Speech and language pathology

Speech-language pathology is the study of disorders that affect a person's speech, language, cognition, voice, swallowing (dysphagia) and the rehabilitative or corrective treatment of physical and/or cognitive deficits/disorders resulting in difficulty with communication and/or swallowing. 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.

Communication includes speech (articulation, intonation, rate, intensity, voice, resonance, fluency), language (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 and 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.

The practice is called:

• Speech-language pathology (SLP) in the United States and Canada

• Speech and language therapy (SLTs) in the United Kingdom, Ireland and South Africa. Within the United Kingdom a Speech and Language Therapy team is often referred to by clinicians as the «SALT» team.

• Speech pathology in Australia

• Speech-language therapy in New Zealand

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

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:

  1. speech (i.e., phonation, articulation, fluency, resonance, and voice including aeromechanical components of respiration);

  2. language (i.e., phonology, morphology, syntax, semantics, and pragmatic/social aspects of communication) including comprehension and expression in oral, written, graphic, and

  3. manual modalities; language processing; preliteracy and language-based literacy skills, including phonological awareness;

  4. 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);

  5. cognitive aspects of communication (e.g., attention, memory, problem solving, executive functions).

  6. 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 aerodynamics 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 cognitive-communication disorders.

  • Educating and counseling individuals, families, co-workers, educators, and other persons in the community regarding acceptance, adaptation, and decisions about communication and swallowing.

  • 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. 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 accordingly.

Professional Roles

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 outcome 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 speech-language pathology assistants and other support personnel.

• Promote healthy lifestyle practices for the prevention of communication, hearing, swallowing, or other upper aerodigestive disorders.

Patients/clients

Speech and language therapists work with:

• Babies with feeding and swallowing difficulties

• Children with mild, moderate or severe:

  1. learning difficulties

  2. physical disabilities, language delay

  3. specific language impairment

  4. specific difficulties in producing sounds (including vocalic r and lisps)

  5. hearing impairment

  6. cleft palate

  7. stammering

  8. autism/social interaction difficulties

  9. dyslexia

  10. voice disorders

• Adults with eating and swallowing and/or communication problems following

1. stroke

2. head injury (Traumatic brain injury)

3. Parkinson's disease

4. motor neuron disease

5. multiple sclerosis

6. Huntington's disease

7. dementia

8. cancer of the head, neck and throat (including laryngectomy)

9. voice problems

10. mental health issues

11. learning difficulties, physical disabilities

12. stammering (dysfluency)

13. hearing impairment

14. transgender voice therapy (usually for male-to-female individuals)