Role of Speech and Language Therapist in a Rehabilitation Team

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Introduction

Speech and language therapists, also known as speech and language pathologists, are specialists in the area of communication, voice, speech, language, hearing, feeding, swallowing, as well as the social and cognitive aspects of communication. They provide assessment, diagnosis, treatment and support across the life span for people who have difficulties with human communication, feeding, and swallowing in order to achieve their maximum potential. In this context, human communication encompasses all those processes associated with the comprehension and production of oral and written language, as well as non-verbal and/or alternative communication. Communication and swallowing are broad terms encompassing many facets of function.

• Communication includes speech production and fluency, language, cognition, voice, resonance, and hearing.

• Swallowing includes all aspects of swallowing, including related feeding behaviors.

Speech and Language Therapy is governed internationally by the International Association of Communications Sciences and Disorders, which is ta non-profit worldwide organisation of professionals and scientists in communication, voice, speech language pathology, audiology and swallowing. Speech and Language therapy is an autonomous profession, which means they may practice independently or within an inter-professional framework, collaborating with other professionals such as audiologists, physicians, nurses, educators, dieticians, occupational therapists, physiotherapists, psychologists, child care staff and social workers, as well as communication health assistants and can accept referrals from a range of sources, including from an individual themselves (self-referral) or from other people involved with that individual.

Where Speech and Language Therapists Work

Speech and language therapists work together with children, adults, families, carers to carry out assessments and plan personalised therapy programmes which meet each individual’s communication and swallowing needs. They work in wide variety of contexts and environments including: community health centres, hospital wards and intensive care units, outpatient departments, children’s centres, mainstream and special schools, assessment units, day centres and nursing homes, clients’ homes and courtrooms, prisons and young offenders’ institutions

Knowledge and Skills for Clinical Practice

Assessment

Speech and Language therapists have expertise in the differential diagnosis of disorders of communication and swallowing. Communication, speech, language, and swallowing disorders can occur developmentally, as part of a medical condition, or in isolation, without an apparent underlying medical condition. They can diagnose communication and swallowing disorders but do not differentially diagnose medical conditions. The assessment process utilizes the ICF framework, which includes evaluation of body function, structure, activity and participation, within the context of environmental and personal factors. The assessment process can include, but is not limited to, culturally and linguistically appropriate behavioral observation and standardized and/or criterion-referenced tools; use of instrumentation; review of records, case history, and prior test results; and interview of the individual and/or family to guide decision making. The assessment process can be carried out in collaboration with other professionals. Speech and Language therapists;

• administer standardized and/or criterion-referenced tools to compare individuals with their peers;
• review medical records to determine relevant health, medical, and pharmacological information;
• interview individuals and/or family to obtain case history to determine specific concerns;
• utilize culturally and linguistically appropriate assessment protocols;
• engage in behavioral observation to determine the individual's skills in a naturalistic setting/context;
• diagnose communication and swallowing disorders;
• use endoscopy, videofluoroscopy, and other instrumentation to assess aspects of voice, resonance, velopharyngeal function and swallowing;
• document assessment and trial results for selecting AAC interventions and technology, including speech-generating devices;
• document assessment results, including discharge planning;
• formulate impressions to develop a plan of treatment and recommendations; and
• discuss eligibility and criteria for dismissal from early intervention and school-based services.

Treatment

Speech and Language therapists optimise individuals' ability to communicate and swallow, thereby improving quality of life through development and implementation of treatment to address the presenting symptoms or concerns of a communication or swallowing problem or related functional issue. The ultimate goal of therapy is to improve an individual's functional outcomes.

• provide culturally and linguistically appropriate services;
• integrate the highest quality available research evidence with practitioner expertise and individual preferences and values in establishing treatment goals;
• utilize treatment data to guide decisions and determine effectiveness of services;
• integrate academic materials and goals into treatment;
• deliver the appropriate frequency and intensity of treatment utilizing best available practice;
• engage in treatment activities that are within the scope of the professional's competence;
• utilize AAC performance data to guide clinical decisions and determine the effectiveness of treatment; and
• collaborate with other professionals in the delivery of services.

Intervention

• Language Intervention
  • The speech and language therapists will interact with a child by playing and talking, using pictures, books, objects, or ongoing events to stimulate language development. The therapist may model correct vocabulary and grammar, and use repetition exercises to build language skills.
    Articulation Intervention
  • Articulation, or sound production, exercises involve having the speech and language therapist model correct sounds and syllables in words and sentences for a child, often during play activities. The level of play is age-appropriate and related to the child's specific needs. The SLP will show the child how to make certain sounds, such as the "r" sound, and may show how to move the tongue to make specific sounds.
    Oral-motor/Feeding and Swallowing Interventions
  • Speech and language therapists use a variety of oral exercises including facial massage and various tongue, lip, and jaw exercises to strengthen the muscles of the mouth for eating, drinking, and swallowing. ThesSpeech and language therapists may also introduce different food textures and temperatures to increase a child's oral awareness during eating and swallowing.

Modalities, Technology, and Instrumentation

Speech and Language therapists use advanced instrumentation and technologies in the evaluation, management, and care of individuals with communication, feeding and swallowing, and related disorders. Speech and Language therapists are also involved in the research and development of emerging technologies and apply their knowledge in the use of advanced instrumentation and technologies to enhance the quality of the services provided. Some examples of services that Speech and Language therapists offer in this domain include, but are not limited to, the use of

• the full range of AAC technologies to help individuals who have impaired ability to communicate verbally on a consistent basis.
• endoscopy, videofluoroscopy, fiber-optic evaluation of swallowing (voice, velopharyngeal function, swallowing) and other instrumentation to assess aspects of voice, resonance, and swallowing;
• telehealth/telepractice to provide individuals with access to services or to provide access to a specialist;
• ultrasound and other biofeedback systems for individuals with speech sound production, voice, or swallowing disorders; and
• other modalities (e.g., American Sign Language), where appropriate.

Resources

• Cieza A, Causey K, Kamenov K, Hanson SW, Chatterji S, Vos T. Global Estimates of the need for rehabilitation based on the Global Burden of Disease study 2019: a systematic analysis for the Global Burden of Disease Study 2019. The Lancet. 2020 Dec 1.