courtesy : Speech therapy
History
Early history
In the 18th century, speech problems were viewed as symptoms of disease. Speech therapy was therefore provided to treat the diseases using a medical framework. Jean-Marc Itard, one of the known physicians from this era, practiced the medical model. In his 1817 writings he theorized that stuttering was as a result of a problem of the nerves that control the tongue and larynx. Other therapists (referred to as elocutionists) like John Thelwall were against the medical model. Instead of surgeries, Thelwall’s therapy practices included imitation, education and stimulation depending on individual needs.
Development into a profession
The development of SLP into a profession took different paths in the various regions of the world. Three identifiable trends influenced the evolution of SLP in the United States during the late 19th century to early 20th century: the elocution movement, scientific revolution, and the rise of professionalism. Although there were some groups of self-proclaimed speech correctionists in early 1900s, the professional organization that is now the American Speech–Language–Hearing Association was founded in 1925.
The profession
Speech-language pathologists (SLPs) 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. SLPs work to assess levels of communication needs, make diagnoses based on the assessments, and then treat the diagnoses or address the needs. 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 providing 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.
- augmentative and alternative communication, for individuals with severe language and communication impairments.
- 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.
A common misconception is that speech–language pathology is restricted to the treatment of articulation disorders (e.g. helping English-speaking individuals enunciate the traditionally difficult r) and/or the treatment of individuals who stutter but, in fact, speech–language pathology is concerned with a broad scope of speech, language, literacy, swallowing, and voice issues involved in communication, some of which include:
- Word-finding and other semantic issues, either as a result of a specific language impairment (SLI) such as a language delay or as a secondary characteristic of a more general issue such as dementia.
- Social communication difficulties involving how people communicate or interact with others (pragmatics).
- Language impairments, including difficulties creating sentences that are grammatical (syntax) and modifying word meaning (morphology).
- Literacy impairments (reading and writing) related to the letter-to-sound relationship (phonics), the word-to-meaning relationship (semantics), and understanding the ideas presented in a text (reading comprehension).
- Voice difficulties, such as a raspy voice, a voice that is too soft, or other voice difficulties that negatively impact a person’s social or professional performance.
- Cognitive impairments (e.g. attention, memory, executive function) to the extent that they interfere with communication.
- Parent, caregiver, and other communication partner coaching.
The components of speech production include: (i) phonation (producing sound), (ii) resonance, (iii) fluency, (iv) intonation, (iv) pitch variance; (v) voice (including aeromechanical components of respiration).
The components of language include: (i) Phonology (manipulating sound according to the rules of a language); (ii) Morphology (understanding components of words and how they can modify meaning); (iii) Syntax (constructing sentences according to the grammatical rules of a target language), (iv) Semantics (interpreting signs or symbols of communication such as words or signs to construct meaning); (v) Pragmatics (social aspects of communication).
Primary pediatric speech and language disorders include: (i) receptive and (ii) expressive language disorders, (iii) speech sound disorders, (iv) childhood apraxia of speech (CAS), (v) stuttering, and (vi) language-based learning disabilities. Speech pathologists work with people of all ages.
Swallowing disorders include difficulties in any system of the swallowing process (i.e., oral, pharyngeal, esophageal), as well as functional dysphagia and feeding disorders. Swallowing disorders can occur at any age and can stem from multiple causes.
Multi-discipline collaboration
SLPs collaborate with other health care professionals, often working as part of a multidisciplinary team. They can provide information and referrals to audiologists, physicians, dentists, nurses, nurse practitioners, occupational therapists, rehabilitation psychologists, dietitians, educators, behavior consultants (applied behavior analysis) and parents as dictated by the individual client’s needs. For example, the treatment for patients with cleft lip and palate often requires multidisciplinary collaboration. Speech–language pathologists can be very beneficial to help resolve speech problems associated with cleft lip and palate. Research has indicated that children who receive early language intervention are less likely to develop compensatory error patterns later in life, although speech therapy outcomes are usually better when surgical treatment is performed earlier. Another area of collaboration relates to auditory processing disorders, where SLPs can collaborate in assessments and provide intervention where there is evidence of speech, language, and/or other cognitive-communication disorders.
Working environments
SLPs work in a variety of clinical and educational settings. SLPs work in public and private hospitals, private practices, 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 SLPs also work in community health, providing services at prisons and young offenders’ institutions or providing expert testimony in applicable court cases.
Most SLPs working environments include one on one time with the client
Following the American Speech–Language–Hearing Association’s 2005 approval of the delivery of speech/language services via video conference or telepractice, SLPs in the United States have begun to use this service model.
Children with speech, language, and communication needs (SLCN) are particularly at risk of not being heard because of communication challenges. Speech-language pathologists (SLPs) can overlook the significance of supporting communication as a tool for the child to shape and influence choices available to them in their lives, even though it is advised that children with SLCN can and should be actively involved as equal partners in decision-making about their communication needs. Building these skills is especially crucial for SLPs working in settings related to traditional education.
