Uncategorized

Scope of Practice

November 19, 2014 by in Uncategorized

There have been some exciting new developments in the domain of health care policy as it pertains to speech-language pathologists (SLPs). For a long time, we as speech pathologists have known that our work encompasses treating disorders of feeding, swallowing, speech, and language. I personally have always agreed with the American Speech and Hearing Association (ASHA) (http://www.asha.org/slp/clinical/Cognitive-Communication/) that cognitive communication disorders are within the scope of practice for SLPs. In my opinion, since language is so tightly linked to cognition (cognition is, after all, often linguistically mediated!) it seems obvious to me that treatment for cognitive communication disorders and impairments would be within the scope of practice for a speech pathologist. Unfortunately, certain insurance entities have refused to recognize cognitive communication disorders as an area to be treated by SLPs. In this regard, there has been controversy over a speech therapist’s scope of practice, particularly concerning services that insurance companies are willing to cover.

Fortunately, according to a recent ASHA newsletter article, the National Uniform Claim Committee (NUCC), “an organization that is devoted to developing, adopting, and modifying national standards for health care transactions, has adjusted its definition of what can be considered the scope of practice for SLPs, which reflects our actual scope of practice. The definition reads as follows: ‘The speech-language pathologist is the professional who engages in clinical services, prevention, advocacy, education, administration, and research in the areas of communication and swallowing across the life span from infancy through geriatrics. Speech-language pathologists address typical and atypical impairs and disorders related to communication and swallowing in the areas of speech sound production, resonance, voice, fluency, language (comprehension and expression), cognition, and feeding and swallowing.'”

Although the new NUCC terminology is not identical to that of Medicare and other health plans, it is, according to the above-mentioned article, “the only code set that can be used for HIPAA-covered transactions.” Hopefully, this will help to broaden the scope of treatment that will be covered by insurance companies.

“How does speech-language therapy differ from tutoring?”

July 10, 2014 by in For Parents, Uncategorized

I have often been asked this question by parents, and even educators. It is important for parents and professionals to know the differences between speech-language therapy and tutoring in order to make informed decisions about the services they retain or recommend for their children and students. While both speech-language therapy and tutoring can involve academic subjects and homework, the goals of speech-language therapy and tutoring are very different, as are the manners in which curricular materials are used.

The goal of tutoring is to help students succeed with academic subjects and complete homework. Candidates for tutoring are those who need additional explanation of the curriculum presented in class, not necessarily because of an underlying language problem or learning disability, but because further elaboration or clarification of the material is required.  Imagine a student in high school who is succeeding in every class except for chemistry.  The student does not have a language impairment or learning disability, but needs additional explanation of the material in order to understand it, because chemistry in particular is a particularly difficult subject for this student. Tutoring sessions will most likely be devoted to helping the student understand the materials and complete homework. Given effective tutoring, this student will most likely succeed in chemistry, now that the subject has been better explained.

Speech and language therapy, on the other hand, targets the linguistic and/or cognitive weaknesses or vulnerabilities of a student, in order for the student to be able to access curricular material.  Rather than focusing on helping the student to complete homework assignments, the goal is to build and strengthen skills that the student needs in order to understand and complete the assignments.  For example, let’s say that a student has a receptive language impairment (difficulty understanding and/or processing language). Many subskills are involved in language comprehension and processing.  A speech language therapist would investigate the areas that contribute to the impairment, and provide the student with direct, targeted instruction and practice using strategies in order to improve upon specific linguistic areas of need.  Curricular materials often are used in order to target speech or language skills, but the goal of using these materials is to help the child practice using strategies to improve speech and language in a functional context; therefore, although the homework assignments may well be completed, this is not the ultimate goal of a speech-language therapist.  The goal is to improve the student’s language skills so the student will be able to independently understand and complete assignments across all classes or subjects.

Another important difference between tutoring and speech-language therapy is that the latter targets goal areas outside of the academic arena.  Language permeates all aspects of life, and so language therapy is also devoted to improving language skills not only to help children succeed in school, but to to help improve communication skills in the context of daily life situations.

Both tutoring and speech-language therapy are valuable services, but they have different goals.  It is important to keep this information in mind when determining whether to obtain tutoring or speech-language therapy services for your child.

In honor of Aphasia Awareness Month, here are some facts about aphasia!

June 17, 2014 by in For Adults, For Caregivers, Uncategorized

Today’s post is in honor of Aphasia awareness month!  “Aphasia” is a term derived from the Greek a- (not) and phanai (speech), which forms the Greek word, aphatos.  While aphasia can take many forms, and can result from many different etiologies, overall, aphasia is a condition in which some kind of neurological changes have impacted a person’s ability to process language (receptive language skills) and produce language (expressive language skills).

Aphasia profiles can vary widely in characteristics and in severity. In some cases, a person with aphasia may have both impaired receptive and expressive language, while others may have relatively unimpaired receptive language skills, but cannot express what they understand or want to say, and therefore may come across as failing to understand what is going on around them, when they actually do.  Still, in other situations, a person may seem to be highly verbal and may sound fluent, but may have poor comprehension skills.

Aphasia profiles can differ not only in terms of strengths and weaknesses in expressive and receptive language, but also in terms of modality.  Some people may be able to understand what they hear better than what they read, and for others, it may be the opposite.  To complicate the situation even more, cognitive impairments in areas such as memory or attention can also impact a person’s language skills.

Individuals with aphasia may also be impacted by motor speech disorders, such as apraxia, which affects the ability to produce motor sequences needed for speech, and dysarthria, a condition in which the musculature for speech and articulation is affected.  Swallowing impairment, or dysphagia, is another potential concomitant disorder that people with aphasia may experience.

I hope this brief post has given you some insight into the complex issues that individuals with aphasia can face.  If you have a loved one who has been diagnosed with aphasia, here are some general tips to help you communicate effectively:

  1. Speak slowly.  Many people do not realize how quickly they speak!  For an individual who does not have a comprehension deficit, understanding a person who speaks quickly isn’t a problem, but for a person who has a receptive language impairment (and other potential memory issues) it is important to speak more slowly.  This doesn’t mean you should speak in an exaggerated way; just speak naturally, but with a slower pace.
  2. Try using visuals.  For example, if you are talking about a schedule, look at the calendar together, and block out any extra or distracting visual information, so that you are looking only at the day/event in question.   Just be sure not to use overwhelming amounts of visual information.
  3. Encourage the use of gesture and drawing.  There is some evidence that, for people with aphasia who have trouble with word retrieval  (e.g., they know what they want to say but the word is on the tip of the tongue and they cannot seem to think of the word), it can be helpful to use gestures, or even to try drawing.  Drawing or using gestures may either help the speaker think of the word, or otherwise will at least help you, as the listener, figure out what the speaker is trying to say.
  4. Give the speaker extra time.  Individuals who have aphasia may require extra time to process incoming information, or in order to formulate the language they wish to express.
  1. Remember that communication is the goal.  Whether a person is speaking, writing, or using gestures to communicate, the goal is communication!  It can be very frustrating when one isn’t understood but has a lot to say.  Hopefully you can appreciate some of the challenges faced by people who have aphasia, and can use some of these tips to improve communication with your friends and loved ones with this condition.