Speech-Language Pathology

May is Better Speech and Hearing Month!

What Does a Speech-Language Pathologist Do?

A speech-language pathologist (SLP), or speech therapist, provides a wide range of services in the medical setting. Those services reach far beyond treating “speech” alone.

Did you know? SLPs have specialized education to treat changes with:

  • Cognitive-communication, including memory, attention, problem-solving, reasoning, and executive functions
  • Language, including changes with talking, listening, reading, or writing
  • Speech, including changes from respiration to articulation
  • Voice
  • Swallowing
  • Social Pragmatics

SLPs treat changes with these functions due to a variety of disorders, including:

  • Stroke or Brain Injury
  • Head or Neck Cancer
  • Neurodegenerative disorders
  • Other acquired illnesses or disorders
  • Traumatic Brain Injuries
  • Voice Traumas

An SLP will help determine what the difficulty is, so that a personalized therapy plan can be made for you. Speech therapy will focus on a plan that makes participation easier for the things you need to do.

Cognitive-communication changes can occur after brain injury or changes including stroke, brain injury, tumor, or neurodegenerative diseases.

A speech-language pathologist is specially trained to treat cognitive-communication disorders in order to maximize life participation and brain neuroplasticity. Every person has different needs, so your therapy time could include:

  • Treatment focused on improving cognition
  • Strategies to improve life participation
  • Technology or language supports to improve participation
  • Changes in the environment to improve participation.
  • Communication partner training
  • Role play and real-life activities practice.
  • Education, counseling, and support

There is hope for improvement in life participation with cognitive-communication disorders - because of brain neuroplasticity. Brains are amazing! It is possible for brains to make new neuron connections and strengthen old and new pathways - even when damage has occurred in the brain.

Medical Settings For SLP

Speech therapy can occur in many medical therapy settings. Your unique plan may be impacted by your medical status, location, insurance coverage, and your input.

Speech therapy settings may include:

Acute Care: Medical care occurring in the hospital after a sudden medical change happens in acute care. This is likely where you will see speech therapy for the first time for an evaluation. In the US, average stays are 1 week or less, but vary by client.

Inpatient Rehab Some clients qualify for intensive rehabilitation with multiple therapies at an inpatient rehab facility. Speech therapy may be as frequent as 5-7x/week. In the US, average stays are about 2 weeks, but vary by client.

Skilled Nursing Facility: Some clients may complete rehabilitation at a skilled nursing facility if they are unable to tolerate intensive therapy. Therapy services will vary based on the client’s case and needs. In the US, average stays are 3-4 weeks, but vary by client.

Home Health Therapy: Clients may be referred for ongoing therapy to take place within their home. These appointments are typically a few times each week and may last for several weeks.

Outpatient Therapy: Clients may be referred for ongoing therapy at a clinic or facility. These appointments are typically a few times each week. These appointments may continue for several months but vary by client.

Long-Term Care: Clients may be referred to a long-term acute care hospital if they require ongoing complex medical services. Therapy will be part of the team, but services will vary based on the client’s case.

University / Community Clinic: Your area may have community or university clinics. Typically, no insurance is required to qualify. Often, clients find out about these services if there are insurance coverage issues for traditional speech therapy.

What is dysphagia?

People with dysphagia have difficulty swallowing and may even experience pain while swallowing (odynophagia). Some people may be completely unable to swallow or may have trouble safely swallowing liquids, foods, or saliva. When that happens, eating becomes a challenge. Often, dysphagia makes it difficult to take in enough calories and fluids to nourish the body and can lead to additional serious medical problems.

How do we swallow?

Swallowing is a complex process. Some 50 pairs of muscles and many nerves work to receive food into the mouth, prepare it, and move it from the mouth to the stomach. This happens in three stages. The first stage, called the oral phase, the tongue collects the food or liquid, making it ready for swallowing. The tongue and jaw move solid food around in the mouth so it can be chewed. Chewing makes solid food the right size and texture to swallow by mixing the food with saliva. Saliva softens and moistens the food to make swallowing easier. Normally, the only solid we swallow without chewing is in the form of a pill or caplet. Everything else that we swallow is in the form of a liquid, a puree, or a chewed solid.

The second stage begins when the tongue pushes the food or liquid to the back of the mouth. This triggers a swallowing response that passes the food through the pharynx, or throat (see figure). During this phase, called the pharyngeal phase, the larynx (voice box) closes tightly and breathing stops to prevent food or liquid from entering the airway and lungs.

The third stage begins when food or liquid enters the esophagus, the tube that carries food and liquid to the stomach. The passage through the esophagus, called the esophageal phase, usually occurs in about three seconds, depending on the texture or consistency of the food, but can take slightly longer in some cases, such as when swallowing a pill.


Voice Disorders

voice disorder occurs when voice quality, pitch, and loudness differ or are inappropriate for an individual's age, gender, cultural background, or geographic location.  A voice disorder is present when an individual expresses concern about having an abnormal voice that does not meet daily needs—even if others do not perceive it as different or deviant.

A number of different systems are used for classifying voice disorders. For the purposes of this document, voice disorders are categorized as follows:

  • Organic — voice disorders that are physiological in nature and result from alterations in respiratory, laryngeal, or vocal tract mechanisms.
    • Structural — organic voice disorders that result from physical changes in the voice mechanism (e.g., alterations in vocal fold tissues such as edema or vocal nodules; structural changes in the larynx due to aging)
    • Neurogenic — organic voice disorders that result from problems with the central or peripheral nervous system innervation to the larynx that affect functioning of the vocal mechanism (e.g., vocal tremor, spasmodic dysphonia, or paralysis of vocal folds)
  • Functional — voice disorders that result from improper or inefficient use of the vocal mechanism when the physical structure is normal (e.g., vocal fatigue; muscle tension dysphonia or aphonia; diplophonia; ventricular phonation)