Who is a Speech Language Pathologist?
A Speech Language Pathologist (commonly referred to as an SLP or speech therapist) is a professional who assesses, diagnoses, treats and helps prevent disorders related to speech, language, cognition, voice, swallowing and fluency. Each of these disorders are described briefly below.
SLPs work with a wide variety of people, ranging from infants to the elderly. Some SLPs choose a specialty area to focus their practice and/or research such as swallowing or voice disorders. Others opt to specialize and work with a particular population such as pediatrics or adults. However, most SLPs typically work with a range of disorders and treat people across the lifespan during the span of their careers.
Which settings do Speech Language Pathologists work in?
Speech Language Pathologists provide professional services in a wide variety of settings, such as:
- rehabilitation centers
- skilled nursing facilities (SNFs)
- community clinics
- colleges and universities
- private practice
- state and local health departments
- state and federal government agencies
- home health care
- adult day care centers
- centers for persons with developmental disabilities
- early intervention centers
- research laboratories
- private agencies
Who is a Medical Speech Language Pathologist?
Medical SLPs are speech language pathology professionals who predominantly work in medical settings. The settings within the healthcare environment are diverse and may include acute care hospitals, long term acute care hospitals, inpatient rehabilitation settings, outpatient settings, sub-acute rehabilitation, skilled nursing facilities (SNFs), long term care facilities, NICU (neonatal intensive care unit) settings, private clinics as well as home health care settings.
Medical SLPs are a critical and integral part of every healthcare setting. Their expertise provides invaluable benefits to the patients as well as the team in managing disorders that affect the patient’s overall health, well-being and quality of life. The skills and expertise of SLPs in healthcare settings cannot be duplicated by members of any other profession.
Which disorders do Medical SLPs help diagnose and treat?
A Medical SLP can help diagnose and treat the following disorders:
- Speech Disorders
- Language Disorders
- Voice and Fluency Disorders
- Swallowing/Feeding Disorders
- Cognitive-Communication Disorders
Medical SLPs may also have expertise and specialized training in working with patients with head/neck cancers, trach/vent dependent patients, patients who may require AAC (Augmentative and Alternative Communication) options and more. Each of these have been summarized briefly below.
What are speech disorders? What is ‘dysarthria’ and ‘apraxia’?
When a person is unable to produce speech sounds correctly or fluently, or has problems with his or her voice, then he/she is said to have a speech disorder. Although voice and fluency disorders are essentially a subcategory of speech disorders, they have been discussed separately in the questions that follow for ease of understanding.
Two common speech disorders that a Medical SLP helps diagnose and treat are ‘dysarthria’ and ‘apraxia’ of speech, which have been discussed below. In addition to these, SLPs may also help treat articulation disorders associated with cleft lip/palate, orofacial myofunctional disorders and/or other speech sound disorders associated with developmental, neurological and genetic conditions.
Dysarthria is a motor speech disorder. The muscles of the mouth, face, and respiratory system may become weak, move slowly or do not move at all after a stroke or other brain injury.
This may result in any or all of the following symptoms, depending on the site and extent of damage:
- Slurred speech
- Slow rate of speech
- Rapid rate of speech with a mumbling quality
- Limited tongue, lip, and jaw movements
- Abnormal intonation (rhythm)
- Changes in vocal quality
- Abnormal intensity (loudness) of voice
- Drooling or poor control of saliva
- Chewing and swallowing difficulties
Dysarthria may be caused by any condition affecting the nervous system such as:
- Brain injury
- Cerebral palsy
- Parkinson’s disease
- Lou Gehrig’s disease/Amyotrophic Lateral Sclerosis (ALS)
- Huntington’s disease
- Multiple Sclerosis
- Side effects of medications
Both children and adults can have dysarthria. The treatment depends on the cause, type, and severity of the symptoms. A skilled Medical SLP works with the child or adult utilizing a number of therapy techniques and/or compensatory strategies to improve his/her communication abilities and overall quality of life.
Apraxia of Speech
Apraxia of speech is a motor speech disorder. It is caused by damage to the parts of the brain related to speaking. Other terms include acquired apraxia of speech, verbal apraxia and dyspraxia. When children have apraxia, it is commonly referred to as childhood apraxia of speech.
People with apraxia of speech have trouble sequencing the sounds in syllables and words. The severity depends on the nature of the brain damage. They know what words they want to say, but have difficulty coordinating the muscle movements necessary to produce those words.
Apraxia of speech can be mild or severe. People with apraxia may demonstrate the following symptoms:
- difficulty imitating speech sounds
- difficulty imitating non-speech movements (oral apraxia)
- groping behavior when trying to produce sounds
- an inability to produce sounds at all (in severe cases)
- inconsistent errors
- slow rate of speech
- somewhat preserved ability to produce automatic speech (rote speech),
Apraxia can occur in conjunction with dysarthria (muscle weakness affecting speech production) or aphasia (language difficulties related to neurological damage).
An SLP works with people with apraxia of speech to improve speech abilities and overall communication skills. The muscles of speech often need to be ‘retrained’ to produce sounds correctly and sequence sounds into words. Exercises are designed to allow the person to repeat sounds over and over and practice correct mouth movements for sounds. In severe cases, augmentative and alternative communication options may be necessary.
What are language disorders? What is ‘aphasia’?
When a person has trouble understanding others (receptive language), or sharing thoughts, ideas and feelings completely (expressive language), then he or she is said to have a language disorder. More specifically, a language disorder is the impaired comprehension and/or use of spoken language, written language and/or other symbol systems.
Language disorders may be developmental in nature and may be carried forward into adulthood or may be acquired. The most common acquired language disorder is called ‘aphasia’ and has been discussed below:
‘Aphasia’ is an acquired neurogenic language disorder resulting from an injury to the brain, most typically the left hemisphere, that affects all language modalities. Aphasia is not a single disorder, but instead is a family of disorders that involve varying degrees of impairment in four primary areas:
- spoken language expression
- spoken language comprehension
- written expression
- reading comprehension
A person with aphasia often has relatively intact nonlinguistic cognitive skills, such as memory and executive function skills, although these and other cognitive deficits may co-occur with aphasia. Sensory deficits such as auditory and visual agnosia and visual field deficits (e.g., hemianopia or visual field cuts) may also be present.
Aphasia symptoms vary across individuals, with some of the variation being related to the neural regions that are damaged and to the extent of that damage. Some common symptoms of aphasia are listed below:
A. Verbal Expression Impairments
- difficulty finding words (anomia)
- speaking with effort
- speaking in single words
- speaking in short, fragmented phrases
- omitting smaller words like ‘the’, ‘of’ and ‘was’ (telegraphic speech)
- putting words in the wrong order
- substituting sounds and/or words
- making up words (e.g., jargon)
B. Auditory Comprehension Impairments
- difficulty understanding spoken utterances
- providing unreliable answers to ‘yes/no’ questions
- failing to understanding complex grammar
- requiring extra time to understand spoken messages
- misinterpreting subtleties of language
- lacking awareness of errors
Very often, a person with aphasia experiences both expressive and receptive difficulties, but each to varying degrees. In addition, the person with aphasia may have similar (parallel) difficulties in written expression and reading comprehension as well.
C. Reading Comprehension Impairments (Alexia)
- difficulty comprehending written material
- difficulty recognizing some words by sight
- inability to sound out words
- substituting associated words for a word
- difficulty reading non-content words (e.g., function words such as ‘to’, ‘from’, ‘the’)
D. Written Language Impairments (Agraphia)
- difficulty writing or copying letters, words, and sentences
- writing single words only
- substituting incorrect letters or words
- spelling or writing nonsense syllables or words
- writing sentences with incorrect grammar
Aphasia is caused by damage to the language centers of the brain. In most people, these language centers are located in the left hemisphere, but aphasia can also occur as a result of damage to the right hemisphere. Common causes of aphasia are:
-ischemic: blockage that disrupts blood flow to a region of the brain
-hemorrhagic: a ruptured blood vessel that damages surrounding brain tissue
- traumatic brain injury
- brain tumors
- brain surgery
- brain infections
- other neurological diseases (e.g., Dementia)
Speech-language pathologists (SLPs) play a central role in the screening, assessment, diagnosis and treatment of persons with aphasia. Treatment for the individual with a speech or language disorder may target specific sounds, sound patterns or language to improve overall intelligibility. The treatment plan is individualized in each person’s situation to target the needs of the individual and ultimately improve the quality of life.
What are feeding/swallowing disorders? What is ‘dysphagia’?
Feeding and swallowing disorders (also known as dysphagia) include difficulty with any step of the feeding and swallowing process—from accepting foods and liquids into the mouth to the entry of food into the stomach and intestines. Dysphagia is very common in children as well as adults.
Dysphagia can occur in any phase of the swallow. Although there are differences in the relationships between anatomical structures and in the physiology of the swallowing mechanism across the age range, typically, the phases of the swallow are defined as:
- ORAL PREPARATORY PHASE: preparing the food or liquid in the oral cavity to form a bolus; including sucking liquids, manipulating soft boluses and chewing solid food.
- ORAL TRANSIT PHASE: moving or propelling the bolus posteriorly through the oral cavity.
- PHARYNGEAL PHASE: initiating the swallow; moving the bolus through the pharynx.
- ESOPHAGEAL PHASE: moving the bolus through the cervical and thoracic esophagus and into the stomach via esophageal peristalsis (Logemann, 1998).
A feeding or swallowing disorder in children includes developmentally atypical eating and drinking behaviors, such as not accepting age-appropriate liquids or foods, being unable to use age-appropriate feeding devices and utensils, or being unable to self-feed. A child with dysphagia may refuse food, accept only a restricted variety or quantity of foods and liquids, or display mealtime behaviors that are inappropriate for his or her age.
Pediatric dysphagia may result from a number of causes such as nervous system disorders (e.g., cerebral palsy, meningitis, encephalopathy), gastrointestinal conditions, prematurity and/or low birth weight, cleft lip and/or palate conditions affecting the airway and autism to name a few.
Children with pediatric dysphagia may have a wide variety of symptoms. Not all signs and symptoms are present in every child.
Following are some of the common signs and symptoms of dysphagia seen in very young children:
- refusing food or liquid
- failure to accept different textures of food
- long feeding times (e.g., more than 30 minutes)
- difficulty chewing
- difficulty breast feeding
- coughing or gagging during meals
- excessive drooling or food/liquid coming out of the mouth or nose
- difficulty coordinating breathing with eating and drinking
- increased stuffiness during meals
- frequent spitting up or vomiting
- recurring pneumonia or respiratory infections
- less than normal weight gain or growth
Some of the long-term effects for a child diagnosed with pediatric dysphagia include:
- poor weight gain and/or malnutrition
- aspiration pneumonia
- compromised pulmonary status
- food aversion
- oral aversion
- rumination disorder
- ongoing need for enteral or parenteral nutrition
Speech-language pathologists play a key role in the assessment, diagnosis and treatment of infants and children with swallowing and feeding disorders.
Dysphagia in Adults
Swallowing disorders are very common in adults and in the geriatric population as well. These could affect one or all phases of the swallow function listed above. Dysphagia in adults may result from several neurological impairments, medical conditions, trauma and a number of surgical interventions.
Some common signs and symptoms of dysphagia include:
- coughing during or right after eating or drinking
- wet or gurgly sounding voice during or after eating or drinking
- extra effort or time needed to chew or swallow
- food or liquid leaking from the mouth or getting stuck in the mouth
- recurring pneumonia or chest congestion after eating
- weight loss or dehydration from not being able to eat enough
Dysphagia in adults may result in:
- poor nutrition
- risk of aspiration (food or liquid entering the airway), which can lead to pneumonia and chronic lung disease
- less enjoyment of eating or drinking resulting in decreased quality of life
- embarrassment or isolation in social situations involving eating
- dependence on enteral or parenteral nutrition
SLPs play an essential role in the diagnosis of dysphagia by performing bedside swallow evaluations, endoscopic evaluations of swallow and/or videofluoroscopic evaluations of swallow function. Once the deficits are diagnosed, the treatment would differ based on the underlying cause, nature of the deficits and severity of the impairments.
An SLP may recommend:
- specific dysphagia therapy (exercises to improve muscle movement and swallow function)
- positions or strategies to help the individual swallow more effectively
- specific food and liquid textures that may be easier and safer to swallow (modified diet)
Thus, SLPs play a critical role in the assessment and treatment of dysphagia in children and adults. Majority of the caseload of a medical SLP involves dysphagia. SLPs in the United States may choose to obtain Board Recognition in the specialty area of swallowing and swallowing disorders as well. Information about this can be found at http://www.swallowingdisorders.org. You could also visit the National Foundation of Swallowing Disorders website for additional resources.
What are voice disorders?
A voice disorder is an abnormality of one or more of the three characteristics of voice: pitch, intensity (loudness), and quality (resonance).
- Pitch may be described as the relative tone of a person’s voice. A disorder may result from pitch being inappropriate for an individual’s age and gender. An inability to perceive pitch and pitch patterns may result in a monotonous voice, a high-pitched voice or inappropriate use of repeated pitch patterns.
- Loudness describes the volume or intensity of a person’s voice. A person who spends a great deal of time in a noisy location or who is suffering from hearing loss may speak with high intensity, or louder than normal. A soft or inaudible voice may be associated with a psychological condition such as shyness or with a structural defect of the vocal cords.
- Disorders of voice quality are related to how the vocal cords function. Breathiness is caused by vocal cord vibration that does not have a closed phase, while hoarseness is caused by vocal cords that are closed too tightly, so they cannot vibrate properly. Other disorders are related to how the voice resonates. If the nasal passage becomes blocked such as with a cold, then air is unable to reach the nasal cavity and a voice sounds hyponasal. Hypernasality results when too much air passes through the nasal cavities during phonation or when there is an obstruction in the anterior nasal cavities.
Voice disorders are more common than most people realize. Most voice disorders are caused by misuse of the voice and vocal abuse. Other voice disorders may result from a virus or a surgical procedure. Certain medical conditions (such as reflux, dystonias, allergies, asthma, effects of certain medications) and lifestyle habits (such as smoking, alcohol, sodas, caffeine, insufficient hydration) can also affect the voice.
Voice therapy with an SLP primarily involves learning how to produce the voice without strain, using proper breath support for conversation and vocal projection (if necessary), reducing excessive muscle tension, using alternatives to vocal misuse habits, relaxation techniques, vocal and non-vocal warm-up techniques, proper hydration and dietary guidelines regarding reflux precautions and education about how the voice works. Most importantly, voice therapy techniques help unlearn old habits and create new, healthy habits that become second-nature, last a long time, and restore the person’s ability to communicate with ease in a variety of situations.
What are fluency disorders? What is ‘stuttering’ and ‘cluttering’?
Fluency disorders are those that affect the natural flow of speech. Specifically, a fluency disorder is an interruption in the flow of speaking, characterized by atypical rate, rhythm and repetitions in sounds, syllables, words and phrases.
Fluency disorders may be developmental, psychogenic or could result from a neurological disease or pharmacological reaction. The most commonly known fluency disorder is stuttering. In addition to stuttering, some people may also have a lesser common fluency disorder known as cluttering. Both of these have been discussed further.
Stuttering is a fluency disorder characterized by disruptions in the production of speech sounds, also called ‘dysfluencies’. The flow of speech is disrupted by involuntary repetitions and prolongations of sounds, syllables, words or phrases as well as involuntary silent pauses or blocks in which the person who stutters is unable to produce speech sounds fluently.
- Developmental Stuttering: Stuttering is typically a developmental disorder beginning in early childhood and continuing into adulthood in at least 20% of affected children. In developmental stuttering, the speaker knows what words he/she wishes to convey, but is unable to easily initiate the act of speaking or produce the words without repetitions or prolongations of the sounds. This type of stuttering is felt to occur when a child’s speech and language abilities are unable to meet his or her verbal demands. Developmental stuttering is usually outgrown.
- Acquired Stuttering: In some cases, stuttering may be acquired in adulthood as the result of a neurological event such as a head injury, tumour, stroke, or drug use. This stuttering has different characteristics from its developmental equivalent: it tends to be limited to part-word or sound repetitions, and is associated with a relative lack of anxiety and secondary stuttering behaviors. Fluency disorders resulting from neurological trauma and disease have been given many labels including: acquired stuttering, cortical stuttering, and neurogenic stuttering. They have been documented to be transient or persistent, and an independent speech disorder or a symptom of a neurological disease. It is rare in comparison to developmental stuttering.
- Psychogenic Stuttering: Psychogenic stuttering usually arises after a traumatic experience. It’s symptoms tend to be homogeneous: the stuttering is of sudden onset and associated with a significant event, it is constant and uninfluenced by different speaking situations, and there is little awareness or concern shown by the speaker. Psychogenic stuttering occasionally occurs in individuals who have some types of mental illness or individuals who have experienced severe mental stress or anguish.
Most treatment programs for people who stutter are ‘behavioral’. Treatment strategies and techniques are tailored based on the person’s diagnosis and symptoms. They are designed to teach the person specific skills or behaviors that lead to improved oral communication. Over time, people learn to produce smooth speech at faster rates, in longer sentences, and in more challenging situations until speech sounds both fluent and natural. ‘Follow-up’ or ‘maintenance’ sessions with the SLP are often necessary after completion of formal intervention to prevent relapse.
Cluttering involves excessive breaks in the normal flow of speech that seem to result from disorganized speech planning, talking too fast or in spurts, or simply being unsure of what one wants to say. By contrast, the person who stutters typically knows exactly what he or she wants to say but is temporarily unable to say it. To make matters even more confusing, since cluttering is not well known, many who clutter are described by themselves or others as ‘stuttering’. Also, and equally confusing, cluttering often occurs along with stuttering.
Cluttering may be accompanied by any of the following:
- Confusing, disorganized language or conversational skills
- Limited awareness of fluency and rate of speech
- Mispronunciation or slurring of speech sounds
- Speech that is difficult to understand
- Social or vocational problems resulting from cluttering symptoms
- Sloppy handwriting
- Distractibility, hyperactivity, or a limited attention span
- Auditory perceptual difficulties
The SLP plays a critical role in the diagnosis and treatment of cluttering, especially since it is such a rare disorder. Therapy for cluttering is tailored to the client’s unique difficulties since there is limited data available regarding the standard procedures for treatment. Nevertheless, a number of therapeutic strategies have been recommended over the years, many of which have been effective with clutterers.
What are cognitive-communication disorders?
Cognitive-communication disorders include difficulty with any aspect of communication that is affected by a disruption of one or more cognitive processes. Examples of cognitive processes include: attention, memory, organization, problem solving/reasoning, and executive functions. Cognitive-communication disorders may be mild or severe enough to affect activities of daily living, academic and work performance.
Cognitive-communication disorders may result from strokes, brain injuries, tumors, neurological diseases, certain medications or even alcohol and drug abuse. It is ASHA’s position statement that speech-language pathologists play a primary role in the screening, assessment, diagnosis, and treatment of infants, children, adolescents, and adults with cognitive-communication disorders.
Symptoms of cognitive communication disorders vary widely depending on the type, severity and cause of the disorder. The treatment and therapy would thus depend greatly on the type of disorder, underlying cause and severity of symptoms. Cognitive communication disorders commonly seen by medical SLPs include those resulting from Dementia, Right Hemisphere Dysfunction (RHD) and Traumatic Brain Injuries (TBI). Each of these have been discussed below:
Traumatic Brain Injury (TBI)
TBI results from a variety of etiologic factors including motor vehicle accidents, falls, gunshot wounds or any other trauma involving a blow to the head. The extent of trauma following TBI is determined by a combination of primary damage caused by impact to the head, and secondary damage resulting from such factors as infection, oxygen deprivation, brain swelling, and elevated intracranial pressure.
No two injuries are the same; consequently, TBI results in a diverse, idiosyncratic constellation of cognitive-communicative, physical, and psychosocial deficits. The most common consequence of TBI is a reduced capacity to pursue premorbid interests and daily activities at the same functional level. Such difficulties exist along a broad continuum that can range from needing additional time to complete tasks to near total dependence on others for all basic needs.
The most characteristic features of TBI are the resulting cognitive disturbances that are often present after the injury. Multiple areas may be disrupted, including attention, memory, organization, reasoning, executive functioning, communication, and social skills. Recovery following TBI progresses through a series of predictable stages. However, it is important to emphasize that recovery is specific to individual circumstances and therefore may vary in both extent and rate. Pre-injury abilities, personality of the individual, and severity of the injury all influence recovery.
Following TBI, a person may have difficulties in the following areas:
- expressing thoughts and ideas
- comprehending spoken or written language
- taking turns in conversation
- maintaining a topic of conversation
- using an appropriate tone of voice
- interpreting the subtleties of conversation
- responding to facial expressions and body language
- keeping up with others in a fast-paced conversation
TBI also results in a number of cognitive impairments. Cognition (thinking skills) includes an awareness of one’s surroundings, attention to tasks, memory, reasoning, problem solving, and executive functioning (e.g., goal setting, planning, initiating, self-awareness, self-monitoring and evaluation). Each of these may be affected and impaired to varying degrees in a person after TBI, depending on the location and severity of the injury to the brain.
The SLP works with the person and his or her family/caregivers as part of a team to evaluate the person and develop an appropriate treatment plan. The treatment program and therapy sessions will vary depending on the stage of recovery, but it will always focus on increasing independence in everyday life.
Right Hemisphere Dysfunction (RHD)
Right hemisphere dysfunction results from damage to the right side of the brain.In most people, the left side of the brain contains the person’s language centers and is primarily responsible for language. The right side controls specific cognitive functions and more abstract skills. Damage to the right hemisphere of the brain leads to a number of cognitive-communication deficits, including difficulty with the following:
- problem solving
- social communication
- left-sided neglect
- impaired awareness of deficits (anosognosia)
The SLP plays an important role if often diagnosing somebody with RHD. The SLP identifies the deficits and works with the person to improve his or her overall cognitive-communication abilities.
Dementia is a group of symptoms related to memory loss and overall cognitive impairment. Most types of dementias continue to worsen and are usually irreversible. Alzheimer’s disease is the most common and well-studied cause of dementia, affecting up to 70% of those diagnosed with dementia.
Individuals with dementia are often on the caseloads of speech-language pathologists working in all sectors of health care, from acute to long-term care settings. The symptoms of dementia can be different depending on the diagnosis. In most cases, people with dementia have a gradual loss of memory and other cognitive functions.As the disease gets worse, an individual may experience the following:
- Difficulty on the job
- Getting lost in familiar areas
- Problems handling personal affairs
- Personality changes
- Depression (as the person recognizes his or her deficits)
- Significant memory loss
- Difficulty following simple directions
- Decreasing communication skills
- Difficulty swallowing
- By the final stages: inability to self fee, walk independently, or speak intelligibly.
Several medications exist that seem to slow down the progression of symptoms, but they do not reverse the disease. More often, behavioral interventions are used to help the person recall important information or performing daily activities.
A speech-language pathologist (SLP) can help the person with dementia use strategies to preserve communication and cognitive functioning for as long as possible. The SLP works to increase reliance on more intact cognitive abilities and compensate for deficient ones. Several treatment techniques are available to help individuals with dementia achieve optimal cognitive-communication function.
What role does an SLP play with head and neck cancer patients?
People who have been treated for head and neck cancer, such as laryngeal cancer or oral cancer, often experience swallowing problems (dysphagia). The seriousness of the swallowing problem depends on the type and nature of the treatment, the size and location of the tumor and the nature of reconstruction, if any.
Speech-Language pathologists work as an integral part of the cancer rehabilitation team and help to educate the patient and caregivers throughout intervention. The goal is to maximize swallow and communicative function as well as to assist in the maintenance of quality of life.
Speech-Language pathologists play an important role in the management of head/neck cancer patients as follows:
- Weaning from a tracheostomy tube for surgical patients.
- Training in secretion management and airway protection exercises.
- Swallowing assessment via clinical evaluation and/or instrumental evaluation such as the modified barium swallow study (MBSS) or laryngoendoscopic evaluation of the swallow (FEES).
- Training in swallowing exercises to improve the strength and movement of the oral/pharyngeal structures.
- Education and management of the effects of chemo/radiation treatment including reinforcement of dental hygiene and pain management techniques.
- Assisting patients on tube and/or oral diets to increase oral intake and decrease tube feeding dependence in conjunction with a cancer dietician.
For communication, the SLP plays a critical role by assisting the patient with:
- Pre and post operative counselling
- Training in stoma care
- Training in the use of an electrolayrnx or one-way speaking valve
- Training in the use of an augmentative communication device
- Compensatory strategies to improve speech intelligibility
- Training in vocal hygiene and voice remediation
The SLP typically follows the patient throughout their course of medical treatment and beyond. As cancer rehabilitation professionals, SLPs pay close attention to the patient’s individual needs, priorities and tailor the treatment plans to best meet the patient’s goals. The primary focus is on maintaining health, safety and most importantly quality of life.
What role does an SLP play with trach/vent dependent patients?
Patients with respiratory failure and distress are now surviving with the help of medical advances including tracheostomy tubes and mechanical ventilation.
Tracheostomy: A tracheostomy is a surgical opening in the windpipe (trachea). A tube is placed in the opening, and air goes in and out through the tube instead of through the mouth and nose. For some, a tracheostomy is short-term. For others, it is long-lasting or permanent. People who have a tracheostomy cannot speak in the same way as those who do not. Air no longer passes through the vocal folds so the person cannot produce sounds easily.
Ventilator: For some people, a tracheostomy tube alone may not be enough. The tube may need to be connected to a breathing machine (ventilator) that provides a mixture of gases for life support. People on ventilators can speak as long as the tracheostomy tube allows air to flow through the vocal folds. However, the speech patterns of ventilator users may sound different.
Patients: The trach/vent dependent patients often are medically fragile with a complex variety of diagnoses including respiratory failure, spinal cord injury, cardiac complications, cerebrovascular accidents and complex neurological disorders. Ages vary but the majority of patients are adults. Speech-language pathologists help these patients regain verbal communication and return to oral intake of food—both of which are essential for maintaining a good quality of life.
Settings: At one time, adults with tracheostomies and ventilator-dependence were found only in hospitals, in intensive or acute care beds. Today, these patients are no longer found solely in intensive care units of hospitals, but may progress to long-term acute care, subacute, extended care, and community (home care) settings.
Role of the SLP: The role of the SLP in the care of adults with tracheostomies and ventilator-dependence has evolved as the medical management of these complex patients has changed. Further advances in the area of mechanical ventilation, in conjunction with the ability to treat infections and manage chronic pulmonary conditions, have resulted in many patients living out a significant part of their remaining lifespan as ventilator dependent.
Consults for adults with tracheostomies and/or ventilator-dependence often include a request to assess swallowing safety. Although a causal relationship has not been clearly established, most clinicians working with this population will encounter varying degrees of disordered swallowing. This finding may be related to the complications inherent in tracheostomy and ventilator-dependence, associated procedures, or the co-morbidities that actually precipitated the respiratory failure.
The SLP typically evaluates the person’s cognitive and language skills, oral-motor and swallowing functioning and ability to produce voice in different situations. Whatever communication method is recommended for the person, the SLP plays a central role in making sure that the person and his or her caregivers know how to maximize communication. Thus, the use of tracheostomies and ventilators is life sustaining. But it is the Speech-Language Pathologist who helps these patients regain their speech and swallowing functions to help make their life enriching.
Are there communication options for people who cannot speak?
When children or adults cannot use speech to communicate effectively in all situations, there are other options referred to as Augmentative and Alternative Communication options or AAC.
The term augmentative means supplemental or additional to speech, such as the use of gestures, facial expressions etc. The use of the term alternative acknowledges that there are some individuals whose speech is sufficiently impaired that they must rely completely on systems which do not augment speech but are alternatives to speech for communication.Augmentative and alternative communication (AAC) thus includes all forms of communication (other than oral speech) that are used to express thoughts, needs, wants, and ideas.
People with severe speech or language problems rely on AAC to supplement existing speech or replace speech that is not functional. Special augmentative aids, such as picture and symbol communication boards and electronic devices, are available to help people express themselves. This increases social interaction, performance and feelings of self-worth.
Augmentative and Alternative Communication (AAC) is a dynamic area of specialisation in the field of speech-language pathology that is changing rapidly due to advances in technology and an active international research endeavour. The SLP plays a critical role in determining candidacy for AAC, training the individual and caregivers to effectively utilize the AAC system and maximize communication, advocate the use of AAC and facilitate the effective use of the AAC system to help promote and maintain the individuals quality of life.