Talking up speech language pathology
Talking up speech language pathology
Once referred to as “speech teachers” who worked predominantly in the school systems, an SLP is now found in many different medical practice settings: acute care, inpatient and outpatient rehab hospitals, long-term care facilities, assisted living and independent living centers, as well as the home health environment. Today, SLPs are an integral part of interdisciplinary teams across all practice settings, and vigorous demand for their services is fueling a surge in their numbers.
“The role of the SLP in long-term care has certainly gained more credibility and respect in recent years,” notes Ken Scholten, president of Agility Health. “The role of the SLP has evolved significantly, with an increase in education, treatment efficacy data and advocacy regarding the scope of practice, particularly with regard to the impact SLP services can have on the elderly and individuals with dementia.”
A decade of difference
Ten years ago, Scholten says, one SLP would typically cover four buildings in long-term care. The SLP would go to each building, each day, and typically see two or three patients for 30 minutes for dysphagia treatment.
“It was not unusual to have a week with less than full-time hours,” he said. “SLPs now see a caseload requiring the services of at least one full-time SLP within a facility, if not more.”
“We are in a good place because there are a number of improvements and advances that have fundamentally enabled us to see patients in the acute phase of their speech condition. With early diagnosis, we have the opportunity to provide improved patient outcomes,” says Martha Schram, president of Aegis Therapies.
Yet even as the profession's overall state of speech pathology stock has risen in clinical circles, the role of the SLP is still misunderstood, says Erin Knoepfel, director of SLP clinical services for Genesis Rehab Services.
“There is often a misperception of what we do in the rehab setting. Typically. we are referred to as speech therapists, but that title is very misleading and does not represent our broad scope of practice,” she says.
“In the rehab setting, many people are aware of our knowledge and skill in the area of swallowing and swallowing disorders but do not realize that we also assess and provide therapeutic interventions to address receptive and expressive communication disorders, cognitive-communication disorders and speech impairments due to various types of medical conditions and disorders.”
SLPs also are responsible for the provision of therapeutic services to establish a communication system for patients with hearing impairments, and for those requiring alternative and augmentative communication systems, she adds.
From an industry-wide perspective, speech language pathology has experienced significant expansion and growth in the past 10 to 15 years. In particular, Schram says speech language pathology has become a much larger component of her company's long-term care services.
“Historically, SLP was thought of as a service provided primarily to the pediatric patient population and was isolated to language or speech impediments in school-age children,” she says. “Today, speech pathology is frequently administered to an aging population and includes some physical treatment such as in the case of dysphagia, which afflicts about 80% of the patient base.”
Dysphagia and dementia
To be sure, dysphagia's impact on healthcare economics, quality of life and caregiver burden is significant. SLPs play a primary role in the evaluation and treatment of adults with swallowing disorders, notes Ethel Coppa, director of SLP clinical services for Fox Rehabilitation.
“Given the high incidence and prevalence of dysphagia and the potentially severe and even fatal consequences, appropriate diagnosis and management of swallowing is critical,” she said. “SLPs are knowledgeable about both normal and abnormal anatomy, physiology, and neurophysiology of the tracts responsible for respiration, swallowing and speech. Both their educational and clinical background allows them to assume a variety of roles with expertise related to the evaluation and treatment of those with swallowing disorders.”
People with dementia-associated communication problems are the SLP profession's fastest-growing clinical population, Coppa noted, with an estimated 4.5 million Americans currently diagnosed with Alzheimer's disease.
That incidence is projected to rise to between 11.3 and 16 million by the end of 2050. These projections make it “crucial that appropriate assessments and interventions are implemented and carried through with caregiver education,” she said.
Schram says her firm is seeing more patients with dementia and has “more therapies” available to treat a wider range of patients.
Agility's Scholten also acknowledges the dementia growth and says that speech therapy will increasingly be made available in the residential setting.
“With the continued rise of the eldest of the elderly returning home, the length of rehab therapy stays declining and an increasing demand for rehab within their own environment, there will be much higher demand for homecare SLPs and an SLP specialty area in dementia,” he says.
From an SLP's standpoint, technology has made the day-to-day evaluation and treatment of patients easier, observes Carol Winchester, vice president of BEST Dysphagia Management Services.
“Whether it is a quick review of a standardized assessment on the Internet, ‘Googling' a diagnosis that may be new or an online literature review, today's SLPs have a wealth of information at their fingertips,” she says. “Diagnostic capabilities have blossomed with advancements in dysphagia diagnosis with the ability to perform the [fiberoptic endoscopic evaluation of swallowing] test at bedside.
“With the bedside endoscopic swallowing test formerly requiring more than 50 pounds of equipment being carted to the bedside, technology has reduced the equipment needed to that which can fit into a small laptop bag. This allows the test to be performed by a certified SLP in virtually any setting,” she says.
Gail Johnson, director of clinical practice and training for SunDance Rehabilitation, adds that as technology advancements continue to enhance rehabilitation opportunities, “one can imagine possibilities for improved communication with families at a distance through Skype or I-Chat, the ability to share test results and progress immediately during the chat, or the potential to have access to an off-site physician for consultation.”
A burgeoning geriatric population, combined with breakthroughs in technology and clinical knowledge, have ensured that speech pathology will continue to grow in importance going forward, professionals say. In Johnson's view, the future of rehabilitation lies in the area of clinical outcomes, with the focus “on a rehabilitation team to provide functional therapy that will have a meaningful, measurable result for the patient.”
To be sure, there has been increasing focus on the need to obtain objective measures “not only during the initial assessment, but also during treatment sessions to quantify progress,” Knoepfel says. There is currently an increase in the development and research in the use of equipment such as the Iowa Oral Performance Instrument, Vital Stim/Neuromuscular Electrical Stimulation, and surface Electromyography (sEMG) Biofeedback units to measure progress in SLP practice areas, she explains.
“There is also an increased focus on obtaining outcome measures to show the amount of progress achieved following active SLP services,” she says. “By implementing these types of measures, there will be more consistency established between the number of treatment sessions needed to address clinical conditions.”
Schram is interested to see if Medicare will one day cover speech language pathologist assistants.
“As ‘therapist supply' becomes more challenging, beneficiary access to needed care may be an impetus for Medicare to consider this in the same manner as they have for occupational and physical therapists,” she explains. “That is likely something in the far distant future in long-term care, but something we can hope to see as a consideration.”