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, 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.^[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 (SLTs) 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&LT 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, 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, 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 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.^[2] 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-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 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);
• 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 therapist, 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 as the surgical treatment is performed earlier.^[4]

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

Education:

• ENTRY-level Master's Degree. Optional Ph.D or clinical doctorate in Speech Pathology (SLP-D).
• Must receive passing score on the national Speech-Language Pathology board exam (the PRAXIS).
• After completing their Master's or doctoral degree, all SLPs must also complete a 9 month clinical fellowship year (CFY).
• Successful completion of the CFY and passing the PRAXIS then allows the SLP to apply for the American Speech and Hearing Association (ASHA) certificate of clinical competence (CCCs) and full state licensure to practice

• Credentials commonly written as M.S. CCC-SLP or Ph.D CCC-SLP, etc. to indicate the practioner's graduate degree and successful completion of the fellowship year/board exams to obtain the certificate of clinical competence (CCC).

Post-graduation 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 can work in a wide range of settings. Clinical environments include: public and private hospitals, skilled nursing facilities (SNFs), long term acute care (LTAC) facilities, hospice ^[7], and home health care. 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

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 require specialized training. These include instrumental evaluations, such as 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. 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-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 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.^[11] 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[12][13] Specific Language Impairment (SLI) Auditory Processing Disorder[14]

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

References

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. 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

• Glossary of Speech-Language Pathology / Speech and Language Therapy Terminology

v t e Symptoms and signs: Speech and voice / Symptoms involving head and neck (R47–R49, 784) Acute Aphasias Expressive aphasia · Receptive aphasia · Conduction aphasia  · Anomic aphasia · Global aphasia  · Transcortical sensory aphasia · Transcortical motor aphasia  · Mixed transcortical aphasia Progressive Aphasias Progressive nonfluent aphasia  · Semantic dementia  · Logopenic progressive aphasia Other speech disturbances Apraxia of speech · Auditory verbal agnosia · Dysarthria · Schizophasia · Aprosodia/Dysprosody Specific language impairment · Thought disorder · Pressure of speech · Derailment · Clanging · Circumstantiality Symbolic dysfunctions Developmental dyslexia/Alexia · Agnosia (Astereognosis, Prosopagnosia, Visual agnosia)  · Gerstmann syndrome · Developmental dyspraxia/Apraxia (Ideomotor apraxia) · Dyscalculia/Acalculia · Agraphia Voice disturbances Dysphonia/Aphonia Other Epistaxis · Headache · Post-nasal drip · Neck mass M: PSO/PSI mepr dsrd (o, p, m, p, a, d, s), sysi/epon, spvo proc(eval/thrp), drug(N5A/5B/5C/6A/6B/6D) M: MOU anat/devp noco/cofa(c)/cogi/tumr, sysi proc (peri), drug (A1)

v t e Pathology of the nervous system, primarily CNS (G04–G47, 323–349) Inflammation Brain Encephalitis (Viral encephalitis, Herpesviral encephalitis) · Cavernous sinus thrombosis · Brain abscess (Amoebic) Spinal cord Myelitis: Poliomyelitis · Demyelinating disease (Transverse myelitis) · Tropical spastic paraparesis · Epidural abscess Both/either Encephalomyelitis (Acute disseminated) Meningoencephalitis Brain/ encephalopathy Degenerative Extrapyramidal and movement disorders Basal ganglia disease: Parkinsonism (PD, Postencephalitic, NMS) · PKAN · Tauopathy (PSP) · Striatonigral degeneration · Hemiballismus · HD · OA Dyskinesia: Dystonia (Status dystonicus, Spasmodic torticollis, Meige's, Blepharospasm) · Chorea (Choreoathetosis) · Myoclonus (Myoclonic epilepsy) · Akathesia Tremor (Essential tremor, Intention tremor) · Restless legs · Stiff person Dementia Tauopathy: Alzheimer's (Early-onset) Primary progressive aphasia  · Frontotemporal dementia/Frontotemporal lobar degeneration (Pick's, Dementia with Lewy bodies) Multi-infarct dementia Mitochondrial disease Leigh's disease Demyelinating autoimmune (Multiple sclerosis, Neuromyelitis optica, Schilder's disease) · hereditary (Adrenoleukodystrophy, Alexander, Canavan, Krabbe, ML, PMD, VWM, MFC, CAMFAK syndrome) · Central pontine myelinolysis · Marchiafava-Bignami disease · Alpers' disease Episodic/ paroxysmal Seizure/epilepsy Focal · Generalised · Status epilepticus · Myoclonic epilepsy Headache Migraine (Familial hemiplegic) · Cluster · Tension Cerebrovascular TIA (Amaurosis fugax, Transient global amnesia Acute aphasia) Stroke (MCA, ACA, PCA, Foville's, Millard-Gubler, Lateral medullary, Weber's, Lacunar stroke) Sleep disorders Insomnia · Hypersomnia · Sleep apnea (Obstructive, Ondine's curse) · Narcolepsy · Cataplexy · Kleine-Levin · Circadian rhythm sleep disorder (Advanced sleep phase disorder, Delayed sleep phase disorder, Non-24-hour sleep-wake disorder, Jet lag) CSF Intracranial hypertension (Hydrocephalus/NPH, Idiopathic intracranial hypertension) · Cerebral edema · Intracranial hypotension Other Brain herniation · Reye's · Hepatic encephalopathy · Toxic encephalopathy Spinal cord/ myelopathy Syringomyelia · Syringobulbia · Morvan's syndrome · Vascular myelopathy (Foix-Alajouanine syndrome) · Spinal cord compression Both/either Degenerative SA Friedreich's ataxia · Ataxia telangiectasia MND UMN only: PLS · PP · HSP LMN only: PMA · PBP (Fazio-Londe, Infantile progressive bulbar palsy) · Spinal muscular atrophies (SMA, SMARD1, SBMA, SMAX2, SMA-PCH, SMA-LED) both: ALS M: CNS anat(n/s/m/p/4/e/b/d/c/a/f/l/g)/phys/devp noco(m/d/e/h/v/s)/cong/tumr, sysi/epon, injr proc, drug(N1A/2AB/C/3/4/7A/B/C/D)

v t e Developmental disorders: Dyslexia and related specific developmental disorders (F80–F83, 315) General conditions Speech and language/ communication disorders Expressive language disorder · Landau–Kleffner syndrome · Lisp · Mixed receptive-expressive language disorder · Specific language impairment Scholastic skills/ learning disorder Dyslexia( Developmental dyslexia) · Dysgraphia (Disorder of written expression) · Dyscalculia) Motor function Developmental dyspraxia Other Auditory processing disorder · Scotopic sensitivity syndrome Related topics Dyslexia research · Management of dyslexia/Dyslexia interventions · Reading acquisition · Writing system · Spelling · Literacy · Irlen filters · Recording for the Blind & Dyslexic · Neuropsychology Lists Languages by Writing System · People with dyslexia · Dyslexia in fiction M: PSO/PSI mepr dsrd (o, p, m, p, a, d, s), sysi/epon, spvo proc(eval/thrp), drug(N5A/5B/5C/6A/6B/6D)

v t e Mental and behavioral disorders (F 290–319)   Neurological/symptomatic Dementia Mild cognitive impairment Alzheimer's disease Multi-infarct dementia Pick's disease Creutzfeldt–Jakob disease Huntington's disease Parkinson's disease AIDS dementia complex Frontotemporal dementia Sundowning Wandering Autism spectrum Autism Asperger syndrome PDD-NOS High-functioning autism Other Delirium Post-concussion syndrome Organic brain syndrome   Psychoactive substances, substance abuse, drug abuse and substance-related disorders Intoxication/Drug overdose Physical dependence Substance dependence Rebound effect Double rebound Withdrawal   Schizophrenia, schizotypal and delusional Psychosis Schizoaffective disorder Schizophreniform disorder Brief reactive psychosis Schizophrenia Disorganized schizophrenia Delusional disorder Folie à deux   Mood (affective) Mania Bipolar disorder (Bipolar I Bipolar II Cyclothymia Bipolar NOS) Depression (Major depressive disorder Dysthymia Seasonal affective disorder Atypical depression Melancholic depression)   Neurotic, stress-related and somatoform Anxiety disorder Phobia Agoraphobia Social anxiety Social phobia (Anthropophobia) Specific phobia (Claustrophobia) Specific social phobia Other Panic disorder Panic attack Generalized anxiety disorder OCD stress (Acute stress reaction PTSD) Adjustment disorder Adjustment disorder with depressed mood Somatoform disorder Somatization disorder Body dysmorphic disorder Hypochondriasis Nosophobia Da Costa's syndrome Psychalgia Conversion disorder (Ganser syndrome Globus pharyngis) Neurasthenia Mass Psychogenic Illness Dissociative disorder Dissociative identity disorder Psychogenic amnesia Fugue state Depersonalization disorder   Physiological/physical behavioral Eating disorder Anorexia nervosa Bulimia nervosa Rumination syndrome NOS Nonorganic sleep disorders (Nonorganic hypersomnia Nonorganic insomnia) Parasomnia (REM behavior disorder Night terror Nightmare) Sexual dysfunction sexual desire (Hypoactive sexual desire disorder Hypersexuality) sexual arousal (Female sexual arousal disorder) Erectile dysfunction orgasm (Anorgasmia Delayed ejaculation Premature ejaculation Sexual anhedonia) pain (Vaginismus Dyspareunia) Postnatal Postpartum depression Postnatal psychosis   Adult personality and behavior Sexual and gender identity Sexual maturation disorder Ego-dystonic sexual orientation Sexual relationship disorder Paraphilia (Voyeurism Fetishism) Other Personality disorder Impulse control disorder (Kleptomania Trichotillomania Pyromania Dermatillomania) Body-focused repetitive behavior Factitious disorder (Münchausen syndrome)   Mental disorders diagnosed in childhood Mental retardation X-Linked mental retardation (Lujan-Fryns syndrome) Psychological development (developmental disorder) Specific Pervasive Emotional and behavioral ADHD Conduct disorder (ODD) emotional disorder (Separation anxiety disorder) social functioning (Selective mutism RAD DAD) Tic disorder (Tourette syndrome) Speech (Stuttering Cluttering) Movement disorder (Stereotypic)   Symptoms and uncategorized Catatonia False pregnancy Intermittent explosive disorder Psychomotor agitation Sexual addiction Stereotypy Psychogenic non-epileptic seizures Klüver-Bucy syndrome M: PSO/PSI mepr dsrd (o, p, m, p, a, d, s), sysi/epon, spvo proc(eval/thrp), drug(N5A/5B/5C/6A/6B/6D)

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