Dolphin-assisted therapy offers hope to disabled children, parents
BY FRANCES ROBLES
frobles@MiamiHerald.com
WILLEMSTAD, Curacao -- A 350-pound dolphin named Matteo tickles a toddler with his snout, sparking a burst of giggles.
The disabled child hitches a ride on Matteo's belly while gleeful parents snap photos. The dolphin expels water through its blowhole and rests its head gently on the girl's shoulder while her parents silently plead for results.
It's a scene Kirsten ''Kiki'' Kuhnert has watched thousands of times. She used to be one of those moms who prayed for miracles at the side of a dolphin therapy center pool, thinking: Maybe this will make my child talk. Maybe some day he'll walk.
''I have seen kids speak their first word, mothers cry because their autistic son looked at her in the eye or kissed her,'' Kuhnert said. ``Every day a little miracle.
``How big a miracle is in the eye of the beholder.''
Kuhnert, a single mom from Key Biscayne, has dedicated the past 15 years of her life to raising funds for dolphin-assisted therapy, a controversial behavior-modification treatment for severely disabled children. Struck by tragedy as a young mother of a 2-year-old, the Germany native turned her heartbreak into a calling.
Convinced that swimming with the animals paired with intensive speech or physical therapy helps with autism, Down's syndrome, cerebral palsy and other debilitating ailments, Kuhnert spends her days snapping orders at therapists and trouble-shooting emergencies at a therapy center at the Seaquarium in Willemstad, Curacao. She makes phone call after phone call raising money to get children to treatment, at $7,000 or more for just two weeks of care.
But, these days, she is hardly ever by the pool, rarely with the children. The memories of the son she lost sting too much.
A MOM'S MISSION
It was June 18, 1994. Kuhnert was the married mother of two kids from an upper-class family in Germany who made her living in sports event marketing.
That June day, the family had gathered at the country club to celebrate her infant daughter Kira's christening, when suddenly they realized they had lost sight of Tim, Kuhnert's 2-year-old.
''We looked for 15 minutes,'' she remembers. ``He was 15 yards away behind a hedge, in an unsecured swimming pool. This is where they found him. He was lifeless.''
Tim suffered brain damage that left him in a coma and with cerebral palsy. Kuhnert became obsessed, she says -- the type of mom who would ''fly to a rain forest and dance'' to make their kids well.
She traveled to hospitals around the globe, fought with neurologists, lost her marriage.
In 1995, Kuhnert flew from Germany to the Keys, where her little boy swam with dolphins at a facility that has since closed. After four days of being put in the water with a dolphin -- following 16 months in a coma -- Tim woke up.
''I was so happy. I thought every kid that has a problem should be able to do this,'' she said. 'I thought, `Somebody should set up something like a foundation.' ''
That's what Kuhnert did.
''She was so excited about it, she started kind of a crusade to help kids come,'' said David Nathanson, a South Dade psychologist who is considered the founder of dolphin-assisted therapy. ``She's very dedicated and passionate. I would call her semi-eccentric -- in a good way.''
Nathanson ran a company called Dolphin Human Therapy in a variety of locations from Miami Seaquarium to Key Largo and Mexico from 1995 until 2006. In that time, he said, Kuhnert held raffles, organized dinners and made countless calls to send at least 1,000 children to therapy. She'd get airlines to donate tickets and corporations to write checks.
SOUTH FLORIDA
Kuhnert was so dedicated that 10 years ago she packed up and moved to South Florida, so her son could be closer to the dolphins she credits for bringing him out of a coma.
Tim remained severely disabled for the rest of his life, communicating by the roll of an eye. He died suddenly last year at 17.
''He was the funniest, most charming person in the world,'' his mother said. ``He was an angel the day he was born.''
Despite her loss, Kuhnert continues on her quest to find funding for other families to visit the Curacao center.
Her dedication will be honored Thursday when she is presented with an award of excellence by the German American Business Chamber of Florida at the InterContintenal Hotel in Miami.
Kuhnert helped create the program at the Curacao Dolphin Therapy & Research Center, an interdisciplinary treatment center on the grounds of the Sea Aquarium in Willemstad.
The owner pays her a consulting fee to supervise speech and physical therapists and she uses the rest of her time to raise money for her charity, Dolphin Aid, which provides grants for people, largely Europeans, to come. ''She is an inspiring, very driven individual,'' said owner Adriaan ''Dutch'' Schrier. ``I am a son of a Presbyterian Dutch farmer -- I don't believe in hocus pocus or so-called miracles. But what I've witnessed here . . . ''
Among the perceived miracles is the case of Daniuq Kuypers, a 12-year-old who did not speak until after swimming with dolphins in Curacao at the age of 10.
''The only thing I can tell you is that I came here with a daughter who did not speak and flew back to Holland, and she spoke,'' said Daniuq's father, Hans Kuypers, a Dutch homicide detective. ``For 10 years, I had no contact with my daughter. Now she can say why she wants to cry or has pain.
``I can't be sure if it was the dolphin that caused it, and I don't care.''
Kuhnert admits she's not exactly a trained expert.
''I didn't know what I was doing. I was just a mom trying to do the right thing,'' she said. ``I am not a nurse nor a therapist. I was just a mom.''
The therapy has been the target of criticism largely from animal rights groups, which consider it dangerous to humans and unfair to dolphins.
''Because of the lack of scientific study, there are two vulnerable groups being exploited: dolphins and children and parents seeking a miracle under expensive circumstances,'' said Courtney Vail, director of the Caribbean program for the Whale and Dolphin Conservation Society. ``There is such an affinity for these animals, it's easy to believe. But if you are going to claim it has a medical benefit, you have to validate it.''
EXPERT VIEW
Janelle Nimer, a Ph.D. candidate at the University of Tennessee who researched dolphin therapy for her three-year fellowship in veterinary medicine, says experts are not sure why the therapy shows results, but they believe it could have to do with the sonar the animals emit under water.
She tried it herself in Mexico and felt a ''high-like'' feeling for two weeks. The research, Nimer said, shows children show improvements compared to traditional therapy alone.
''All animal therapy is controversial, because it hasn't been researched as it should have been,'' she said. ``People are afraid dolphins are being mistreated. You have exotic animals and parents of autistic kids who are willing to try anything.''
Those who support the therapy say one only needs to see the benefits to believe.
''Therapy without the dolphin does not work. The dolphin without the therapy does not work,'' said Marco Stork, an Amsterdam newspaper ad salesman with two autistic sons. ``They work together.''
His son Damian, 8, had been in speech therapy for three years, and only started speaking after that work was combined with two weeks of two-hour-a-day swims with dolphins.
''His first word was spelen -- play,'' said Stork, who speaks Dutch. ``Something he could never have said, he said after three days here. Every day we saw a little bit more, a little more.''
frobles@MiamiHerald.com
WILLEMSTAD, Curacao -- A 350-pound dolphin named Matteo tickles a toddler with his snout, sparking a burst of giggles.
The disabled child hitches a ride on Matteo's belly while gleeful parents snap photos. The dolphin expels water through its blowhole and rests its head gently on the girl's shoulder while her parents silently plead for results.
It's a scene Kirsten ''Kiki'' Kuhnert has watched thousands of times. She used to be one of those moms who prayed for miracles at the side of a dolphin therapy center pool, thinking: Maybe this will make my child talk. Maybe some day he'll walk.
''I have seen kids speak their first word, mothers cry because their autistic son looked at her in the eye or kissed her,'' Kuhnert said. ``Every day a little miracle.
``How big a miracle is in the eye of the beholder.''
Kuhnert, a single mom from Key Biscayne, has dedicated the past 15 years of her life to raising funds for dolphin-assisted therapy, a controversial behavior-modification treatment for severely disabled children. Struck by tragedy as a young mother of a 2-year-old, the Germany native turned her heartbreak into a calling.
Convinced that swimming with the animals paired with intensive speech or physical therapy helps with autism, Down's syndrome, cerebral palsy and other debilitating ailments, Kuhnert spends her days snapping orders at therapists and trouble-shooting emergencies at a therapy center at the Seaquarium in Willemstad, Curacao. She makes phone call after phone call raising money to get children to treatment, at $7,000 or more for just two weeks of care.
But, these days, she is hardly ever by the pool, rarely with the children. The memories of the son she lost sting too much.
A MOM'S MISSION
It was June 18, 1994. Kuhnert was the married mother of two kids from an upper-class family in Germany who made her living in sports event marketing.
That June day, the family had gathered at the country club to celebrate her infant daughter Kira's christening, when suddenly they realized they had lost sight of Tim, Kuhnert's 2-year-old.
''We looked for 15 minutes,'' she remembers. ``He was 15 yards away behind a hedge, in an unsecured swimming pool. This is where they found him. He was lifeless.''
Tim suffered brain damage that left him in a coma and with cerebral palsy. Kuhnert became obsessed, she says -- the type of mom who would ''fly to a rain forest and dance'' to make their kids well.
She traveled to hospitals around the globe, fought with neurologists, lost her marriage.
In 1995, Kuhnert flew from Germany to the Keys, where her little boy swam with dolphins at a facility that has since closed. After four days of being put in the water with a dolphin -- following 16 months in a coma -- Tim woke up.
''I was so happy. I thought every kid that has a problem should be able to do this,'' she said. 'I thought, `Somebody should set up something like a foundation.' ''
That's what Kuhnert did.
''She was so excited about it, she started kind of a crusade to help kids come,'' said David Nathanson, a South Dade psychologist who is considered the founder of dolphin-assisted therapy. ``She's very dedicated and passionate. I would call her semi-eccentric -- in a good way.''
Nathanson ran a company called Dolphin Human Therapy in a variety of locations from Miami Seaquarium to Key Largo and Mexico from 1995 until 2006. In that time, he said, Kuhnert held raffles, organized dinners and made countless calls to send at least 1,000 children to therapy. She'd get airlines to donate tickets and corporations to write checks.
SOUTH FLORIDA
Kuhnert was so dedicated that 10 years ago she packed up and moved to South Florida, so her son could be closer to the dolphins she credits for bringing him out of a coma.
Tim remained severely disabled for the rest of his life, communicating by the roll of an eye. He died suddenly last year at 17.
''He was the funniest, most charming person in the world,'' his mother said. ``He was an angel the day he was born.''
Despite her loss, Kuhnert continues on her quest to find funding for other families to visit the Curacao center.
Her dedication will be honored Thursday when she is presented with an award of excellence by the German American Business Chamber of Florida at the InterContintenal Hotel in Miami.
Kuhnert helped create the program at the Curacao Dolphin Therapy & Research Center, an interdisciplinary treatment center on the grounds of the Sea Aquarium in Willemstad.
The owner pays her a consulting fee to supervise speech and physical therapists and she uses the rest of her time to raise money for her charity, Dolphin Aid, which provides grants for people, largely Europeans, to come. ''She is an inspiring, very driven individual,'' said owner Adriaan ''Dutch'' Schrier. ``I am a son of a Presbyterian Dutch farmer -- I don't believe in hocus pocus or so-called miracles. But what I've witnessed here . . . ''
Among the perceived miracles is the case of Daniuq Kuypers, a 12-year-old who did not speak until after swimming with dolphins in Curacao at the age of 10.
''The only thing I can tell you is that I came here with a daughter who did not speak and flew back to Holland, and she spoke,'' said Daniuq's father, Hans Kuypers, a Dutch homicide detective. ``For 10 years, I had no contact with my daughter. Now she can say why she wants to cry or has pain.
``I can't be sure if it was the dolphin that caused it, and I don't care.''
Kuhnert admits she's not exactly a trained expert.
''I didn't know what I was doing. I was just a mom trying to do the right thing,'' she said. ``I am not a nurse nor a therapist. I was just a mom.''
The therapy has been the target of criticism largely from animal rights groups, which consider it dangerous to humans and unfair to dolphins.
''Because of the lack of scientific study, there are two vulnerable groups being exploited: dolphins and children and parents seeking a miracle under expensive circumstances,'' said Courtney Vail, director of the Caribbean program for the Whale and Dolphin Conservation Society. ``There is such an affinity for these animals, it's easy to believe. But if you are going to claim it has a medical benefit, you have to validate it.''
EXPERT VIEW
Janelle Nimer, a Ph.D. candidate at the University of Tennessee who researched dolphin therapy for her three-year fellowship in veterinary medicine, says experts are not sure why the therapy shows results, but they believe it could have to do with the sonar the animals emit under water.
She tried it herself in Mexico and felt a ''high-like'' feeling for two weeks. The research, Nimer said, shows children show improvements compared to traditional therapy alone.
''All animal therapy is controversial, because it hasn't been researched as it should have been,'' she said. ``People are afraid dolphins are being mistreated. You have exotic animals and parents of autistic kids who are willing to try anything.''
Those who support the therapy say one only needs to see the benefits to believe.
''Therapy without the dolphin does not work. The dolphin without the therapy does not work,'' said Marco Stork, an Amsterdam newspaper ad salesman with two autistic sons. ``They work together.''
His son Damian, 8, had been in speech therapy for three years, and only started speaking after that work was combined with two weeks of two-hour-a-day swims with dolphins.
''His first word was spelen -- play,'' said Stork, who speaks Dutch. ``Something he could never have said, he said after three days here. Every day we saw a little bit more, a little more.''
Labels: Dolphin-assisted therapy, Physiotherapy, Speech Therapy
26 April 2009
Surgery ‘improves life of kids with cerebral palsy
Publish Date: Sunday,26 April, 2009, at 12:27 PM Doha Time
Dr Shaarani: ‘Two to three years of age is the time to show an affected child to a surgeon
By Bonnie JamesSurgical interventions improve the quality of life of children with cerebral palsy, Hamad Medical Corporation’s consultant orthopaedic surgeon Dr Mohamed Shaarani said yesterday.“Surgery enables many wheelchair-bound children to be transferred to walkers and those who are crippled to get on to wheelchairs,” he explained to Gulf Times on the sidelines of the first cerebral palsy symposium in Qatar.
Children with cerebral palsy have spasticity (stiff or rigid muscles with exaggerated, deep tendon reflexes, for example, a knee-jerk reflex), which can interfere with walking, movement, or speech.“We elongate some muscles and cut some others to make them loose and allow movement and flexibility,” pointed out Dr Shaarani, also a consultant paediatric orthopaedic.
Between two to three years of age is the ideal time to show an affected child for the first time to a surgeon, he added.In a presentation about dental problems in cerebral palsy, Primary Healthcare Department’s senior consultant Dr Mutaz Ahmed observed that incidence of dental decay is higher in this group, mainly due to poor oral hygiene.“Dental caries, gum disease, malocclusion, enamel defects, increased incidence of dental trauma, drooling, and grinding of teeth are among the main problems,” he explained.The incidence of gum disease is three times more among those with cerebral palsy than in the general population. The affected group also have a higher rate of dental enamel defects.“The increased risk for dental trauma can be attributed to problems with balance and muscle weakness in legs,” Dr Ahmed pointed out.Giving sedation, including general anaesthesia, is a very important option when doing dental procedures on an individual with cerebral palsy, as it may otherwise be difficult to control the patient.Highlighting the significance of maintaining proper dental hygiene in those with cerebral palsy the senior consultant suggested that parents should be instructed by dentists in this regard.“Cerebral palsy patients should be seen by a dentist every six months,” Dr Ahmed recommended while observing that electric toothbrush can be very useful for them.
Radiology, seizure disorders, growth and nutrition, medical management of spasticity, roles of physiotherapy, occupational therapy, orthotic, speech therapy and dietician, and education were the other topics of presentations at the symposium.
Dr Shaarani: ‘Two to three years of age is the time to show an affected child to a surgeon
By Bonnie JamesSurgical interventions improve the quality of life of children with cerebral palsy, Hamad Medical Corporation’s consultant orthopaedic surgeon Dr Mohamed Shaarani said yesterday.“Surgery enables many wheelchair-bound children to be transferred to walkers and those who are crippled to get on to wheelchairs,” he explained to Gulf Times on the sidelines of the first cerebral palsy symposium in Qatar.
Children with cerebral palsy have spasticity (stiff or rigid muscles with exaggerated, deep tendon reflexes, for example, a knee-jerk reflex), which can interfere with walking, movement, or speech.“We elongate some muscles and cut some others to make them loose and allow movement and flexibility,” pointed out Dr Shaarani, also a consultant paediatric orthopaedic.
Between two to three years of age is the ideal time to show an affected child for the first time to a surgeon, he added.In a presentation about dental problems in cerebral palsy, Primary Healthcare Department’s senior consultant Dr Mutaz Ahmed observed that incidence of dental decay is higher in this group, mainly due to poor oral hygiene.“Dental caries, gum disease, malocclusion, enamel defects, increased incidence of dental trauma, drooling, and grinding of teeth are among the main problems,” he explained.The incidence of gum disease is three times more among those with cerebral palsy than in the general population. The affected group also have a higher rate of dental enamel defects.“The increased risk for dental trauma can be attributed to problems with balance and muscle weakness in legs,” Dr Ahmed pointed out.Giving sedation, including general anaesthesia, is a very important option when doing dental procedures on an individual with cerebral palsy, as it may otherwise be difficult to control the patient.Highlighting the significance of maintaining proper dental hygiene in those with cerebral palsy the senior consultant suggested that parents should be instructed by dentists in this regard.“Cerebral palsy patients should be seen by a dentist every six months,” Dr Ahmed recommended while observing that electric toothbrush can be very useful for them.
Radiology, seizure disorders, growth and nutrition, medical management of spasticity, roles of physiotherapy, occupational therapy, orthotic, speech therapy and dietician, and education were the other topics of presentations at the symposium.
Labels: Balance, Cerebral Palsy, dietician, Education, growth, nutrition, Occupational Therapy, Orthopaedic, orthotic, Physiotherapy, Radiology, seizure disorders, spasticity, Speech Therapy, surgery
07 February 2009
Speech-language pathologist
Speech-language pathology is the study of disorders that affect a person’s speech, language, cognition, voice, swallowing (dysphagia) and the rehabilitative or corrective treatment of physical and/or cognitive deficits/disorders resulting in difficulty with communication and/or swallowing. Speech-language pathologists (SLPs) or Speech and Language Therapists (SLTs) address people’s speech production, vocal production, swallowing difficulties and language needs through speech therapy in a variety of different contexts including schools, hospitals, and through private practice.
Communication includes speech (articulation, intonation, rate, intensity), language (phonology, morphology, syntax, semantics, pragmatics), both receptive and expressive language (including reading and writing), and non-verbal communication such as facial expression and gesture. Swallowing problems managed under speech therapy are problems in the oral, laryngeal, and/or pharyngeal stages of swallowing (not oesophageal).
Depending on the nature and severity of the disorder, common treatments may range from physical strengthening exercises, instructive or repetitive practice and drilling, to the use of audio-visual aids and introduction of strategies to facilitate functional communication. Speech therapy may also include sign language and the use of picture symbols (Diehl 2003).
The practice is called:
Speech-language pathology (SLP) in the United States and Canada
Speech and language therapy (SLT) in the United Kingdom, Ireland and South Africa
Speech pathology in Australia
Speech-language therapy in New Zealand
Other terms in use include speech therapy, logopaedics and phoniatrics.
Contents
1 Scope of practice
2 Professional roles
3 Education
4 Methods of assessment
5 Patients/clients
6 Place of work
7 Colleagues
8 See also
9 External links
Scope of practice
The practice of speech-language pathology involves:
Providing prevention, screening, consultation, assessment and diagnosis, treatment, intervention, management, counseling, and follow-up services for disorders of:
speech (i.e., phonation, articulation, fluency, resonance, and voice including aeromechanical components of respiration);
language (i.e., phonology, morphology, syntax, semantics, and pragmatic/social aspects of communication) including comprehension and expression in oral, written, graphic, and manual modalities; language processing; preliteracy and language-based literacy skills, including phonological awareness;
swallowing or other upper aerodigestive functions such as infant feeding and aeromechanical events (evaluation of esophageal function is for the purpose of referral to medical professionals);
cognitive aspects of communication (e.g., attention, memory, problem solving, executive functions).
sensory awareness related to communication, swallowing, or other upper aerodigestive functions.
Establishing augmentative and alternative communication (AAC) techniques and strategies including developing, selecting, and prescribing of such systems and devices (e.g., speech generating devices.)
Providing services to individuals with hearing loss and their families/caregivers (e.g.,auditory training; speechreading; speech and language intervention secondary to hearing loss; visual inspection and listening checks of amplification devices for the purpose of troubleshooting, including verification of appropriate battery voltage).
Screening hearing of individuals who can participate in conventional pure-tone air conduction methods, as well as screening for middle ear pathology through screening tympanometry for the purpose of referral of individuals for further evaluation and management.
Using instrumentation (e.g., videofluoroscopy, EMG, nasendoscopy, stroboscopy, computer technology) to observe, collect data, and measure parameters of communication and swallowing, or other upper aerodigestive functions in accordance with the principles of evidence-based practice.
Selecting, fitting, and establishing effective use of prosthetic/adaptive devices for communication, swallowing, or other upper aerodigestive functions (e.g., tracheoesophageal prostheses, speaking valves, electrolarynges). This does not include sensory devices used by individuals with hearing loss or other auditory perceptual deficits.
Collaborating in the assessment of central auditory processing disorders and providing intervention where there is evidence of speech, language, and/or other cognitivecommunication disorders.
Educating and counseling individuals, families, co-workers, educators, and other persons in the community regarding acceptance, adaptation, and decision makes about communication, swallowing, or other upper aerodigestive concerns.
Advocating for individuals through community awareness, education, and training programs to promote and facilitate access to full participation in communication, including the elimination of societal barriers.
Collaborating with and providing referrals and information to audiologists, educators, and health professionals as individual needs dictate.
Addressing behaviors (e.g., perseverative or disruptive actions) and environments (e.g., seating, positioning for swallowing safety or attention, communication opportunities) that affect communication, swallowing, or other upper aerodigestive functions.
Providing services to modify or enhance communication performance (e.g., accent modification, transgendered voice, care and improvement of the professional voice, personal/ professional communication effectiveness).
Recognizing the need to provide and appropriately accommodate diagnostic and treatment services to individuals from diverse cultural backgrounds and adjust treatment and assessment services according.
Professional roles
Speech-language pathologists serve individuals, families, groups, and the general public through a broad range of professional activities. They:
Identify, define, and diagnose disorders of human communication and swallowing and assist in localization and diagnosis of diseases and conditions.
Provide direct services using a variety of service delivery models to treat and/or address communication, swallowing, or other upper aerodigestive concerns.
Conduct research related to communication sciences and disorders, swallowing, or other upper aerodigestive functions.
Educate, supervise, and mentor future speech-language pathologists.
Serve as case managers and service delivery coordinators.
Administer and manage clinical and academic programs.
Educate and provide in-service training to families, caregivers, and other professionals.
Participate in outcomes measurement activities and use data to guide clinical decision making and determine the effectiveness of services provided in accordance with the principles of evidence-based practice.
Train, supervise, and manage speech-language pathology assistants and other support personnel.
Promote healthy lifestyle practices for the prevention of communication, hearing, swallowing, or other upper aerodigestive disorders.
Education
In the UK( United Kingdom) , SLTs undertake a three to four year degree course devoted entirely to the study of clinical language sciences and communicative disorders. This qualifies them to work in any of the three main clinical areas. The course, which varies according to university, includes intensive study of core theoretical components underpinning competence to practice , Linguistics, Psychology and Medical science, in addition to the study of a range of communicative disorders in children and adults. Students are also expected to become familiar with a range of policies, processes and procedures relevant to working in different contexts, including health and education. The course is very demanding, and is assessed via coursework, exams and clinical placement. Some universities require students to assess and diagnose an ‘unseen client’ prior to completing their degree course; all require the completion of a pilot study related to the field of Speech and Language Therapy. Throughout the course, students undertake a variety of clinical placements in which their ability to practise is continually assessed. All courses require students to complete a certain amount of hours of clinical placement, although the structure of placement differs from course to course.
Upon qualifying SLT’s enter the profession as a newly-qualified practitioner. The recommended career course is that they then achieve a number of competencies, which qualify them to work autonomously. The Royal College of Speech and Language Therapists, the professional body representing Speech and Language Therapists in the UK, provides a framework of competencies which therapists are expected to achieve within 12–18 months of beginning clinical practice. Access to supervision during this period varies from trust to trust, and each individual therapist is expected to provide documentary evidence of competencies achieved to a senior colleague (usually a manager) who determines whether a therapist meets the required criteria for admission to the ‘full register’.
Speech and Language Therapists in the UK are required by law to register with the Health Professions Council, a regulatory body governing a range of health professions. The Health Professions Council has the power to discipline members who do not meet the rigorous standards for effective and safe clinical practice, and may ’strike off’ or deregister members who fail to maintain these standards.
In the United States, Speech Language Pathology practice is regulated by the laws of the individual states. However, by 2006, the minimal requirements to be a certified SLP member of the American Speech-Language Hearing Association were: a graduate degree in Speech-Language Pathology, which typically entails 2 years of post graduate work; a completed clinical fellowship year, which is generally employment for a year while supervised by a practicing SLP who is also ASHA certified; and passing the Praxis Series examination. The graduate degree work to acquire a Master’s in Speech-Language Pathology is rigorous and demanding, requiring many hours of supervised clinical practica, and intensive didactic coursework in medical sciences, phonetics, linguistics, phonology, scientific methodology, and other subjects.
Certification by ASHA is noted as carrying one’s “C”s. (Certificate of Clinical Competence) It is noted after an SLP’s name as: CCC-SLP.
In Australia, Speech Pathologists either undertake a four year undergraduate degree, or a two year Masters degree to qualify. These dual pathways are considered by Speech Pathology Australia to produce equally prepared graduates. To be eligible for optional membership of Speech Pathology Australia, students must study in one of the accredited courses outlined on their website. Speech Pathology degrees in Australia vary in curriculum, but always include streams teaching anatomy and physiology, professional practice, communication and swallowing disorders, and often some elementary psychology and audiology. Most include no or minimal elective subjects. All degrees include a heavy clinical component, and many also include a research component in final year. Once graduated, students become fully qualified Speech Pathologists and are eligible for any Level 1 position, without the need for an internship or general examination. Registration is only required in the state of Queensland, and membership of the professional organization is optional, although it is encouraged.
Methods of assessment
There are separate standardized assessment tools administered for infants, school-aged children, adolescents and adults. Assessments primarily examine the form, content, understanding and use of language, as well as articulation, and phonology. Oral motor and swallowing assessments often require specialized training which includes the use of bedside examination tools and endoscopic/modified barium radiology procedures.
Individuals may be referred to an SLP for the following: Traumatic brain injury; Stroke; Alzheimer’s disease and dementia; Cranial nerve damage; Progressive neurological conditions (Parkinson, ALS, etc); Developmental delay; Learning disability (speaking and listening); Autism Spectrum Disorders (including Asperger Syndrome); Genetic disorders that adversely affect speech, language and/or cognitive development; Injuries due to complications at birth; Feeding and swallowing concerns; Craniofacial anamolies that adversely affect speech, language and/or cognitive development; and Augmentative Alternative Communication needs.
There are myriad Speech-Language Assessment tools used for chidren and adults, depending on the area of need.
Patients/clients
Speech and language therapists work with:
Babies with feeding and swallowing difficulties
Children with mild, moderate or severe:
learning difficulties
physical disabilities, language delay
specific language impairment
specific difficulties in producing sounds (including vocalic r and lisps)
hearing impairment
cleft palate
stammering
autism/social interaction difficulties
dyslexia
voice disorders
Adults with eating and swallowing and/or communication problems following
stroke
head injury (Traumatic brain injury)
Parkinson’s disease
motor neuron disease
multiple sclerosis
Huntington’s disease
dementia
cancer of the head, neck and throat (including laryngectomy)
voice problems
mental health issues
learning difficulties, physical disabilities
stammering (dysfluency)
hearing impairment
transsexual women seeking voice therapy
In the United States, the cost of speech therapy for a child younger than three years old is likely covered by the state early intervention (zero to three) program.
In Britain, the majority of Speech and Language therapy is funded by the National Health Service (and increasingly, by partners in Education) meaning that initial assessment is available cost-free to all clients at the point of service, regardless of age or presenting problem. The large numbers of referrals contribute to high caseloads and long waiting lists, although this differs from area to area. To meet the needs of many of these clients, it has become necessary for many services to focus heavily on training and consultative models of service provision. The number of hours of direct therapy available to clients varies widely from trust to trust and most areas operate strict guidelines for prioritisation to meet the high clinical demand.
Place of work
Speech and language therapists work in community health centres, hospital wards and outpatient departments, mainstream and special schools, further education colleges, day centers and in their clients’ homes. Some now work in courtrooms, prisons and young offenders’ institutions.
Some speech and language therapists who work independently will see children and adults in their own homes, and may offer appointments on a Saturday.
Colleagues
SLTs/SLPs work closely with others involved with the client, for example difficulties with eating and drinking may also involve an occupational therapist. Speech and language therapists also work closely with parents and caregivers and other professionals, such as audiologists, teachers, nurses, dietitians, physiotherapists, and doctors.
Communication includes speech (articulation, intonation, rate, intensity), language (phonology, morphology, syntax, semantics, pragmatics), both receptive and expressive language (including reading and writing), and non-verbal communication such as facial expression and gesture. Swallowing problems managed under speech therapy are problems in the oral, laryngeal, and/or pharyngeal stages of swallowing (not oesophageal).
Depending on the nature and severity of the disorder, common treatments may range from physical strengthening exercises, instructive or repetitive practice and drilling, to the use of audio-visual aids and introduction of strategies to facilitate functional communication. Speech therapy may also include sign language and the use of picture symbols (Diehl 2003).
The practice is called:
Speech-language pathology (SLP) in the United States and Canada
Speech and language therapy (SLT) in the United Kingdom, Ireland and South Africa
Speech pathology in Australia
Speech-language therapy in New Zealand
Other terms in use include speech therapy, logopaedics and phoniatrics.
Contents
1 Scope of practice
2 Professional roles
3 Education
4 Methods of assessment
5 Patients/clients
6 Place of work
7 Colleagues
8 See also
9 External links
Scope of practice
The practice of speech-language pathology involves:
Providing prevention, screening, consultation, assessment and diagnosis, treatment, intervention, management, counseling, and follow-up services for disorders of:
speech (i.e., phonation, articulation, fluency, resonance, and voice including aeromechanical components of respiration);
language (i.e., phonology, morphology, syntax, semantics, and pragmatic/social aspects of communication) including comprehension and expression in oral, written, graphic, and manual modalities; language processing; preliteracy and language-based literacy skills, including phonological awareness;
swallowing or other upper aerodigestive functions such as infant feeding and aeromechanical events (evaluation of esophageal function is for the purpose of referral to medical professionals);
cognitive aspects of communication (e.g., attention, memory, problem solving, executive functions).
sensory awareness related to communication, swallowing, or other upper aerodigestive functions.
Establishing augmentative and alternative communication (AAC) techniques and strategies including developing, selecting, and prescribing of such systems and devices (e.g., speech generating devices.)
Providing services to individuals with hearing loss and their families/caregivers (e.g.,auditory training; speechreading; speech and language intervention secondary to hearing loss; visual inspection and listening checks of amplification devices for the purpose of troubleshooting, including verification of appropriate battery voltage).
Screening hearing of individuals who can participate in conventional pure-tone air conduction methods, as well as screening for middle ear pathology through screening tympanometry for the purpose of referral of individuals for further evaluation and management.
Using instrumentation (e.g., videofluoroscopy, EMG, nasendoscopy, stroboscopy, computer technology) to observe, collect data, and measure parameters of communication and swallowing, or other upper aerodigestive functions in accordance with the principles of evidence-based practice.
Selecting, fitting, and establishing effective use of prosthetic/adaptive devices for communication, swallowing, or other upper aerodigestive functions (e.g., tracheoesophageal prostheses, speaking valves, electrolarynges). This does not include sensory devices used by individuals with hearing loss or other auditory perceptual deficits.
Collaborating in the assessment of central auditory processing disorders and providing intervention where there is evidence of speech, language, and/or other cognitivecommunication disorders.
Educating and counseling individuals, families, co-workers, educators, and other persons in the community regarding acceptance, adaptation, and decision makes about communication, swallowing, or other upper aerodigestive concerns.
Advocating for individuals through community awareness, education, and training programs to promote and facilitate access to full participation in communication, including the elimination of societal barriers.
Collaborating with and providing referrals and information to audiologists, educators, and health professionals as individual needs dictate.
Addressing behaviors (e.g., perseverative or disruptive actions) and environments (e.g., seating, positioning for swallowing safety or attention, communication opportunities) that affect communication, swallowing, or other upper aerodigestive functions.
Providing services to modify or enhance communication performance (e.g., accent modification, transgendered voice, care and improvement of the professional voice, personal/ professional communication effectiveness).
Recognizing the need to provide and appropriately accommodate diagnostic and treatment services to individuals from diverse cultural backgrounds and adjust treatment and assessment services according.
Professional roles
Speech-language pathologists serve individuals, families, groups, and the general public through a broad range of professional activities. They:
Identify, define, and diagnose disorders of human communication and swallowing and assist in localization and diagnosis of diseases and conditions.
Provide direct services using a variety of service delivery models to treat and/or address communication, swallowing, or other upper aerodigestive concerns.
Conduct research related to communication sciences and disorders, swallowing, or other upper aerodigestive functions.
Educate, supervise, and mentor future speech-language pathologists.
Serve as case managers and service delivery coordinators.
Administer and manage clinical and academic programs.
Educate and provide in-service training to families, caregivers, and other professionals.
Participate in outcomes measurement activities and use data to guide clinical decision making and determine the effectiveness of services provided in accordance with the principles of evidence-based practice.
Train, supervise, and manage speech-language pathology assistants and other support personnel.
Promote healthy lifestyle practices for the prevention of communication, hearing, swallowing, or other upper aerodigestive disorders.
Education
In the UK( United Kingdom) , SLTs undertake a three to four year degree course devoted entirely to the study of clinical language sciences and communicative disorders. This qualifies them to work in any of the three main clinical areas. The course, which varies according to university, includes intensive study of core theoretical components underpinning competence to practice , Linguistics, Psychology and Medical science, in addition to the study of a range of communicative disorders in children and adults. Students are also expected to become familiar with a range of policies, processes and procedures relevant to working in different contexts, including health and education. The course is very demanding, and is assessed via coursework, exams and clinical placement. Some universities require students to assess and diagnose an ‘unseen client’ prior to completing their degree course; all require the completion of a pilot study related to the field of Speech and Language Therapy. Throughout the course, students undertake a variety of clinical placements in which their ability to practise is continually assessed. All courses require students to complete a certain amount of hours of clinical placement, although the structure of placement differs from course to course.
Upon qualifying SLT’s enter the profession as a newly-qualified practitioner. The recommended career course is that they then achieve a number of competencies, which qualify them to work autonomously. The Royal College of Speech and Language Therapists, the professional body representing Speech and Language Therapists in the UK, provides a framework of competencies which therapists are expected to achieve within 12–18 months of beginning clinical practice. Access to supervision during this period varies from trust to trust, and each individual therapist is expected to provide documentary evidence of competencies achieved to a senior colleague (usually a manager) who determines whether a therapist meets the required criteria for admission to the ‘full register’.
Speech and Language Therapists in the UK are required by law to register with the Health Professions Council, a regulatory body governing a range of health professions. The Health Professions Council has the power to discipline members who do not meet the rigorous standards for effective and safe clinical practice, and may ’strike off’ or deregister members who fail to maintain these standards.
In the United States, Speech Language Pathology practice is regulated by the laws of the individual states. However, by 2006, the minimal requirements to be a certified SLP member of the American Speech-Language Hearing Association were: a graduate degree in Speech-Language Pathology, which typically entails 2 years of post graduate work; a completed clinical fellowship year, which is generally employment for a year while supervised by a practicing SLP who is also ASHA certified; and passing the Praxis Series examination. The graduate degree work to acquire a Master’s in Speech-Language Pathology is rigorous and demanding, requiring many hours of supervised clinical practica, and intensive didactic coursework in medical sciences, phonetics, linguistics, phonology, scientific methodology, and other subjects.
Certification by ASHA is noted as carrying one’s “C”s. (Certificate of Clinical Competence) It is noted after an SLP’s name as: CCC-SLP.
In Australia, Speech Pathologists either undertake a four year undergraduate degree, or a two year Masters degree to qualify. These dual pathways are considered by Speech Pathology Australia to produce equally prepared graduates. To be eligible for optional membership of Speech Pathology Australia, students must study in one of the accredited courses outlined on their website. Speech Pathology degrees in Australia vary in curriculum, but always include streams teaching anatomy and physiology, professional practice, communication and swallowing disorders, and often some elementary psychology and audiology. Most include no or minimal elective subjects. All degrees include a heavy clinical component, and many also include a research component in final year. Once graduated, students become fully qualified Speech Pathologists and are eligible for any Level 1 position, without the need for an internship or general examination. Registration is only required in the state of Queensland, and membership of the professional organization is optional, although it is encouraged.
Methods of assessment
There are separate standardized assessment tools administered for infants, school-aged children, adolescents and adults. Assessments primarily examine the form, content, understanding and use of language, as well as articulation, and phonology. Oral motor and swallowing assessments often require specialized training which includes the use of bedside examination tools and endoscopic/modified barium radiology procedures.
Individuals may be referred to an SLP for the following: Traumatic brain injury; Stroke; Alzheimer’s disease and dementia; Cranial nerve damage; Progressive neurological conditions (Parkinson, ALS, etc); Developmental delay; Learning disability (speaking and listening); Autism Spectrum Disorders (including Asperger Syndrome); Genetic disorders that adversely affect speech, language and/or cognitive development; Injuries due to complications at birth; Feeding and swallowing concerns; Craniofacial anamolies that adversely affect speech, language and/or cognitive development; and Augmentative Alternative Communication needs.
There are myriad Speech-Language Assessment tools used for chidren and adults, depending on the area of need.
Patients/clients
Speech and language therapists work with:
Babies with feeding and swallowing difficulties
Children with mild, moderate or severe:
learning difficulties
physical disabilities, language delay
specific language impairment
specific difficulties in producing sounds (including vocalic r and lisps)
hearing impairment
cleft palate
stammering
autism/social interaction difficulties
dyslexia
voice disorders
Adults with eating and swallowing and/or communication problems following
stroke
head injury (Traumatic brain injury)
Parkinson’s disease
motor neuron disease
multiple sclerosis
Huntington’s disease
dementia
cancer of the head, neck and throat (including laryngectomy)
voice problems
mental health issues
learning difficulties, physical disabilities
stammering (dysfluency)
hearing impairment
transsexual women seeking voice therapy
In the United States, the cost of speech therapy for a child younger than three years old is likely covered by the state early intervention (zero to three) program.
In Britain, the majority of Speech and Language therapy is funded by the National Health Service (and increasingly, by partners in Education) meaning that initial assessment is available cost-free to all clients at the point of service, regardless of age or presenting problem. The large numbers of referrals contribute to high caseloads and long waiting lists, although this differs from area to area. To meet the needs of many of these clients, it has become necessary for many services to focus heavily on training and consultative models of service provision. The number of hours of direct therapy available to clients varies widely from trust to trust and most areas operate strict guidelines for prioritisation to meet the high clinical demand.
Place of work
Speech and language therapists work in community health centres, hospital wards and outpatient departments, mainstream and special schools, further education colleges, day centers and in their clients’ homes. Some now work in courtrooms, prisons and young offenders’ institutions.
Some speech and language therapists who work independently will see children and adults in their own homes, and may offer appointments on a Saturday.
Colleagues
SLTs/SLPs work closely with others involved with the client, for example difficulties with eating and drinking may also involve an occupational therapist. Speech and language therapists also work closely with parents and caregivers and other professionals, such as audiologists, teachers, nurses, dietitians, physiotherapists, and doctors.
Labels: Access, brain injuries, cancer, Carers, developmental disabilities, language, multiple sclerosis, Occupational Therapy, Physiotherapy, Speech Therapy