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Speech-language pathology is a field of expertise practiced by a clinician known as a Speech-language pathologist (SLP), also called speech and language therapist, or speech therapist, who specializes in the evaluation and treatment of communication disorders and swallowing disorders.
The components of speech production include: phonation, producing sound; resonance; fluency; 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.
Swallowing disorders includes oropharyngeal and functional dysphagia in adults and children and feeding disorders in children and infants.
The Speech-Language Pathology profession
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-language pathologists (SLPs) work to prevent, assess, diagnose, and treat speech, language, social communication, cognitive-communication, and swallowing disorders in children and adults. 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. Services are provided in the following areas:
- 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.
Speech, language, and swallowing disorders result from a variety of causes, such as a stroke, brain injury, hearing loss, developmental delay, a cleft palate, cerebral palsy, or emotional issues.
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 physicians, nurse practitioners, 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 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.
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, 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. 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.
Subsequent to the American Speech-Language-Hearing Association’s (ASHA’s) 2005 approval of the delivery of Speech-Language Pathology services via video conference, or telepractice, SLPs have begun delivering services via this service delivery method.
Speech-language pathologists conduct research related to communication sciences and disorders, swallowing disorders, or other upper aerodigestive functions.
Education and Training
In the United States, Speech-Language Pathology is a Master’s entry-level professional degree field. Clinicians must hold a Master’s degree in Speech-Language Pathology (e.g. M.A., M.S., or M.Ed.) that is from a university that holds regional accreditation and from a communicative sciences and disorders program that is accredited by the American Speech-Language-Hearing Association (ASHA), the profession’s governing body. Beyond the Master’s degree, some SLPs may choose to earn a clinical doctorate in Speech Language Pathology (e.g. CScD or SLP.D), or a doctoral degree that has a research and/or professional focus (e.g., Ph.D., or Ed.D.). All degrees must be from a university that holds regional accreditation, but only the Master’s degree is accredited by the American Speech-Language-Hearing Association (ASHA). All clinicians are required to complete 400 clinical hours (25 observation hours often completed during the undergraduate degree and 375 hours of graduate Clinical Practicum). They 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 year (CFY) as a clinical fellow (CF). The CFY is no less than 36 weeks of full-time (no more than 35 hours per week) experience (or the equivalent part-time experience), totaling a minimum of 1260 hours). During the CFY, the CF cannot earn CFY hours unless they work more than 5 hours in a week and cannot earn any CFY hours beyond 35 hours in a week.
- American Speech-Language-Hearing Association (ASHA) Certificate of Clinical Competence (CCC) and full state licensure to practice, following successful completion of clinical fellowship year(CFY).
Maintaining Licensure Through Continuing Education:
- To maintain licensure, SLPs participate in periodic earning of Continuing Educational Units (CEU).
Continuing Education and Training Obligations:
- Educate, supervise, and mentor future Speech-Language Pathologists.
- 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.
- Credentials of a clinical fellow typically read as: MA, CF-SLP.
- Credentials of a fully licensed SLP commonly read as: MA, CCC-SLP, indicating a practitioner’s graduate degree and successful completion of the fellowship year/board exams to obtain the “three Cs” the Certification of Clinical Competence, in speech-language pathology.
Salary by state or district in the United States:
Average salaries for speech-language pathologists vary somewhat throughout the United States, ranging on average between 40-100K depending on setting and years of experience.
Methods of assessment
Clients and patients requiring speech and language pathology services
Speech-Language Pathologists work with clients and patients who may present with a wide range of issues.
Infants and childrenInfants 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
- Autism, including Asperger syndrome
- 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
In the US, 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. 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. 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.
In the UK, children are entitled to an assessment by local NHS Speech and Language Therapy teams, usually after referral by health visitors or education settings, but parents are also entitled to request an assessment directly. If treatment is appropriate, a care plan will be drawn up. Speech therapists often play a role in multi-disciplinary teams where a child has speech delay or disorder as part of a wider health condition.