Speech Pathology.

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Abstract.

Speech pathology or speech language therapy, speech-language pathology and many other terms are all definitions of this special profession dealing with communication and swallowing disorders that cannot be amended using medical or surgical methods. Language has many components, including phonology, pragmatics and morphology, all influencing the way and effectiveness of how we communicate with society. Certain disorders have been demonstrated to hamper this from efficiently happening hence the need for specialized intervention. In providing their assistance to families, support groups and the society as whole, speech pathologists mainly handle cases on an individual basis that vary from person to person in terms of complexity and severity. Service is provided based on the best and most current clinical observations, as well as the patients’ own preferences and values. As the primary providers of professional care for all communication and swallowing disorders, speech pathologists are autonomous in their practice. However as is the norm with most professions that base their activity on the human body and its function, these professionals usually collaborate with clinical professionals for the management of a variety of disorders that shoe a bearing to speech and swallowing disorders. In the scope of this paper, we shall attempt to delve into a wide albeit shallow view of speech pathology, both as a profession and as a practice. It is hoped that by the end a largely generalized but complete knowledge of speech pathology shall be at hand.

Introduction.Speech pathologists have been termed as professionals that deal with both communication and swallowing disorders. In the course of their practice, they are expected to carry out their work in a systematic manner so that the results are realized in an effective manner. In keeping with the spirit, we shall look at this practice in a similar fashion to ensure a good grasp of its fundamentals as well as obtain a good perspective through a look at historical perspectives alongside current trends and issues. In doing this, we shall look at professional roles and activities, as well as look into some examples of common disorders. These roles are;

1. Clinical services and collaborations.

2. Prevention and advocacy.

3. Practice settings and ethical issues.

4. Historical practices and current trends.

Professional roles and activities. Some common disorders.Frattali(1999) describes impairment as “specific speech, language, swallowing or cognitive deficits” (p. 32) effectively capturing the very essence of speech pathology therein. In addressing their patients, speech therapists, as speech pathologists are sometimes referred to as, many disorders are encountered. These have been broadly encompassed into seven major categories depending on their causes. These are: disorders of the speech sound production including; articulation, apraxia, dysarthria, ataxia and dyskinesia. Resonance disorders include; hyper nasality, hypo nasality, cul-de-sac resonance and mixed resonance. Voice disorders include; phonation quality, pitch, loudness and respiration. Fluency may be affected by stuttering and cluttering.

In disorders caused by problems with speech voice production, apraxia is the most common. This has been explained termed by Wertz (in Helm-Estabrooks &Holland, 1998) as “a neurogenic speech disorder resulting from sensorimotor impairment of the capacity to program and execute in coordinated and normally timed sequences, the positioning of the speech musculature for the volitional production of speech sounds with loss of impairment of phonological rules not being adequate to explain the observed pattern of deviant speech” (Helm-Estabrooks &Holland, 1998, p. 12). Apraxia can be oral, affecting the patient’s ability to manipulate his/her jaw, lips or tongue. It can also be acquired as a result of stroke, tumor or head head trauma. Suggestions for therapy include working on large muscle groups by training them to refine movement (Vinson, 2001, p. 105.

Resonance disorders are most commonly caused by cleft palates, but sub mucous cleft palates cause this to occur mostly in children. Childhood apraxia, as well as enlarged adenoids also causes resonance disorders. VPDs, or velopharyngeal disorders are resonance disorders resulting from an inconsistent closure of the opening between the nose and mouth. During observation, resonance disorders are diagnosed through a variety of methods which vary from talking to the patient to assess articulation, standardized testing, nasometry and nasal endoscopy. All these are methods of identifying some of the most common resonance disorders such as hyper nasality. Treatment may involve the speech pathologist training the patient, mostly children, to use their velopharyngeal valve and tongue correctly in closing/opening either the mouth/nose cavity, or his/her recommendation for surgery in cases of cleft palates and velopharyngeal dysfunction.

Voice disorders are characterized by a distinct variation in quality of sound produced as a result of various causes depending on the specific disorder. Hoarseness is one of the most common, itself caused by a myriad of things; polyps, Nodules, vocal cord cysts, cancer of the vocal cords, granuloma, vocal cord scarring and vocal cord paralysis. Apart from those requiring surgical intervention, speech therapists are able to treat most of them using a mix of techniques varying from posture during telephone calls to proper use of your voice as well as avoiding misuse of the same.

Fluency disorders are caused by inappropriate interactions between the patient’s motor skills and his/her language skills. Stuttering is a common problem especially in children under the age of five. It is characterized by prolongation of syllables, inability to complete them and the use of interjections. Facial grimacing and avoidance of eye contact are other signs that accompany this disorder. Speech pathologists usually treat stuttering using desensitization to create awareness of oncoming stutter moments, speech modification using control strategies as well as structured activities aimed at building confidence and self esteem – important for this process. Samples of sentences given to investigate stutter should be analyzed for rate of speech according to Shipley & McAfee (1992).

Clinical services.Speech pathologists provide various clinical services that go into ensuring patients are assisted in reverting to or joining normal communication patterns and processes. After gathering data, speech pathologists assist in the process of guiding their patients in making decisions regarding what services to seek and their effectiveness. In addition, making service delivery decisions is a major task they are tasked with as things like the need for admission, location and discharge need to be made. Finally, as concerns this issue of service delivery, they aid in establishing the context in which therapy is to be administered. It can be done in school, at home, via tele-practice or at a specialized institution.

Speech pathologists screen individuals for hearing loss or middle ear pathology. This is done in collaboration with other professional to identify risk cases, infants and neonates as well as adults and children. Screening methods utilized include; pure-tone air conduction methods such as otoscopic inspection, otoacoustic emission screening and screening tympanometry. More specifically, instrumentation at the speech pathologist’s disposal includes; videofluoroscopy, electromyography, nasendoscopy, stroboscopy, nasometry, computer technology and endoscopy. Herein, data is collected, observed and compares with parameters set for communication and swallowing as well as other upper aerodigestive functions.

After screening, speech therapists provide individuals with hearing loss as well as other communication disorders with auditory training, speech therapy and language intervention. This is especially important for children with cochlear implants and listening amplification devices which should also be checked for normal function, volume and battery voltage. This comes hand in hand with selecting, fitting and training on proper use of adaptive and/or prosthetic devices for communication and swallowing, such as electrolarynges and speaking valves. It should be however noted that hearing aids are not the domain of speech pathologists as the ASHA (2004) points out.

Finally, speech therapists are tasked with the duty of assessing and addressing behavior that may influence communication as well as swallowing. This encompasses forums to discuss and demonstrate proper sitting in class, at home and office, as well as swallowing safety for all age groups. In addition to this form of proactive action, the provision of modification services to enhance human communication from the current transgender or professional perspectives lies squarely on speech pathologists. Sex changes therapy as well as professional modification, especially in an entertainment set up all requires the services of speech therapists.

Prevention and Advocacy. If people, especially children according to Tubelle (2008), develop or already have speech or language development disorders, they are observed to face certain difficulties in life’s many fields. This is why the prevention of such is of paramount importance. Providing early identification as well as intervention services has been demonstrated to aid in their prevention and increase in severity. The provision of adequate social- psychological environments at an early age has been discussed by Langmeier & Mateichek (1984) as contributory factors in development of communication and language disorders. Speech pathologist need to impress upon young parents on the need for providing such to their children.

Speech pathologist just like many other welfare professionals encourage healthy lifestyles as these have a wide spread and long lasting impact on the quality of life we lead. It has been proven that doing this can help prevent some communication disorders as well as swallowing issues human face in the course of life. Smoking offers a good example of a lifestyle that leads to a communication disorder as the smoke has been shown to lead to hoarseness and pitch changes. Wearing helmets and seatbelts can also reduce the chances of sustaining trauma to the head, a leading cause of apraxia among many other disorders.. Regular exercise should also enable the musculature develop, especially in young children, as Miltina(2005) shows by advocating for morning exercises in front of mirrors to assist the tongue and associated tissues develop properly.

Keeping away from injurious circumstances can help prevent individuals from sustaining injury to their ears. Children are especially prone to hearing damage given the fragility of their ear tissue. In addition, abuse harm, either physical or verbal can have large impacts on a person’s communication or aero-digestive system. It is important for parents, friends and family members to be able to identify signs of abuse in order to address them with the help of speech therapists since these have been proven to be underlying causes of speech and communication disorders.

The impact of culture on communication should be systematically eroded as some cultures implicitly encourage communication behavior that might lead to disorders. Vinson (2001) illustrates how the Native American individual is less likely to answer a rhetorical or leading question as this is considered an insult to elders (p. 314). This poses grave danger to children who need to understand the importance of questioning things as this is an avenue to learning. Carolina Piedmont culture also exhibits a shunning of answering questions as this is widely regarded to be a sign of being in trouble.

Some diseases have the potential to harm an individual’s capacity to communicate or swallow properly. Logemann(1998) described this as varying from child to child but generally “ children may exhibit oral reflexive behaviors ; inability to hold material in a cohesive bolus, especially if the material is being masticated; and/or disorganized lingual movements that do not contribute to a smooth peristaltic action of the tongue in moving the material posteriorly” (p. 324). Illnesses such as cerebral malaria and meningitis are quite harmful to a person’s executive function and brain function. Cerebral palsy affects the ability to swallow and control jaw muscles which predisposes the victim to communication as well as swallowing problems. Speech therapists encourage the prevention of contracting these illnesses to avoid developing communication problems.

A relationship between feeding and speech development has been long thought to exist and was recently proven. Individuals that lack the motor skills practice gained from eating have been noted to have lower intelligence since their speech is impaired as they grow. Pinder & Fogerty (1999) noted that children with good eating habits and development exhibited higher speech and communication skills since the act of eating exercised their oral motor skills. This had been demonstrated earlier by Evans-Morris & Klein (1989) who noted that “children with problems developing their motor skills for eating exhibited problematic development in forming intelligible speech”. To avoid this, children and invalid adults should be encouraged to feed themselves in order to develop the motor skills necessary for feeding, as well developing those for speech and communication.

Practice settings and ethical issues.

Professional setting for the speech therapist may vary from place to place depending on region and training. But the main areas where these professionals can operate from include; public and private schools, universities and their counseling centres, correctional institutions, corporate and industrial setting, private settings, early childhood centres, kindergartens and daycare centres as well as in various government set ups. However, the main settings we might find them are in hospital and medical care settings, so that they work in tandem with other professionals in a multi-discipline environment.

Speech pathologists are very much aware of the responsibility they have to their clients and society. This includes a wide variety of people from different backgrounds, sharing differing beliefs and holding onto different values. Students, focus groups, patients, family and friends as well as total strangers form this cleint base. This necessitates the need for a code of conduct and ethics which they are to use in order for their respective interests to be protected.

Should there be a violation of such ethics and professional standards, an effort at informal resolution should be made. If this is not possible, the violations should be reported to appropriate boards of ethics and tentative action followed. Failure to report any violation constitutes a violation itself in addition to endangering the execution of speech therapy by undermining its integrity in professionalism. Examples of ethical dilemmas that may face a speech pathologist working for example in the field of palliative care include: the decision whether or not oral intake should be replaced with enteric feeding as exemplified by Kinlaw (2005). Another dilemma would be making the deciding on a speech pathology intervention strategy when the person with palliative needs and their spouses, family and friends have contrasting wishes regarding treatment according to Tulsky (2005) ‘s example. Also, deciding if speech pathology and therapy is appropriate if clients administered with temporary care can be invited to participate in research activities/processes as shown by Riley & Ross (2005.

Historical practices and current trends.Historically, speech pathology as a profession and practice is traceable to the early Mesopotamian and Sumerian ages, but on a strictly scientific basis, it traces its roots to the 18th century works of men like Benjamin Franklin, Benjamin Rush and Jean Jacques Rousseau. These scientists might not have known it at the time, but the analysis of apoplexy – as stroke was known then and effects of paralysis on child socialization formed the most concrete foundation for speech pathology. These gave way to the early 20th century works of Samule Potter, Edward Wheeler and Sara Stinchfield., the first person in America to receive a PhD in speech pathology.

Early practice by these pioneers involved more of practice driven approaches to remedying speech and communication disorders, using sound bombardment, sound imitation and sequencing. This demonstrated a bias towards sound articulation rather than striking a balance between sound and motor skills, as is shown by Sinchfield-Hawk in 1938. However, more modern methods of assisting those suffering from these deficits were forwarded much later in the likes of Manolson’s(1992) social attunement principles, Bruner’s (1997) social reciprocity theory as well as Pound et al(2000) s’ work on aphasia.

Conclusion.It is evident how debilitating the lack of a good ability to communicate is to the human being, him being a social creature with high intelligence. Speech pathology has been with us for a very long time, during which is has evolved from hepatoscopy – the inspection of patient’s livers for signs of demonic traits in the ancient times, to an thoroughly systematic and documented scientific profession that seeks to restore one of man’s core needs, that of effective and efficient communication. In trying to research on the same, we have come across a good range of language and speech disorder examples and how they are generally managed, peeked into how best to avoid the occurrence of these serious conditions as well as raised a few ethical issues that an average practitioner might encounter. Finally, we had a short look at the history of speech pathology, historical practice and current trends. It is hoped that this research paper will leave a firm grasp of what speech pathology entails, as well as a general description and perspective in the practice, its challenges, competence and all issues relating to its practice.

References. Ball, M., & Damico, J. (2007). Clinical considerations. Clinical Aphasiology: Future Directions (p. 275). London: Routledge.

Byung, S., Duchan, J., & Pound, C. (2013). The Aphasia Therapy File, Volume 2. New Jersey: Psychology Press.

Irwin, D. (2007). Professionalism. Ethics for Speech-language Pathologists and Audiologists: An Illustrative Casebook (p. 156). Oklahoma: Cengage Learning.

Vinson, B. (2001). Counseling. Essentials for Speech-language Pathologists (p. 47). Miami: Cengage Learning.

Helm-Estabrooks, N. & Holland, A. L. (1998). The power of one: Every aphasia treatment case is a case study. In: N. Helm-Estabrooks and A. L. Holland (Eds). Approaches to the Treatment of Aphasia. San Diego, CA: Singular Publishing Group.  http://isbndb.com/d/book/approaches_to_treatment_of_aphasia/prices.html?t=1303754416

Cooper, P., & Stein, A. (2013). Mangament of infant feeding. Childhood Feeding Problems and Adolescent Eating Disorders (p. 1984). Massachussets: Routledge.

Beech, J., Harding, L., & Hilton-Johns, D. (1993). Assessments in Speech and Language Therapy NFER Assessment Library Routledge-NFER assessment library. Reading: CUP Archive.

Shippley, K., & McAfee, J. (2009). Assessment in Speech-language Pathology: A Resource Manual. London: Cengage Learning.

Murdoch, B. (2009). Speech and Language Disorders Associated with Subcortical Pathology. Melbourne: John Wiley & Sons.

Stinchfield-Hawk, S. (1950). Speech therapy for the physically handicapped. Boston: Stanford University Press.

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