When I mention my career in conversation, the next question that often comes up is something along the lines of “What do speech therapists do?” I must admit that I often have a hard time expressing the gist of my job in just a few words. Some people guess that I work on articulation of speech sounds, with people for whom English is their second language, or with individuals who are nonverbal. They are right, and then there’s so much more!
The scope of practice for a speech-language pathologist may surprise you. In fact, areas of practice are continually evolving. Here is an overview of service delivery areas in the practice of speech therapists:
When speech therapists say “speech” (as opposed to language), we are often talking about speech sound production. Articulation, phonological, and motor planning/execution disorders fall under this category.
The area of language includes spoken (listening and speaking) and written (reading, writing, spelling) language. Skill areas include grammar, semantics (vocabulary and meaning of words/sentences), pragmatics (social language), and paralinguistics (nonverbal communication). Early intervention speech therapists work on prelinguistic skills, which includes joint attention, intentionality, and other foundational pre-verbal skills.
The area of fluency includes stuttering and cluttering. Stuttering is defined as a fluency disorder characterized by the disruption of forward flowing speech. Stuttering typically presents as sound syllable repetitions, speech sound prolongations, and/or blocks (no sound) and may be accompanied by physical struggle and tension. Cluttering is a fluency disorder which is characterized by a rate of speech that is perceived to be abnormally rapid, irregular, or both.
Cognitive skills include attention, memory, problem-solving, and executive functioning skills. Some disorders that are associated with needs in these areas include attention deficit disorders, learning disabilities, developmental disorders, and dementia.
VOICE & RESONANCE:
Speech therapists also address issues related to voice and use of the vocal folds. This includes phonation quality, pitch and loudness, and alternative phonation methods. Resonance disorders occur when there is an opening, obstruction, or inconsistent movement that affects the way air flows through the speech system.
FEEDING & SWALLOWING:
This area includes all phases of feeding at various ages, including sucking, chewing, and swallowing. Feeding therapists also address negative mealtime behaviors and atypical eating patterns (e.g., food refusal, food selectivity, negative physiologic response). Some feeding therapists also assist with use of feeding tubes and individuals with complex medical disorders.
When speech therapy addresses speech, language, communication and/or listening skills impacted by hearing loss and/or deafness, it is considered aural habilitation or rehabilitation. Habilitation refers to improving the communication of an individual who has not yet developed these skills, typically in very young children. Alternatively, rehabilitation refers to restoring skills that are lost. Communication methods may include listening and spoken language, cued speech/language, and/or sign language.
There are also those areas in which speech therapists treat which are considered advantageous, but not medically urgent. Some examples include business communication, preventive vocal hygiene, professional voice use, and accent/dialect modification.
Phew! There is quite a range of skills, disabilities, and disorders that fall under the umbrella of speech therapy. Of course, not every speech therapist is an expert in every area.
Hope this was interesting and/or helpful! Did this spark your curiosity in any specific areas? Do tell!
Sarah Michael, SLP – National Speech/Language Therapy Center