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Speech and language pathologists / speech therapist

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Definition and Scope of Practice

Speech-language pathologists, sometimes called speech therapists, assess, diagnose, treat, manage and help to prevent disorders related to speech, language, cognitive-communication, voice, swallowing, and fluency. [1,2,5]


Terminology referring to speech-language pathology may vary and can include, speech-language pathology (SLP), speech and language therapy (SLT), speech and language pathology, speech therapy, speech pathology, speech-language therapy, logopaedics and phoniatrics.


Speech-language pathologists help people who have speech problems such as: [1]

  • Inability to produce speech sounds or inability to produce sounds clearly
  • Speech rhythm and fluency problems, such as stuttering and syntax [6]
  • Voice disorders, such as inappropriate pitch, tone or harsh voice, inappropriate speech intensity and speed
  • Problems understanding and producing language, which may include non-verbal communication such as writing, gestures, and facial expression
  • Modifying an accent or improving professional tone
  • Cognitive communication impairments, such as attention, memory, and problem solving disorders
  • Swallowing difficulties (dysphasia) in the oral, laryngeal and pharyngeal stages of swallowing


What does a Speech Pathologist do?

A speech-language pathologist determines a patient’s needs though screening and instrumentation, assessment, and diagnosis of what type of treatment or intervention is necessary. The pathologist will then develop an individualized management plan tailored to the patient’s needs based on their ability, socioeconomic status, cultural background, social support, and many other factors that influence patient care. The speech pathologist provides counseling to the patient and follow-up care. The speech pathologist will also strive to educate the patient, family, and community about how to overcome communication barriers in society. The goal of the speech-language pathologist is to help their patients develop or recover reliable communication and swallowing skills so they can fulfill their educational, vocational, and social roles and goals. [1]


Although most speech-language therapists spend time working one-on-one with individuals, they may perform their job in conjunction with physicians, social workers, psychologists, and other therapists. Speech-language pathologists in schools collaborate with teachers, special educators, interpreters, other school personnel, and parents to develop management plans for their patients. [1]


Assessment, Treatment and Intervention

Individual methods and strategy for assessment and treatment vary for infants, children, adolescents and adults. [7] Strategies a speech language pathologist may teach can include, but are not limited to: [2]


  • auditory training
  • speech reading, sign language or picture symbols
  • speech and language intervention secondary to hearing loss
  • seating positions and compensatory strategies for improved swallowing
  • physical strengthening exercises
  • instructive or repetitive practice and drilling
  • use of audio-visual aids
  • provision of alternative methods, aids or assistive devices facilitating communication


Individuals may be referred to an SLP for the following: Traumatic brain injury; Stroke; Alzheimer's disease and dementia; Cranial nerve damage; Progressive neurological conditions (Parkinson's disease, ALS, etc); Developmental delay; Learning disability (speaking and listening); Autism Spectrum Disorders (including Asperger Syndrome); hearing impairment; laryengectomy, sometimes resulting from cancer; Genetic disorders that adversely affect speech, language and/or cognitive development; Injuries due to complications at birth; Feeding and swallowing concerns; Craniofacial anomalies that adversely affect speech, such as cleft palate, language and/or cognitive development; and Augmentative Alternative Communication needs, and many other communication disorders such as stammering, accent reduction, improving tone, etc.


Use of Assistive Technology in Speech Pathology

A speech language pathologist uses a wide variety of assistive technologies all geared toward improving or facilitating communication. The devices may be related to hearing or amplification of hearing, speaking, generating or translating speech, visual recognition, or strengthening or muscles for speaking and swallowing. Speech pathologists may also interact with prosthetic devices that facilitate communication. [10]


Examples of assistive devices a speech pathologist may use:

  • Amplifications devices for hearing sounds or voice amplification (i.e. hearing aids, earphones and headphones, microphones, telephone amplifiers, etc)
  • Speech recignition devices [8]
  • Augmentative and Alternative Communication devices (i.e. picture boards, press and talk boards, recorded playing messages, or other speech generating devices) [1]
  • Voice generation devices (i.e. Servox Digital Electronic Larynx, NuVois Digital Speech Aid, intra-oral adaptors, etc)[2]
  • Orthotic devices, such as spinal braces, to improve posture and lung capacity for fluency of speech


During therapy, the speech pathologist may also use various electronic toys or teaching devices to teach pronunciation and speaking skills. The speech pathologist may also use simpler devices such as tongue depressors or “cheweys” that patients use to strengthen oral muscles.


The devices that speech therapists use may be available on the commercial market as common, everyday devices while others are designed specifically for the speech therapy market. In some cases, a speech therapist will design, develop, or modify a device specifically for a patient’s needs. It is the responsibilty of teh speech therapist to evaluate is a device is functional for a patient and to explore as many options as possible for each individual patient [9]


Examples of prosthetic devices a speech pathologist may use or encounter:

  • Voice prostheses (i.e. speaking valves, Blom-singer voice restoration system, electrolarynges, stoma vent prostheses, etc.)[3]
  • Prostheses for individuals with clef palate when surgery is not successful (onlay prostheses, oburator, speech bulb, platal lift, palatal stimulator)
  • Prosthetic devices related to hearing (i.e. Cochlear implant, etc)[3,4]


Education and Credentials

To become a speech language pathologist a person must graduate with master’s at an accredited university. In the United States, the American Speech-Language Hearing Association (is the “recognized accrediting agent for college and university departments that offer master’s degree programs in speech-language pathology.” This agency also works to define the scope of practice for speech language pathologists and related fields. Each state has individual requirements for license, credential, certificate and other regulations for an individual seeking to practice in a school or elsewhere. [5]


How to find a Speech Language Pathologist or Speech Therapist

Speech language pathologists do not need a reference or a prescription from a doctor because they have training to both diagnose and treat pathologies; however, in many cases a medical professional such as a primary care physician can provide a reference for a therapist who can provide the services a patient may need. Those searching for a speech language pathologist can use the ASHA website to look up credentialed professionals in the field.[4] In many cases, children have access to speech therapists through school, or may be referred to a speech professional via a teacher who also works with the student.


Professional Associations Related to Speech Pathology

References

  1. Hicks PL, and Larkins P. Opportunities in Speech-Language Pathology Careers. McGraw-Hill, 1996.
  2. Johnson AF, and Jacobson BH. Medical Speech-Language Pathology: A Practitioner's Guide. Thieme, 1998.
  3. Gao R, Basseas S, Bargiotas DT, and Tsoukalas LH. Next-generation hearing prosthetics. Robotics & Automation Magazine, IEEE 10: 21-25, 2003.
  4. Weber PC. Medical and Surgical Considerations for Implantable Hearing Prosthetic Devices. American Journal of Audiology 11: 134-138, 2002.
  5. Bureau of Labor Statistics, U.S. Department of Labor, Occupational Outlook Handbook, 2008-09 Edition, Speech-Language Pathologists, on the Internet at http://www.bls.gov/oco/ocos099.htm (visited October 23, 2008).
  6. Fava E. Clinical Linguistics: Theory and Applications in Speech Pathology and Therapy. John Benjamins Publishing Co, 2002.
  7. Beech JR, Harding L, and Hilton-Jones D. Assessment in Speech and Language Therapy. Routledge, 1993
  8. Raskind MH, and Higgins EL. Speaking to read: The effects of speech recognition technology on the reading and spelling performance of children with learning disabilities. Annals of Dyslexia 49: 251-281, 1999
  9. Balandin S, and Iacono T. AAC and Australian speech pathologists: report on a national survey. Augmentative & Alternative Communication 14: 239-249, 1998.
  10. Glennen S, and DeCoste DC. The Handbook of Augmentative and Alternative Communication. Singular Pub Group, 1997.