What Is Speech-Language Pathology? Rehab Therapy’s Unsung Hero

Two things that are a critical part of nearly everyone’s daily life are communication and swallowing. We communicate to express our feelings, share knowledge, connect with others, and much more. Additionally, the act of swallowing is designed to propel food and liquids from the mouth to the stomach for digestion, and importantly, to protect our airway. Both functions are absolutely vital for survival, so when barriers to their proper function arise, interventions, like speech-language pathology (SLP), are essential.

So precisely what is speech-language pathology? Compared to other healthcare professions, there’s much lower public awareness of speech-language pathology services. Additionally, there’s uncertainty regarding how it integrates with other healthcare specialties. Today, we’ll examine what this profession entails and its role within the broader healthcare landscape. 

So, What Is Speech Language Pathology? 

Also known as speech therapy, speech-language pathology is a field dedicated to assessing, diagnosing, treating, and preventing communication and swallowing disorders. The experts in this field are officially known as speech-language pathologists, or SLPs, for short. However, they’re often referred to as speech therapists as well.

When Did the Field of Speech Language Pathology Emerge?

According to one essay, the field of SLP debuted in the early 1900s, influenced by a prevailing desire for speech that was more precise, efficient, and productive. Following World War I, a significant observation was made: many veterans were struggling with communication disorders as a result of brain injuries. This widespread issue led to a clearer understanding in the United States that individuals with speech difficulties require specialized assistance, spurring national efforts to provide that support. Consequently, in 1925, the American Academy of Speech Correction was established, an organization now known as the American Speech-Language-Hearing Association (ASHA).

The field of modern speech correction was founded as a fundamentally scientific institution, vastly different from what had existed before. There were now professional records that highlighted stuttering as a significant focus at the time. In fact, stuttering accounted for five times more published articles than the average of the other ten ‘speech defect’ categories, which encompassed conditions like aphasia, articulation disorders, cerebral palsy, and cleft palate. 

Who Do Speech Language Pathologists Treat?

When most people think of SLPs, they envision them only treating young children, but that’s not all they do. Speech-language pathologists assist people of all ages, from toddlers to seniors. Their visibility in academic settings and the heightened focus on speech development milestones in early childhood, though, are why people often assume “speech therapy is for kids”. 

They serve a diverse population and address a range of concerns. Some examples of individuals of any age who might benefit from SLP services include those with:

• Reading, writing, and spelling difficulties 
• ADHD or autism spectrum disorder 
• Traumatic brain injury 
• Head and neck cancers
• Hearing impairments  
• Down Syndrome or another genetic syndrome 
• Neurologic conditions, like multiple sclerosis or dementia

People may also seek the services of a speech therapist to modify their accent, such as actors, performers, public speakers, or non-native English speakers. 

Where Do Speech Language Pathologists Work?

It’s often assumed that SLPs fall under the educational sector, as more than 55% of them work in academic settings, like preschools, K-12 schools, and universities. Yet, despite many providing services in these educational environments, speech-language pathologists are still fundamentally considered a healthcare specialty. 

Almost 40% of speech therapists work in a healthcare setting, and of those:

• 13% work in hospitals
• 10% in residential health care facilities (e.g., skilled nursing facility, assisted living, etc.)
• 16% work in nonresidential health care facilities (e.g., free-standing outpatient facilities or home services) 

Within the healthcare field, they’re considered to be members of the rehab therapy umbrella, so they’re often found in physical therapy (PT) and occupational therapy (OT) clinics. SLPs may work within government agencies, as well, such as public health departments or the military. Others might serve as consultants in the private sector or the business world. 

What Does a Speech Language Pathologist Treat? 

Based on their job title, it’s easy to assume that a speech-language pathologist solely treats communication disorders. However, as previously mentioned, their scope of practice extends beyond that. They have an equally crucial, often overlooked, responsibility: treating swallowing difficulties and disorders.

Defining Speech: How Do We Say Things?

Speech is the physical ability to express thoughts and feelings through sounds and words. It’s easiest to think of it as the motor component of spoken communication, as it’s physically how we say things. 

According to ASHA, there are three components of speech, and a patient can have an issue with any one or more of these.

• Fluency: Encompasses the rhythm of speech and is defined by the rate, continuity, and smoothness with which syllables, sounds, and words are made
• Voice: How people use their breath and vocal folds to make noise
• Articulation: The physical ability to make speech sounds using the tongue, mouth, and lips

Examples of Speech Sound Disorders SLPs Treat

A speech-language pathologist can help with speech sound disorders (SSDs), which are challenges involving how we hear, produce, or understand the rules for using speech sounds. Speech sound errors, especially in articulation disorders, may occur from neurologic issues, structural abnormalities, or a hearing impairment. 

Some examples include: 

• Articulation disorders
  • Apraxia 
  • Dysarthria 
• Phonological disorders
  • Consistent 
  • Inconsistent 
• Fluency disorders
  • Stuttering 
  • Cluttering 
• Voice disorders
  • Laryngitis
  • Resonance disorders such as hypernasality 
  • Functional voice disorders, like muscle tension dysphonia (MTD) 

Defining Language: What Do We Say?

While speech refers to the physical act of producing sound, language encompasses the different ways we might use and understand words to meet our needs and wants. This includes how people organize their words, the meaning of words and their combinations, how words are used in different social contexts, and more. 

In essence, language is what we say. It’s a rule-governed system that’s predictable, organized, and systematic. Without such rules, language would be chaotic and unable to serve its primary purpose of communication. 

Examples of Language Disorders SLPs Treat

Speech therapists can help treat the following language disorders: 

• Developmental language disorder 
• Acquired language disorder 
• Expressive language disorder
• Receptive language disorder 

Understanding Swallowing Disorders

Given their job title, it makes sense for speech-language pathologists to assist with communication disorders. However, people are often surprised to learn that they handle swallowing and feeding issues, as well. Since swallowing functions involve some of the same muscles and nerves used in speech, this falls under the purview of SLPs as well. 

There are three phases of swallowing, and an impairment can manifest in one or a combination of the following phases.

• Oral phase: The process of taking in, breaking down, and positioning food or liquid for swallowing
• Pharyngeal phase: The act of propelling food down the throat while simultaneously closing the airway to prevent coughing or choking
• Esophageal phase: The esophagus, a tube extending from the throat to the stomach, uses coordinated opening, closing, and squeezing motions to move food to the stomach

Examples of Swallowing Difficulties SLPs Treat

Although this scope of their work is often overlooked, swallowing disorders, also called dysphagia, make up a massive part of a speech-language pathologist’s medical caseload. In fact, SLPs are the primary providers of dysphagia care.  

Some of the swallowing issues speech therapists assist with stem from the following: 

• Motility problems
  • Achalasia 
  • Jackhammer esophagus 
• Structural abnormalities
  • Esophageal stenosis
  • Zenker’s diverticulum
• Neurologic issues
  • Conditions, like Parkinson’s disease and hyperthyroidism, may cause muscle weakness that affects swallowing
• Allergies
  • Eosinophilic esophagitis 

How Speech Therapists Work with Other Health Specialists   

As established, speech-language pathologists can assist individuals with a wide range of concerns. However, even with their vast range of responsibilities, it’s rare that they work entirely alone. After all, the field itself is inherently interdisciplinary, so it’s common for them to collaborate with other specialties to support a patient throughout their healing journey. 

But what does collaboration look like among speech therapists and other healthcare specialists, such as physicians, mental health providers, and PTs?  We’ll provide a few examples to give you an idea of how comprehensive, patient-centered care looks when SLPs are involved. 

Primary Care Physicians and SLPs Co-treatment

Although SLPscan work autonomously and often don’t require a physician’s order to assist a patient, most are referred by a primary care physician (PCP). But why is that?

Well, there are a couple of key reasons for this. First, patients are more likely to discuss communication or swallowing concerns with their family doctor initially. If the PCP observes and believes the problem exceeds their expertise, they will typically refer the individual to an SLP for a comprehensive evaluation. The other reason is often related to insurance. Payers normally won’t cover SLP services unless a referral is provided, verifying that the individual requires specialist care.

Following the referral, SLPs complete a specialized assessment to diagnose the condition and share the results with the PCP. Their collaborative relationship might then look like:

• A PCP making medication adjustments based on the SLP’s feedback.
• An SLP providing therapy and regularly communicating the patient’s progress to the PCP.
• The SLP recommending dietary modifications, with the PCP ensuring those suggestions meet the patient’s overall nutritional needs.
• The PCP incorporating treatment recommendations from the SLP and subsequently communicating those instructions more clearly to the patient.

Mental Health Providers and Speech Therapists Co-Treatment 

If patients have overlapping communication and mental health needs, these two professionals might co-treat to improve patient outcomes.

Consider, for instance, a teenager with a persistent stutter who experiences significant social anxiety and avoids speaking situations. During speech therapy sessions, the teenager learns to manage their stuttering through techniques such as fluency shaping and develops strategies for effective communication despite disfluencies. Simultaneously, with the help of a mental health provider, they focus on anxiety management and addressing social phobias linked to stuttering.

Joint sessions could also be conducted, allowing the teenager to practice communication techniques in simulated social situations with immediate feedback from both specialists. This collaborative approach enables them to coordinate strategies for reducing avoidance behaviors and fosters a more positive self-image, with each professional reinforcing the other’s therapeutic insights.

Physical Therapist and Speech-Language Pathologist Co-Treatment 

PTs and SLPs are frequent collaborators, especially in rehabilitative settings, as our physical abilities can impact our ability to communicate and swallow, and vice versa. For instance, if a patient has a spinal cord injury and experiences respiratory muscle weakness, they might subsequently have problems with speech. This is because adequate breath support is necessary for speech, and when it’s affected, patients might experience decreased loudness and have difficulty sustaining sound. 

To understand how these two professionals might work together, consider the following example. Let’s say a patient is recovering from a stroke and presents with the following challenges: 

• Hemiparesis, or weakness on one side of the body. 
• Dysphagia, or difficulty swallowing. 
• Dysarthria, or slurred speech as a result of muscle weakness. 

The Physical Therapist’s Role

In this scenario, the physical therapist aims to assist the patient in improving their mobility, strength, and balance, with the goal of enhancing trunk control and seated posture. They’re completing various exercises to help the patient regain use of their affected arm and leg, practicing sitting and standing balance, and eventually working on regaining walking ability.

The Speech Language Pathologist’s Role

The SLP, on the other hand, helps the patient enhance speech clarity and restore safe swallowing function. This is achieved by providing exercises to improve oral motor strength and coordination, making dietary modifications, and strengthening the muscles of articulation. 

What Co-Treatment Looks Like

Where PT and SLP roles come together, magic happens. They may collaborate in the following ways.

• Determining the best position for swallowing: The PT can ensure the patient is positioned safely and stably in their chair or bed. While the patient is in this optimal posture, the SLP can then conduct swallowing exercises or trials with food and liquid, directly observing how good positioning impacts swallowing safety.
• Guiding communication during mobility: Suppose the patient becomes fatigued or struggles to communicate their needs while completing physical therapy. In that case, the SLP can guide the PT on how best to understand the patient’s slurred speech or determine alternative communication methods.
• Enhancing cognitive-motor integration: Movement exercises often require cognitive processing, such as remembering sequences or following multi-step commands, which can be challenging for some patients. An SLP can offer the PT strategies on how to deliver instructions in a manner the patient comprehends, ensuring they can participate effectively.

Speech-Language Pathology: An Integral Part of Healthcare

It’s safe to say that SLPs are among the unsung heroes of the healthcare industry, and it’s time they receive the recognition they so truly deserve. As a vital component of the healthcare puzzle, the role of the speech-language pathologist shouldn’t be underestimated. SLPs not only provide life-sustaining work by teaching safe swallowing techniques, but they also restore human connection through effective communication. Additionally, their role, in many ways, makes it possible for other healthcare professionals to effectively perform their own tasks, seamlessly integrating to support holistic patient well-being.

Ultimately, fully acknowledging and championing the integral work of SLPs is not just deserved recognition, but a crucial step towards truly comprehensive and effective patient care for all.