Social Science: Speech Language Pathology

Speech Language Pathology

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Speech Language Pathology

            Speech-language pathologists (SLP) are specialists who diagnose and treat various types of communication and swallowing problems. According to The American Speech-Language-Hearing Association, some of the areas of service delivery for treatment and evaluation of an SLP include resonance, cognition, speech production, voice, fluency, rehabilitation for hearing-impaired patients as well as auditory rehabilitation (Bracke, 2021). The SLP also helps with feeding and swallowing problems which usually lead to dysphagia example of a swallowing problem that might lead to weight loss, and poor nutrition among other health problems.

Therapy Settings

SLPs provide important services in diverse healthcare and education settings each tailored to a varied population and patient needs. Some of the education settings include;

• Preschool, Early Intervention, and K-12 schools the services offered by SLPs in these settings encompass conducting diagnostic and screening assessments, working on learning, writing, speaking, and listening in both special and general educational programs, supervising clinical fellowships and clinical practicums as well as developing individualized educational programs and individualized family service plans (American Speech-Language-Hearing Association, n.).
• In colleges and university settings, the services offered by SLPs are tailored towards clinical supervision, research, and teaching purposes where SLPs work with various clients within the university core clinical facility and its affiliated educational or healthcare facility (American Speech-Language-Hearing Association, n.d).

Some of the healthcare settings include:

• Hospitals where specifically psychiatric, rehabilitation, and acute care hospitals may provide speech and language services on both in and outpatient services. The speech-language pathologists in hospital settings may provide counseling to not only patients but their families as well, they also may diagnose and treat swallowing problems as well as cognitive language and communication disorders. They may also act to educate and coach other healthcare staff on swallowing, language, and communication disorders.

Other settings where SLPs offer services include;

• Residential healthcare facilities, nonresidential healthcare facilities, private practice, as well as local, state, and federal government agencies. In residential settings, SLPs perform diagnoses and evaluations and offer treatment in nursing care centers as well as assisted living facilities. They treat similar disorders that are usually present in hospitals but take longer to improve functional skills to become more autonomous.

• The nonresidential facilities include free-standing outpatient settings such as doctor’s offices or hearing and speech clinics. The SLPs in these settings may be private practitioners, work in early intervention programs, or be employed by home health agencies.
• The private practice settings of SLPs allow them to be entrepreneurial and make their own choices with regard to target clients, caseloads, and schedules. Therefore, private practice by SLPs allows them to manage the business aspects of therapy by contracting, marketing, and billing.
• The local, state, and federal government agencies include the uniformed services where SLPs provide service to underserved individuals, veterans, and active military personnel. The clinicians are usually employed by the U.S. Public Health Services, U.S. Navy, Army, and Air Force. Also, clinicians provide contractual and consultative services to various individuals across different states as directed by the Public Health Departments in various states.

SLP Scope of Practice: Disorders, disabilities, ages, etc

SLPs have a wide spectrum of practice which encompasses screening, diagnosing, and treating a variety of swallowing, language, and communication disorders across diverse age groups.

Some of the disorders and disabilities include:

• Language disorders such as;

1. Expressive language disorder-which interferes with an individual’s capacity to express information, ideas, and thoughts hence affecting the person’s nonverbal communication (gesture), writing, and speech. The symptoms include; vague words, limited vocabulary, word omission, poor note-taking in schools, and challenges in describing, explaining, or paraphrasing, etc (Lovering, 2022).
2. Receptive language disorder-which is an impairment in the comprehension of gestural, spoken, and written language. The symptoms include but are not limited to understanding another’s person perspective, reading comprehension, following directions/instructions, answering complex/simple questions, and understanding the names of things (Geller, n.d).

• Fluency disorders normally occur when an individual has severe, repeat difficulties with continuous speech. Examples of fluency disorders include stuttering and cluttering. Signs and symptoms of stuttering are words and syllables that are repetitive, sounds that are held too long, and periods of silence when an individual tries to start a sentence but cannot begin producing, what they want to make (Cleveland Clinic, n.d). Signs and symptoms of cluttering on the other hand include omission of syllables or words, unpredicted pauses in the middle of sentences, excessive interruptions to speech, and rhythm of speech that sounds irregular and rapid (Cleveland Clinic, n.d).
• Voice disorders-which include challenges with pitch, intonation, volume, and pitch.
• Swallowing disorders such as dysphagia which is difficulty in swallowing. Some of the symptoms include frequent heartburn, pain while swallowing, hoarseness, drooling, gagging and coughing while swallowing, and regurgitation (Mayo Clinic, n.d).
• Articulation and phonological disorders-while articulation disorders are based on errors (i.e. the substitutions and distortions) in the production of individual speech sounds, phonological disorders focus on predictable rule-based errors (i.e fronting, stopping, and closing consonant deletion) which typically affect more than one sound (American Speech-Language-Hearing Association (n.d).

What is speech/language therapy and why is it important?

SLPs are responsible for the assessment and treatment of speech and language impediments as well as swallowing problems. Discussed below are some of the important aspects of SLP.

• Enhancing communication skills helps the patient improve their non-verbal communication skills such as gestures, body language, and facial expressions. For instance, through video modeling and role-playing activities, patients can learn to comprehend and use nonverbal cues efficiently, enhancing their general communication skills.
• Improve emotional and social development helps in teaching social communication skills. Individuals with social communication disorder are taught specific skills needed to communicate successfully in social situations such as the use of body language and appropriate language, taking turns in a conversation, and how to begin and end conversations.
• Provision of life life-long impact of SLP’s work sometimes is usually life-changing since they help reduce or prevent life-long consequences which are usually related to communication problems. Adult patients who have suffered injuries or stroke can recover and regain communication skills through therapy conducted by SLPs.
• Improving academic performance can teach children strategies to boost comprehension such as taking notes, solving word problems, and re-reading passages which are the basis of writing and reading for academic success.

Terms like frequency, duration, prompting, cueing, therapy models, etc

• Frequency refers to the number of regular times that a behavior or event occurs. Frequencies of speech therapy particularly refer to how often therapy sessions are scheduled which normally is one to three times per week. However, for patients with more severe or complex disorders, the frequency may occur more or even daily. Frequency in SLP can be applied in various contexts such as behavioral observations, therapy sessions, data gathering, and progress evaluation as well as assessment and diagnosis.
• Duration refers to the length of time that a specific therapy session, behavior, or event lasts. Each session should normally last between 30 to 60 minutes. Younger patients usually last less than 30 minutes while older patients may take up to an hour. Basically, the length of duration is determined by the patient’s specific needs, attention span, and age.
• Prompting-in SLP refers to a type of special stimuli, usually verbal or non-verbal, intended to enhance the probability that the client will respond in a desired manner (Dwight, 2022). For instance, while prompting a client to say eyes, the clinician might say “I see with my” while pointing at his/her eyes.
• Cueing-Cues in SLP normally refers to the aid to promote accurate responses. Cues may be auditory, for instance, verbal expressions that might include duration markers, intonation, pitch, stress, and quality (Dwight, 2022). Other cues include visuals such as facial expressions, posture, and gestures. Lastly, there are tactile-kinesthetic cues such as touch to speech mechanisms (Dwight, 2022).
• Therapy Models refer to the clinician’s production of target behavior by the patient to imitate. A perfect example is the clinician's production of the /n/ phoneme for the patient to imitate during conventional articulation therapy (Dwight, 2022).

Resources used in therapy

Some of the resources used in speech therapy include;

• Articulation cards-which are usually used to target a variety of skills such as listening, memory, articulation, and language development. The cards contain words and images that target particular sounds. This helps the patient to practice the production of sounds in seclusion, sentences, phrases, and words.
• Flashcards are cards featuring words and pictures that help clients build concepts and words.
• Visual support is used to assist and enhance communication. The visual aids improve comprehension and offer routine and structure helping the client to avoid frustration during conversation.
• Reinforcement tools include the positive stimuli used to strengthen and encourage desired behaviors during communication. They may include tokens, stickers, and edible items which if given following a response increase the frequency of that response. Verbal praise, for instance, is the type of reinforcement in which a client is praised for modeling a correct response or giving the correct response (Dwight, 2022).
• Games and activities preschool games are a proper language activity for younger patients. For instance, to improve a child’s sentence fluency and pronunciation, the clinician can provide picture cards hide them under a sandbox, and ask the child to find them. When the child finds them, they are asked to pronounce the name of the object they see on the picture card.

Assessment/Evaluation Procedures

• Case history-is usually used to classify any red flags that might be a contributor to language and/or speech difficulty. The case history might take 15 to 30 minutes prior to the start of the assessment of speech and language of the client. The tools used in case history include questionnaires, checklists, and as well as interviews.
• Speech sound evaluations include both speech and phonological analysis. Some of the procedures that are involved in speech analysis include the oral mechanism examination where the clinician assesses the physical condition and mouth’s function among other affiliated features such as lips, jaw, palate, and jaws (Dingemanse & Goedegebure, 2019). The information collected is vital as it contributes to the medical assessment of the client.
• Articulation Examinations-Goldman-Fristoe Test of Articulation is an example of a standardized test that is used to examine a patient’s articulation of the consonant sounds of Standard American English. GFTA is a vital evaluation procedure that helps clinicians to make informed diagnostic and placement decisions.
• Rate and prosody examination-the most practical manner of assessing prosody involves the clinician listening to the client read orally. The procedure is vital in speech therapy since it helps to assess whether the client can identify word meanings, syntactic structures, and word boundaries. Therefore, by using prosodic clues, the client improves their ability to decode unfamiliar words and enhance their reading precision.

Evidence-Based Practice

There are 3 major parts of the evidence-based practice in SLP therapy as discussed below:

• Clinical Expertise-the clinical expertise is an intricate component of the EBP in SLP therapy. It involves SLPs using their background and experience gathered during their training to make judgments and decisions regarding diagnosis and treatment (Greenwell & Walsh, 2021). The clinical expertise enables the clinician to conduct vigorous analysis beyond standardized assessment by integrating both qualitative and observational data.
• The client/Patient/Caregiver Perspectives component comprises the unique set of cultural and personal priorities, values, situations, and choices made by the clients and their families or caregivers. The information regarding the client/caregiver perspective is vital as it can be used as a guide for making informed approaches to intervention that take into account the client’s cultural preferences and values and will produce pertinent and meaningful results for the client (Greenwell & Walsh, 2021).
• Available Evidence/Research evidence component of SLP refers to both external and internal evidence. External evidence refers to the scientific literature such as the peer-reviewed articles in SPL which provide vital information about clinical areas of focus. Through this information, future SLPs learn about research-backed diagnostic, tests, and therapy procedures which are fundamental in SLP. On the other hand, internal evidence refers to gathering and testing the subjective and objective data on the client that the clinician is examining (Greenwell & Walsh, 2021). This helps clinicians to reflect on the client’s progress over a period of time to be able to refine and update their treatment plan.

References

American Speech-Language-Hearing Association (n.d). Who Are Speech-Language Pathologists, and What Do They Do? Available Online at: https://www.asha.org/public/who-are-speech-language-pathologists/#:~:text=Speech%2Dlanguage%20pathologists%2C%20also%20called,put%20sounds%20together%20into%20words. (Accessed 10th July 2024)

American Speech-Language-Hearing Association (n.d). Speech Sound Disorders-Articulation and Phonology. Available at: https://www.asha.org/practice-portal/clinical-topics/articulation-and-phonology/#collapse_2 (Accessed July 10th 2024)

Bracke, C. (2021). The Interdisciplinary Role of the Speech-Language Pathologist in Senior Living Community Engagement. Available at: https://foxrehab.org/slp-role-senior-living-community/ (Accessed 10th July 2024)

Cleveland Clinic. (n.d) .Fluency Disorder. Available at: https://my.clevelandclinic.org/health/diseases/23480-fluency-disorder (Accessed 10th July 2024)

Dingemanse, J. G., & Goedegebure, A. (2019). The important role of contextual information in speech perception in cochlear implant users and its consequences in speech tests. Trends in Hearing, 23, 2331216519838672.

Dwight, D. M. (2022). Here's How to Do Therapy: Hands on Core Skills in Speech-Language Pathology (Vol. 1). Plural Publishing.

Greenwell, T., & Walsh, B. (2021). Evidence-based practice in speech-language pathology: Where are we now?. American Journal of Speech-Language Pathology, 30(1), 186-198.

Lovering, N. (2022). All About Expressive Language Disorder. Available at: https://psychcentral.com/disorders/all-about-expressive-language-disorder-symptoms. (Accessed 10th July 2024)

Geller, A. (n.d). Receptive and Expressive Language Disorders For Children. Available at: https://connectedspeechpathology.com/blog/receptive-and-expressive-language-disorders-in-children. (Accessed July 10th 2024)

Mayo Clinic (n.d).Dysphagia. Available at: https://www.mayoclinic.org/diseases-conditions/dysphagia/symptoms-causes/syc-20372028#:~:text=Dysphagia%20is%20a%20medical%20term,isn't%20cause%20for%20concern.. (Accessed July 10th 2024)