Guest Blogger, Anne Marie Pineiro, M.A. CCC-SLP,
Speech-language Pathologists serve individuals, families, and groups from diverse
linguistic and cultural backgrounds. Services are provided based on applying the
best available research evidence, using expert clinical judgments, and considering
clients’ individual preferences and values. Speech-language pathologists address
typical and atypical communication and swallowing in the following areas:
- speech sound production, articulation, apraxia of speech, dysarthria, ataxia, dyskinesia,
- resonance- hypernasality, hyponasality, cul-de-sac resonance, mixed resonance
- voice- phonation quality, pitch, loudness, respiration
- fluency- stuttering, cluttering
- language (comprehension and expression)
–pragmatics (language use, social aspects of communication)
-literacy (reading, writing, spelling)
– prelinguistic communication (e.g., joint attention, intentionality, communicative signaling)
- cognition- attention, memory, sequencing, problem solving, executive functioning
- feeding and swallowing- 4 phases of swallowing
-oral, pharyngeal, laryngeal, esophageal
–orofacial myology (including tongue thrust)
In providing services to those Adults diagnosed with a variety of Developmental Disabilities, the SLP’s role may become much more defined, focusing on what is most functional to an individual in the areas of speech, receptive and expressive language (verbal or non-verbal communication) and feeding/ swallowing. Very often we are attempting to assess and/or maintain an individual’s current level of functioning in the above areas and to train all those involved in the care of that individual in the strategies and implementation of them to achieve that goal. In our Agency, for example, we break the assessment down into the following areas in order to develop functional and measurable outcomes:
- Does the individual use speech functionally to communicate wants/needs in a variety of settings?
- If so, is their speech understood by all, some, few communicative partners? Are there any strategies a person might use to increase his/her intelligibility- modifying volume, rate, resonance, increasing fluency, etc.? Does the person use Augmentative Communication to supplement speech when he/she cannot be understood e.g. low/high tech communication device, writing, American Sign Language, Picture Language Board, etc.
- Receptive language (Language comprehension) including attention to objects, using objects functionally, identification of objects and/or pictures, comprehending one, two or three-step oral directives, vocabulary, comprehension of attributes and spatial relationships, or auditory comprehension on the word, sentence and paragraph levels. Is comprehension on the literal or inferential levels?
- Expressive language- (Language expression)- for those who are verbal, the MLU (mean length of utterance) is assessed. For non-verbal individuals, language expression can be in the form of pointing to one or two picture symbols consecutively on a picture language communication board or AAC device, writing or typing single words, phrases, sentences or paragraphs on paper, computer or AAC device.
-AAC device assessments for nonverbal individuals take into account the individual’s cognitive skills, physical abilities in order to access the device (direct selection with hand or finger, eye gaze, head pointer, switch/scanning, etc.), receptive and expressive language skills, communicative intent and pragmatic language abilities, and literacy. All those involved in the individual’s care play an extremely important role in whether or not someone may receive an AAC device since they will be the ones to set up/take down the device and provide basic maintenance for the device, including programming, charging, etc.
Feeding and Swallowing:
Many people wonder why an SLP would be the one to review an individual’s mealtime plan or protocol. ASHA guidelines state it best: “The speech-language pathologist is a primary professional involved in assessment and management of individuals with swallowing and feeding disorders. These areas include:
- Performing clinical swallowing and feeding evaluation;
- Performing instrumental assessment of swallowing function with medical professionals as appropriate;
- Identifying normal and abnormal swallowing anatomy and physiology;
- Identifying signs of possible or potential disorders in upper aerodigestive tract swallowing and making referrals to appropriate medical personnel;
- Making decisions about management of swallowing and feeding disorders;
- Developing treatment plans;
- Providing treatment for swallowing and feeding disorders, documenting progress, and determining appropriate dismissal criteria;
- Providing teaching and counseling to individuals and their families;
- Educating other professionals on the needs of individuals with swallowing and feeding disorders and the speech-language pathologists’ role in the diagnosis and management of swallowing and feeding disorders;
- Serving as an integral part of a team as appropriate;
- Advocating for services for individuals with swallowing and feeding disorders;
- Advancing the knowledge base through research activities.
In addition, Speech-language pathologists have extensive knowledge of anatomy, physiology, and functional aspects of the upper aerodigestive tract for swallowing and speech across the age spectrum including infants, children, and adults (including geriatrics). The upper aerodigestive tract includes oral, pharyngeal, and cervical esophageal anatomic regions. Speech-language pathologists also have extensive knowledge of the underlying medical and behavioral etiologies of swallowing and feeding disorders. In addition, they have expertise in all aspects of communication disorders that include cognition, language, and behavioral interactions, many of which may affect the diagnosis and management of swallowing and feeding disorders.”
The dysphagia and feeding disorders that are seen in adults with developmental disability include poorly developed and absent feeding and oral preparation skills and competencies, physiological and anatomical impairments that degrade oral-pharyngeal and esophageal bolus motility, and disruptive or maladaptive mealtime behaviors. Nutrition, hydration, saliva management, ingestion of medications, and management of the oral hygiene bolus may be involved. Upper airway obstruction (choking), aspiration, malnutrition, and dehydration may result from the disorder (Rogers et al., 1994, Sheppard et al., 1988). Source: http://www.asha.org/policy/TR2001-00150/#sec1.3
Therefore, in our Agency that serves Adults with Developmental Disabilities, the SLP works as one member of the Team, including the Occupational Therapist, Physical Therapist, Nurse, Residential Team and Family Members to create a mealtime protocol or plan which simply states the best way to maximize nutrition while at the same time attempting to decrease incidents of choking (partial or complete blockage of the airway) or aspiration (food or liquid making its way into the lungs which can lead to aspiration pneumonia). These plans are developed so that all involved in the individual’s care may be informed of the best feeding practices for that individual which include: adaptive mealtime equipment (any cup spoon, plate, straw, etc. used for an individual to improve ability to eat independently and to improve oral-motor control), positioning in chair or wheelchair, degrees of assistance needed for self-feeding, food and liquid consistencies, food allergies and intolerances, the presence of any mealtime behaviors, including rapid pace of eating which may increase risk of choking or aspiration, and any specific instructions the caregiver would find useful in feeding the individual or maximizing the individual’s ability to feed themselves.
I hope you find this information helpful in identifying the SLP’s role in providing services to adults with Developmental Disabilities.
This information is in no way intended to serve as a complete guide in this area, but is meant to simply assist in identifying ways the SLP works as part of the Interdisciplinary Team in serving adults with developmental disabilities in a day habilitation setting