Speech Language Pathology

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Speech Language Pathology
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Philosophy

• We're committed to ensuring that all people with
  speech, language, and hearing disorders have
  access to quality services to help them
  communicate effectively.
• Principle of Ethics
• -To honor their responsibility to hold
  paramount the welfare of persons they serve
  professionally or participants in research and
  scholarly activities.
• -To honor their responsibility to achieve
  and maintain the highest level of professional
  competence
• -To honor their responsibility to the public by
  promoting public understanding of the
  professions, by supporting the development of
  services designed to fulfill the unmet needs of
  the public, and by providing accurate information
  in all communications involving any aspect of the
  professions, including dissemination of research
  findings and scholarly activities.
• -To honor their responsibilities to the
  professions and their relationships with
  colleagues, students, and members of allied
  professions.
• -Individuals shall uphold the dignity and
  autonomy of the professions, maintain harmonious
  inter-professional and intraprofessional
  relationships, and accept the professions
  self-imposed standards.

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Perceptions

• They fix r and s
• They help people who stutter
• Why are you are the team, he doesnt talk yet?
• They help people project their voices
• They teach sign language

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Definition

• Most people take the ability to communicate for
  granted
• ( Donna Leonard, M.A. CCC- SLP)
• Speech language pathology the study and
  treatment of human communication disorders, that
  include disorders of speech, language and
  swallowing.
• Speech language pathologist A professional who
  specializes in the evaluation, treatment and
  prevention of speech (articulation, fluency, and
  voice) and language disorders (Gelfer)

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What do the terms speech, language and
communication all mean?

• Case Study
• Tom S. had a stroke. He understands most of
  what you say except long sentences. When he
  talks, he doesn't always remember the names of
  things. He also leaves out parts of speech like
  articles and prepositions.
• When you listen to Tom, it sounds as if he is
  reading a telegram. And a poorly printed telegram
  at that! His words are garbled, and consonants
  are not very precise.
• Tom has both a language and a speech problem.
• Language A shared code or system that represents
  concepts and ideas through the use of arbitrary
  symbols.
• Speech is a motor act, involving production of
  sounds owing to meaningful combinations by the
  lips, tongue, teeth, palate and vocal cords.
• Communication is exchange of information, the
  sending and receiving of messages.

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Purpose

• Speech-language pathologists serve individuals,
  families,
• groups, and the general public through a broad
  range of professional activities.
• To identify, define, diagnose, treat and research
  disorders of human communication and swallowing
  and assist in localization of diseases and
  conditions.
• Educate, supervise, and mentor future
  speech-language pathologists.
• Serve as case managers and service delivery
  coordinators.
• Caters to broad array of disorders involving
• - Language in oral, written, graphic, and
  manual modalities
• - Language processing skills, pre literacy
  skills including phonological awareness
• - Swallowing, resonance, voice and upper aero
  digestive tract disorders
• - Cognitive aspects of communication
• - Hearing impairment
• - Stammering ( Fluency disorders)

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Function

• The practice of speech-language pathology
  involves
• 1. Providing prevention, screening, consultation,
  assessment and diagnosis, treatment,
  intervention, management, counseling, and
  follow-up services for disorders of
• Language, articulation, fluency,
  resonance, and voice including aeromechanical
  components of respiration)
• 2. Selecting, devising and/or prescribing
  appropriate AAC tool.
• 3. Using instrumentation (e.g., videofluoroscopy,
  EMG, nasendoscopy, stroboscopy, computer
  technology) to visualize laryngeal mechanism,
  swallowing apparatus and upper aero digestive
  tract and identify disorders/conditions hampering
  normal functioning.
• 4. Aural rehabilitation ( Speech reading,
  auditory training).
• 5. Hearing screening and listening checks for
  various amplification devices to ensure the
  optimal functioning of the devices.
• 6. 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.

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• 7.Educating and counseling individuals, families,
  co-workers, educators, and other persons in the
  community regarding acceptance, adaptation, and
  decision making about communication, swallowing,
  or other upper aero digestive concerns.
• 8. Advocating for individuals through community
  awareness, education, and training programs
• 9. Addressing behaviors (e.g., perseverative or
  disruptive actions) and environments
• 10.Teach in college and university programs.
• 11. Manage agencies, clinics, organizations, or
  private practices.
• 12. Engage in research to enhance knowledge about
  human communication processes.
• 13.Supervise and direct public school or clinical
  programs
• 14.Develop new methods and products to evaluate
  and treat speech-language disorders

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• 15. Promote prevention of communication, hearing,
• swallowing, or other upper aero digestive
  disorders.
• 16.Foster public awareness.
• 17. Recognize the special needs of culturally
  diverse
• populations by providing services that are free
  of potential biases
• 18. Provide services using tele-electronic
  diagnostic measures and treatment methodologies
• (ASHA Desk Reference 2002 Cardinal Documents of
  the Association I - 30 / 2001)
• Member of Interdisciplinary team
• . Speech-language pathologists often work as part
  of a team, which may include teachers,
  physicians, audiologists, psychologists, social
  workers, rehabilitation counselors and others.
  Corporate speech-language pathologists also work
  with employees to improve communication with
  their customers.

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Therapy can take Many forms
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Developmental Disability

• Autism
• Fostering attempt to communicate
• Intervention focus Language Pragmatics
• Alternative and augmentative means of
  communication e.g. PECS
• Some interesting strategies that are employed
• Social Stories, PROMPT, reducing their echolalia
• Downs Syndrome
• Intervention focus Language, literacy and
  articulation.
• Areas developing abstract concepts, semantic and
  syntactic skills
• Physcial Impairment
• Cerebral Palsy
• Intervention focus Identifying and fostering
  appropriate mode of communication, selecting and
  recommending appropriate AAC , developing
  literacy skills, and providing feeding
  swallowing therapy.
• Motor Speech Disorders articulation therapy
  with focus on other basic speech production
  processes (e.g. respiration) muscle
  strengthening exercise

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AAC
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• Hearing Impairment
• Intervention focus Aural Rehabilitation, may
  work with Cochlear Implant population, children
  with different degrees of hearing loss.
• Childhood aphasia
• Intervention focus Receptive and Expressive
  language development.
• Traumatic Brain Injury
• Intervention focus cognition, attention, memory,
  organization skills, executive functions
• Cleft Lip Palate
• Intervention focus language development
  articulation therapy resonance therapy
  strengthening facial and palatal muscles voice
  therapy.
• Specific Language Impairment
• Intervention focus expressive receptive
  language abilities

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• Learning Disability
• Intervention focus - reading and spelling
  abilities, promoting phonological awareness and
  fostering expressive receptive language skills.
• ? Fluency disorder
• Intervention focus - rate reduction, block
  cancellation techniques, modifying environment,
  counseling and helping them cope with peer
  pressures and guilt and shame.

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• Assessments
• Language
• Rossetti Infant Toddler Rating Scale
• Preschool Language Scale-4 (PLS-4)
• Clinical Evaluation of Language
  Fundamentals-Preschool 2 (CELFP-2)
• Clinical Evaluation of Language Fundamentals-4
  (CELF-4)
• Test of Pragmatic Language (TOPL)
• Bayley Scales of Infant and Toddler Development
  Third Edition (Bayley-III)
• Test of Language Development-Preschool-3
  (TOLD-P-3)
• Test of Language Development-Intermediate-3
  (TOLD-I-3)
• The Test of Language Competence Expanded (TLC-E)
• Peabody Picture Vocabulary Test (PPVT)
• Expressive One Word Picture Vocabulary Test
  (EOWPVT)
• Articulation
• Goldman-Fristoe Test of Articulation 2
• Clinical Assessment of Articulation and Phonology
  (CAAP)
• Secord Contextual Articulation Tests (S-CAT)
  Fluency
• Fluency

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More Assessments

• Voice
• Consensus Auditory Perceptual Evaluation of Voice
  CAPE-V
• Video Laryngoscopy (Rigid and Flexible)
• Dysphagia
• Fiberoptic Endoscopic Evaluation of Swallowing
  (FEES)
• Modified Barium Swallow Study
• Oral motor
• Oral motor exam
• Reading and Spelling
• Lindamood Auditory Conceptualization 3 (LAC-3)
• Kauffmann test of educational Achievement-II
  (KTEA-II)
• Gray Oral Reading Test-4 (GORT-4)
• Traumatic Brain Injury
• Scales of Cognitive Ability for Traumatic Brain
  Injury (SCATBI)
• Aphasia
• The Western Aphasia Battery
• The Boston Diagnostic Aphasia Examination

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FEES
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MBS
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Oral Endoscopy
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Practice Settings

• Public and Private Schools
• Hospitals
• Rehabilitation Facilities (Dodd Hall)
• Skilled Nursing Facilities/Long-term Care
  Facilities,
• Home Health
• Community clinics (Columbus Speech and Hearing
  Center)
• Behavioral/Mental Health Facilities
• Private Practice
• Supervisors in University Clinics
• Group Homes
• Sheltered Workshops
• Neonatal Intensive Care Units
• Preschools
• Government Agencies
• Correctional Institutions
• Research
• Corporate and Industrial Settings
• Early Intervention

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Becoming an SLP

• To enter this career, one must have a sincere
  interest in helping people, an above average
  intellectual aptitude, and the sensitivity,
  personal warmth, and perspective to be able to
  interact with the person who has a communication
  problem. Scientific aptitude, patience, emotional
  stability, tolerance, and persistence are
  necessary, as well as resourcefulness and
  imagination. Other essential traits include a
  commitment to work cooperatively with others and
  the ability to communicate effectively both
  orally and in writing.
• www.asha.org

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Educational Requirements

• BA or BS in Communicaiton Disorders or related
  field with prerequsite courses completed.
• MA or MS in Speech Langauge Pathology
• Relevant course work
• Practicum
• 400 clock hours total
• 25 hours of clinical observation
• 375 clock hours in direct client/patient contact
• 325 at the graduate level
• Become Clinically Certified (CCC)
• Pass a national examination
• Complete a supervised Clinical Fellowship
• 36 weeks of full-time clinical practice (35 hours
  per week)
• PhD
• Necessary for a career of professor at the
  university level
• Research
• www.asha.org

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Continuing Education

• 30 Certification Maintenance Hours (CMH) of
  professional development during each 3-year
  certification maintenance (non-ASHA CEU
  activities)
• 3.0 ASHA CEUs (1 CEU10 hours
• This is needed in order to retain certification
• www.asha.org

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Licensing Requirements

• It differs from state to state.
• In Ohio it is necessary that the following be
  completed
• Final graduate transcript if program was
  accredited by the American Speech-Language-Hearing
  Association. (if not both undergraduate and
  graduate are needed)
• Clinical Experience Records (if graduate program
  was not accredited by the accrediting body of the
  American Speech-Language-Hearing Association)
• NTE or Praxis Series II Test score in
  Speech-Language Pathology
• School Certification also involves a separate
  certification
• Course work in educational speech language
  pathology
• 400 hours of supervised experience in the schools
• http//slpaud.ohio.gov/application2.htm

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Contemporary Issues Evidence Based Practice

• Evidence-Based Practice (EBP) integrates
• Clinical expertise
• Best current evidence
• Client values
• Key Steps in the EBP Process
• Frame the Clinical Question
• Find evidence
• Assess the evidence
• Make a clinical decision

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• Contemporary Issues
• Speech Language Pathology Assistants
• ASHA defines seven issues
• Registering assistants and approving training
  programs
• Membership in ASHA
• Discrepancies between state requirements and ASHA
  policies
• Preparation for serving diverse multicultural,
  bilingual, and international populations
• Supervision considerations
• Funding and reimbursement for assistants
  (Medicare)
• Perspectives on career-ladder/bachelor-level
  personnel.
• www.asha.org
• Medicare Caps
• Case Load Sizes
• The median caseload size in schools was 50. The
  highest median case load was in Indiana at 78.
  The smallest was in Vermont with 30.
• www.asha.org

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More Issues

• Lack of awareness
• The need for SLPs
• Speech language pathology is expected to grow
  faster than average through the year 2014.
• The baby boom generation is growing older
• Premature infants, trauma patients, and stroke
  victums are surviving more often.
• Lack of PhD Students
• Fewer professors means fewer students being
  accepted into academic programs
• Also leads to a lack of research
• Lack of specialists in each field
• 91 in hospitals n residential health care
  setting have dysphagia cases
• However often students do not gain a wealth of
  experience in this area in graduate school

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Jargon

• SLI
• FEES
• Apraxia
• Dysphagia vs. Dysphasia
• Articulation vs. Phonological
• NPO
• Pragmatic vs.. Semantic vs.. Syntax
• Echolalia
• CCC SLP
• MBS
• VLS
• AAC
• CLP
• Dx
• Tx
• HI

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Jargon

• SLI Specific Language Impairment
• FEES Fiberoptic Endoscopic Evaluation of
  Swallowing
• Apraxia Motor planning problem
• Dysphagia vs. Dysphasia Swallowing vs. Language
• Articulation vs. Phonological Motor vs.
  Processing
• NPO Nothing by Mouth
• Pragmatic vs. Semantic vs. Syntax Social vs.
  Vocabulary vs. Grammar
• Echolalia imitation
• CCC SLP Certified Clinical Competence in Speech
  Language Pathology
• MBS Modified Barium Swallow Study
• VLS Videolaryngoscopy
• AAC Alternative and Augmentative Communication
• CLP Cleft lip/palate
• Dx Diagnostic/Diagnose
• Tx Treatment
• HI Hearing Impaired

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Earnings

• Healthcare
• Treatment 53,000 to 68,000
• Administration 72,900 to 80,000.
• Schools
• Calendar year 50,000 to 61,000.
• Academic year 46,000 to 53,000.
• www.asha.org

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How many?

• 123,000 in The American Speech-Language Hearing
  Association (ASHA)
• 102,724 speech language patholgoists
  ASHA-certified speech language pathologists.
• 1,305 who are both speech langauge pathologists
  and audiologists.

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Resources

• AHSA www.asha.org
• OSHLA www.oshla.org
• NSSLHA http//www.nsslha.org/nsslha/
• Autism http//www.autism-society.org/site/PageSer
  ver
• Voice http//www.voiceproblem.org/
• ALS http//www.alsa.org/
• Cerebral Palsy http//www.ucp.org/
• Down Syndrome http//www.ndss.org/
• Speech and Language Disorders http//familydoctor
  .org/442.xml
• Dyslexia http//www.interdys.org/
• Brian Injury http//www.biausa.org/
• Stroke http//www.stroke.org/site/PageServer?page
  nameHOME
• Spasmodic Dysphonia http//www.dysphonia.org/

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Self help groups

• AboutFace U.S.A.http//www.aboutfaceusa.org
• The Alzheimer's Associationhttp//www.alz.org
• Amyotrophic Lateral Sclerosis Associationhttp//w
  ww.alsa.org
• Aphasia Hope Foundationhttp//www.aphasiahope.org
  
• The Archttp//www.thearc.org
• Autism Society of Americahttp//www.autism-societ
  y.org
• The Brain Injury Associationhttp//www.biausa.org
  
• The Childhood Apraxia of Speech
  Associatione-mail helpdesk_at_apraxia-kids.orgWeb
  site http//www.apraxia-kids.org
• Children and Adults with Attention Deficit
  Disorder (CHADD)http//www.chadd.org
• Huntingon's Disease Society of America158 W.
  29th Street, 7th Floorhttp//www.hdsa.org/
• International Association of LaryngectomeesFax 2
  09-472-0516Email ial_at_larynxlink.comhttp//www.l
  arynxlink.com
• www.asha.org

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Self Help Groups

• International Dyslexia Associationhttp//www.inte
  rdys.org/
• Learning Disabilities Association of America
  (LDA)http//www.ldanatl.org
• National Coalition on Auditory Processing
  Disordershttp//www.ncapd.org
• National Multiple Sclerosis Societyhttp//www.nms
  s.org
• National Parkinson Disease Foundation800-327-4545
  (V/TTY)
• National Spasmodic Dysphonia Association,
  Inc.E-mail NSDA_at_dysphonia.orghttp//www.dysphon
  ia.org
• National Stuttering Associationwww.nsastutter.org
  
• The Selective Mutism Foundationwww.selectivemutis
  m.org
• Speak Easy International Foundation201-262-0895
• Stuttering Foundation of Americahttp//www.stutte
  ringhelp.org
• United Cerebral Palsy Association, Inc.
• http//www.ucpa.org
• Victory Over Impairments of Communication,
  Expression, and Speech (VOICES)310.910.3555http
  //www.4voices.org/
• WebWhispers Nu-Voice ClubEmail
  webmaster_at_webwhispers.orghttp//www.webwhispers.o
  rg www.asha.org

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References

• www.asha.org
• Gelfer, M.P. (1996). Survey of Communication
  Disorders A Social and Behavioral Perspective.
  New York McGraw-Hill.