What Do Speech-Language Pathologists Do?
Written by Loren Alexander MS CCC-SLP TSSLD
I AM A SPEECH-LANGUAGE PATHOLOGIST (SLP)…
When people make small talk with me and ask what I do, 90% of the time I cannot just say my title and leave it at that. Unless the person I am speaking to or their loved one has had speech therapy, they usually have never heard of my profession or, at best, they have heard the title but have limited knowledge about what types of things speech-language pathologists diagnose and treat. Speech-language pathologists serve people of all ages from birth to death. We are trained to work on the below areas.
Speech
We diagnose and treat speech issues... and by that I do not mean that we help people deliver speeches clearly and confidently although that is a niche thing that we are qualified to do and some of us have made a living doing it. When I say speech issues, I mean that we help people clearly and accurately make speech sounds so that the people they are speaking to can more easily understand what they are saying. Under the umbrella of speech, there are articulation disorders (i.e. a person having difficulty accurately producing the “r” sound so they may say “base” when they really want to say “race”) and phonological disorders (i.e. every time they say a word that has a “k” or “g” sound in it they replace that “k” or “g” sound with a “t” or “d” sound). Speech-language pathologists fix these speech sound errors by increasing the person’s awareness of the sound errors and teaching them where and how to place their tongue and shape their lips in order to accurately produce the sound first in isolation, then in a syllable, then in different positions of a word, then in phrases, followed by sentences and ending in spontaneous conversation.
Language
Speech-language pathologists diagnose and treat language delays and disorders. We help people better comprehend what they are reading and/or hearing, this is called receptive language (i.e. a student in school is reading a passage and trying to answer questions about the passage but they are having trouble understanding what the question is asking them to do and they are having trouble understanding the vocabulary in the passage and what the main idea of the text is). We also help people with their expressive language. Expressive language is communicating thoughts using words and these words can be communicated verbally, in written words, using sign language and/or using Augmentative Alternative Communication (think Stephen Hawking’s use of a device to vocalize his ideas and transmit them from his brain out of the speaker of his device). An example of a person who has expressive language difficulties includes a five year old who speaks in one word phrases and does not combine words together to make phrases and sentences. Another example of an expressive language disorder is an adult who knows what they want to say in their brain and when they try to write or say that idea, the wrong word comes out (i.e. they wanted to say, “The dog needs more food” but they say, “The cat needs more food”) or the words are out of order in the sentence (i.e. they wanted to say, “Where are the car keys?” but what came out was, “The car keys where?”), these could be examples of aphasia and can be caused by a stroke or traumatic brain injury.
OK SO SPEECH-LANGUAGE PATHOLOGIST. WE JUST WENT OVER “SPEECH” IN ONE SECTION AND “LANGUAGE” IN THE SECOND SECTION, ARE WE DONE?
No, we are not done, speech-language pathologists diagnose and treat more than that! Our professional title is a bit misleading because our scope of practice is not limited to speech and language.
Motor Speech
Speech-language pathologists can diagnose and treat Apraxia of Speech and dysarthria.
Apraxia of Speech is a neurological motor planning disorder where the person knows what they want to say in their mind and the spoken production of what they want to say is imprecise due to difficulty motor planning (the brain telling the lips, tongue and muscles how to move to make the sounds accurately and in the order required to communicate their idea). A person can have Apraxia of Speech as a child. A person may also have Acquired Apraxia of Speech later on in life due to a neurological damage, stroke, tumor, and brain injury. Some characteristics of Apraxia of Speech include but are not limited to speech sound substitutions, distortions and/or omissions, speech errors that do not have consistent patterns, impaired timing and intonation of speech, difficulty initiating speech, and groping movements of the jaw, lips and tongue in an effort to get them in the right place to achieve accurate sound production.
Dysarthia is characterized by "abnormalities in the strength, speed, range, steadiness, tone, or accuracy of movements required for breathing” and speaking (Duffy, 2013, p. 4). There are different types of dysarthria and they present differently so I will just touch on some effects of dysarthria to give you just a taste. Dysarthria can cause reduced loudness, voice tremor, breathy voice, rough voice, strained voice, imprecise consonants, distorted vowels, hyper or hypo nasality, short rushes of speech and/or much more.
Cognition
Speech-language pathologists can help individuals improve their cognitive skills. Cognitive skills include memory recall (i.e. remembering what to buy at the grocery store if you do not have a list, learning and remembering the name of a new person you met), organization/planning (i.e. telling a story with the events in the correct order, completing a routine with the steps in the correct sequence), and problem solving (i.e. what to do if you forgot your wallet in a store).
Communication
Speech-language pathologists are the experts on communication. Communication is sharing ideas with others. Ideas can be communicated using spoken words, written words, sign language, gestures, body language, facial expressions and/or Augmentative Alternative Communication (think Stephen Hawking’s use of a device to vocalize his ideas and transmit them from his brain out of the speaker of his device).We use many different modes and combination of modes to communicate. Speech-language pathologists can teach people how to communicate with others in effective, functional and socially appropriate ways. Communication encompasse, but is not limited to, appropriately starting, maintaining and ending a conversation/social interaction with others, and repairing communication breakdowns (i.e. recognizing when the other person did not understand what you communicated and troubleshooting that).
Feeding and Swallowing
Speech-language pathologists diagnose and treat feeding disorders and swallowing disorders. Feeding disorders include a person refusing age or developmentally appropriate food or drinks, inappropriate mealtime behaviors, self feeding skills that are not age or developmentally appropriate. Speech-language pathologists diagnose and treat and swallowing disorders (dysphagia). If someone has dysphagia, they are at risk for choking, aspiration (when food, drink, or foreign objects are breathed into the lungs aka “going down the wrong tube” and having aspiration pneumonia (a potentially deadly lung infection caused by food or liquid entering the lungs). We help people eat and drink safely and help determine what consistencies of food and liquid are safe for people to ingest. We help strengthen the necessary body parts to swallow safely using exercises, as well as recommend feeding utensils, positioning, techniques, strategies, and diet modifications to support safe feeding and swallowing. Our treatment can help people progress from being fed through a tube to safely being fed orally!
Voice
Speech-language pathologists help treat voice disorders. “A voice disorder occurs when voice quality, pitch, and loudness differ or are inappropriate for an individual's age, gender, cultural background, or geographic location” (Aronson & Bless, 2009; Boone, McFarlane, Von Berg, & Zraik, 2010; Lee, Stemple, Glaze, & Kelchner, 2004). Voice disorders can be caused by illness, stroke, vocal abuse and misuse and overuse when speaking, shouting or singing, structural issues in the larynx such as swelling, neurologic issues and aging. Speech-language pathologists can help people who use/were using a tracheostomy or ventilator to breathe speak!
Speech-language pathologists also provide gender affirming voice therapy for transgender individuals. We can teach transgender people to produce a perceivably feminine or masculine voice, depending on the person’s choice, that is authentic to them and will not harm their vocal cords.
Stuttering
Speech-language pathologists diagnose and treat stuttering. We can provide counseling and fluency strategies and techniques to people who stutter express themselves verbally with more ease and confidence.
Speaking Enhancement
Speech-language pathologists can help people modify or acquire accents. If a person is from one country and they are living and working in another country, sometimes they want to modify their accent so that people in their new country can understand them more easily and they do not need to repeat themselves. Individuals seek accent modification services because they feel that their accent is holding them back at school, in the workplace, when making friends and/or when dating. Actors seek accent services in order to learn how to speak with a specific accent for roles.
Literacy
Speech-language pathologists have a role in helping people read and write, whether it is teaching people how to read and put their thought into written words in the first place or helping people who had those skills and have lost those skills due to things like a stroke or traumatic brain injury. We can help people spell (encode), read (decode) written words and comprehend what they are reading.
Everything Else
In addition to assessing and treating people with the above needs, we do a lot of paperwork. We have to document everything we do, and all the progress our patients/clients/students make. We have to bill private insurance, Medicaid, and Medicare. We write session plans, evaluation reports, session notes, progress reports, Individualized Education Plans (IEPs). We attend meetings and sometimes we are case managers and we lead the meetings. We create materials to use in therapy. We collaborate with, consult with and train other professionals in order to set the people we serve up for success. We advocate for our patients/clients/students, for ourselves and for our field. We conduct research and we do research in order to utilize evidence based practice when serving our patients/clients/students and to further our field. We supervise other SLPs and speech-language pathologist assistants (SLP-As), sometimes we are the Director of Rehabilitation at hospitals. Other times we mentor and supervise clinical fellows and students majoring in communication sciences and disorders. Sometimes we are professors and adjunct professors passing on our knowledge to our future colleagues. Some of us run private practices! We maintain our licenses and certifications by taking continuing education courses, attending conferences and paying dues. Speech-language pathologists do a lot and I say that we do the impossible.
Now that you know what speech-language pathologists do, I hope you have a newfound or greater appreciation for my profession. Could you or your loved one benefit from an evaluation or therapy from a speech-language pathologist? If so, schedule an appointment. If not, you can use this information to collaborate with a speech-language pathologist at work. You can decide if you want to be a speech-language pathologist. You can dazzle a potential date when they tell you they are studying communication sciences and disorders or that they are an SLP- it may be the only time they say their title without immediately needing to launch into a five minute long explanation of what they do. You can use this knowledge to show an interest in a profession your loved one is part of/pursuing and show your support in a meaningful way (thanks dad!) and you can hold a conversation with a speech-language pathologist in your life. If you like how I have explained the scope of practice of speech-language pathologists and wish others knew what you just read, please share my blog post and enlighten others.