Speech and language pathology

Speech-language pathologists (SLPs), also called speech and language therapists,[1] or speech therapists, specialize in the evaluation and treatment of communication disorders and swallowing disorders.

The components of speech production include: phonation, producing sound; resonance; 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][3]

 

National approaches to speech and language pathology Speech-language pathology is known by a variety of names in different countries:

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&LT is preferable however, and closer to the official abbreviation SLT used by RCSLT (Royal College of Speech and Language Therapists) [7].
Speech and language therapist (logopedist) are educated to give therapy in the Netherlands.
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.
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 given by The American Speech-Language-Hearing Association (ASHA) have determined the qualification requirements to obtain "Speech-Language Pathology Clinical Fellowship". First, individuals must obtain an undergraduate degree, which may be in a field related to speech-language-hearing sciences. Second, individuals must graduate from an accredited master's program in speech-language pathology. Many graduate programs will allow coursework absent in undergraduate study to be completed during graduate work. Some states licensure regulations differ. 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 CCC in Speech-Language Pathology is awarded, continuing education is required every three years to maintain certification.[4] 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 (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.
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, dietitians), educators, behavior consultants (applied behavior analysis) and parents as dictated by the individual client's needs.

In relation to Auditory Processing Disorders[5] 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.[6]

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:

Speech Pathology is a Master's entry-level field. Clinicians may hold a Master's degree in Speech-Language Pathology (e.g. M.A., M.S., or M.Ed), a clinical doctorate in Speech Language Pathology (e.g. CScD or SLP-D), or a Ph.D.
All clinicians are required to complete 400 clinical hours (25 observation hours during the undergraduate degree and 375 hours of graduate Clinical Practicum).
Must pass multiple Knowledge and Skills Acquisition (KASA) exams
Additional coursework at the undergraduate and graduate level as well as additional licensure is required if the SLP wishes to work in a K-12 school setting.
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 (CF). The CF is 36 weeks of full-time (35 hours per week) experience (or the equivalent part-time experience), totaling a minimum of 1260 hours).[7]
American Speech and Hearing Association (ASHA) certificate of clinical competence (CCC) and full state licensure to practice, following successful completion of clinical fellowship (CF).
Continuing Education and Training Obligations:

Educate, supervise, and mentor future Speech-Language Pathologists.[8]
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.[9]
Professional Suffix:

Credentials of a clinical fellow typically read as: M.A., CFY-SLP.
Credentials of a licensed SLP commonly read as: M.A., CCC-SLP, indicating a practitioner's graduate degree and successful completion of the fellowship year/board exams to obtain certification.
Salary by State or District Average salaries for speech-language pathologists vary somewhat throughout the United States, ranging on average between 55-90K depending on setting and years of experience.

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,[10] 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.[11] 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.[12]

Subsequent to ASHA's 2005 approval of the delivery of Speech-Language Pathology services via video conference, or telepractice,[13] SLPs have begun delivering services via this service delivery method.

Methods of assessment For more details on this topic, see Speech and language 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.

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[14][15]
Autism,[16] including Asperger syndrome[17]
Developmental delay
Feeding disorders- including oral motor deficits
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
Developmental verbal dyspraxia
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.[18] 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. [19] 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[20][21]
Specific Language Impairment (SLI)
Auditory Processing Disorder[22]
 Physical Disabilities
Speech Disorders (like Cluttering)
Stammering, Stuttering (disfluency)
Stroke
Voice Disorders (dysphonia)
Language Delay[23]
Motor speech disorders (dysarthria or Developmental verbal 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,
cancer of the head, neck and throat (including laryngectomy)
mental health issues
transgender voice therapy (usually for male-to-female individuals)