
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 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.
- 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);
- voice (i.e. hoarseness (dysphonia), poor vocal volume (hypophonia), abnormal (e.g. rough, breathy, strained) vocal quality). Research has been proven to demonstrate voice therapy to be especially helpful with certain patient populations, such as individuals with Parkinson's Disease, who often develop voice issues as a result of their disease.
- 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 others; providing information to health care professionals (including doctors, nurses, occupational therapists, and dietitians), educators, and parents as dictated by the individual client's needs.
In relation to Auditory Processing Disorders[3] 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.[4]
Healthcare
- Promote healthy lifestyle practices for the preservation of communication, hearing, or swallowing, or for the treatment of 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
Education:
- Master's degree in Speech-Language Pathology (M.A. or M.S.) or a clinical doctorate in Speech Language Pathology (SLP-D).
- Passing score on the National Speech-Language Pathology board exam (PRAXIS).
- Successful completion of a clinical fellowship year (CFY).
- American Speech and Hearing Association (ASHA) certificate of clinical competence (CCC) and full state licensure to practice, following successful completion of clinical fellowship year (CFY).
- Credentials of a clinical fellow typically read as M.A. CFY-SLP.
- Credentials of a licensed SLP are commonly written as M.A/M.S.. CCC-SLP or Ph.D. CCC-SLP. to indicate the practitioner's graduate degree and successful completion of the fellowship year/board exams to obtain the certificate of clinical competence (CCC).
Continuing Education and Training Obligations:
- Educate, supervise, and mentor future Speech-Language Pathologists.[5]
- 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.[6]
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,[7] 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.[8] 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.[9]
Subsequent to ASHA's 2005 approval of the delivery of Speech-Language Pathology services via video conference, or telepractice,[10] SLPs have begun delivering services via this service delivery method.
Methods of assessment
Assessment of speech, language, cognition, and swallowing can consist of informal (non-standard or criterion based) assessments, formal standardized tests, instrumental measures, language sample analyses, and oral motor mechanism exam. Informal assessments rely on a clinician's knowledge and experience to evaluate an individual's abilities across areas of concern. Formal standardized testing is used to measure an individuals' abilities against peers. Instrumental measures (e.g., nasometer)utilizes equipment to measure physiological or anatomical impairments (e.g., Fiberoptic Endoscopic Evaluation of Swallowing (FEES) or Modified Barium Swallow Study (MBS)). 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.
Referrals to Speech and Language Pathologists should be made if there are any concerns regarding slow or limited communication development in children, cognition (limited attention, disorganization etc. following by a Traumatic Brain Injury), difficulty with word-finding, errors in speech sound production, or for Augmentative Alternative Communication needs.
Clients and patients requiring speech and language pathology services
Speech-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 cleft palate, Down syndrome, DiGeorge syndrome
- Attention deficit hyperactivity disorder[11][12]
- Autism,[13] including Asperger syndrome[14]
- Developmental delay
- 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
- Childhood apraxia of speech
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.[15] 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
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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
- cancer of the head, neck and throat (including laryngectomy)
- mental health issues
- transgender voice therapy (usually for male-to-female individuals)
References
- ^ Block, Frances K.; Amie Amiot, Cheryl Deconde Johnson; Gina E. Nimmo; Peggy G. Von Almen; Deborah W. White; and 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
- ^ "2005 SLP Standards". 2005 Standards and Implementation Procedures for the Certificate of Clinical Competence in Speech-Language Pathology.
- ^ 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.
- ^ 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.(webpage has a translation button)
- ^ "Professional Profile of the Speech and Language Therapist".
- ^ "Roles and Responsibilities of Speech-Language Pathologists in Schools".
- ^ Pollens R (October 2004). "Role of the speech-language pathologist in palliative hospice care". J Palliat Med 7 (5): 694–702. PMID 15588361.
- ^ "Speech and language therapist - NHS Careers".
- ^ "What is speech and language therapy?".
- ^ "ASHA Telepractice Position Statement". Asha.org. Retrieved 2010-04-15.
- ^ Bellani, M.; Moretti, A.; Perlini, C.; Brambilla, P. (Dec 2011). "Language disturbances in ADHD.". Epidemiol Psychiatr Sci 20 (4): 311–5. PMID 22201208.
- ^ "International Statistical Classification of Diseases and Related Health Problems 10th Revision (ICD-10) Version for 2010". World Health Organisation. 2010.
- ^ https://www.nidcd.nih.gov/health/voice/pages/autism.aspx
- ^ http://www.ninds.nih.gov/disorders/asperger/detail_asperger.htm
- ^ http://asha.org/telepractice/
- ^ Ritter, Michaela J. (2009-06). "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.
- ^ "The Role of the Speech-Language Pathologist | DyslexiaHelp at the University of Michigan".
- ^ 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.
Further reading
- 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.
- 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.
- Howell, Peter. Recovery From Stuttering. New York: Psychology Press/Taylor & Francis Group, 2011. Web. 26th October 2012.
External links
- American Speech-Language-Hearing Association (ASHA) - Communication for a Lifetime
- CiteULike Speech and Language Pathology research paper sharing library
- Glossary of Speech-Language Pathology / Speech and Language Therapy Terminology
- National Institutes of Health - Voice, Speech, and Language
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