About Speech and Language Pathology
Speech and language pathology encompasses the study of speech, voice, language and swallowing disorders. The discipline is multidisciplinary and is based on knowledge in medicine, linguistics, phonetics and psychology.
The Speech Language Pathologist’s (SLPs) role is to investigate, diagnose and treat communication disorders in children and adults, due to speech, language and voice disorders or related to other disabilities. Included in the SLPs responsibilities is also diagnostics and treatment of eating and swallowing difficulties. Depending on the focus area of work, SLPs collaborate with, for example, doctors, nurses, psychologists, physiotherapists, dieticians, occupational therapists, preschool staff, teachers and special educational needs teachers.
To be able to speak is something most people take for granted, likewise, to be able to eat and swallow without difficulty. But, what happens if the speech organs do not develop normally during the fetal stage? Children born with cleft palate cannot begin to speak normally for anatomical reasons. Which surgical and training methods provide the best speech development?
The voice carries most of our communication in daily life. We tend to talk from morning to evening. Many people expose their vocal cords to loading during long working days in noisy environments. In addition, half a million Swedes sing I choirs during their leisure time. How do people use their voices in everyday life from a physiological point of view? How can voice problems be prevented? What voice characteristics distinguish different vocal fold injuries? Is "hoarseness" a uniform symptom?
Neurological diseases can affect communication abilities in different ways. The voice becomes weak so that one cannot be heard in a regular conversation. The articulations becomes unclear. The linguistic ability deteriorates so that words are lost and do not form complete sentences. Memorization can make it difficult to keep the thread in a conversation. The communication needs to be supported through training interventions, communication aids or training of the patient's interlocutor by means of special communication technologies. How are the relationships between the brain's function and different communication disorders? How can disorders best be diagnosed? What interventions provide the patients with the ability to communicate effectively and with maintain quality of life?
Another common neurological problem is difficulties to eat and swallow properly. One uses the same body structures as when speaking, but swallowing is controlled by different parts of the nervous system. Swallowing problems may lead to insufficient intake of water fluid and nutrition. One may also risk getting food in the lungs. Swallowing difficulties are therefore a serious health problem. How can such problems be identified at an early stage? Which diagnostic methods are most reliable? How can patients with swallowing difficulties best be treated in the hospital?
These are examples of important research questions in Speech and Language Pathology.
Communicating is a right, and not being able to, a democracy problem
Swallowing disorders (dysphagia)
Swallowing is the act of transporting saliva, drinks and food from the mouth to the stomach. Swallowing and respiration share the same “channel”, mouth – pharynx; swallowing therefore needs to be executed in a safe and efficient manner. During swallowing, airways are closed for appr. 1.5 seconds and respiration is paused to protect from saliva, drinks and food entering into the airways. Difficulties chewing, eating and swallowing (dysphagia) occur as a result of congenital or acquired diseases that affect structures and sensorimotor function in the oral cavity and pharynx. Dysphagia can also occur as a result of aging (presbyphagia). Biological changes related to aging lead to reductions in muscle tissue and strength (sarcopenia) and changes in saliva production, that affect swallowing. The frequency of several health conditions increase with age – so called frail elderly – and it becomes more common that individuals have a multitude of health conditions that affect chewing, swallowing and eating negatively.
Common disorders that affect swallowing are stroke and traumatic brain injuries, neurological disorders (Parkinson’s disease, Multiple Sclerosis – MS, Amyotrofic lateral sclerosis – ALS, Huntington’s disease, muscle dystrophy/dystrophia myotonica, myastenia gravis etc), head and neck tumors, and Chronic Obstructive Pulmonary Disease (COPD). Dysphagia is related to respiratory difficulties and occurs in patients with infectious diseases, and is common in the intensive care unit (ICU). Loss of teeth or the use of dental prostheses and implants affect the ability to chew and prepare the food orally for swallowing. Mouth dryness (xerostomia) and deviant saliva production make it difficult to prepare and transport food in the mouth, and may also reduce or distort the perception of taste of food and drink.
Dysphagia increases the risk of malnutrition, dehydration and airway complications (choking, pneumonia). The risk for complications further increases in individuals that are dependent on feeding. Thus, it is important to identify early signs of dysphagia and start interventions. Knowledge of dysphagia and care routines for the observation and screening of swallowing/dysphagia on all levels in the health care is therefore important. Knowledge of interventions is also of greatest importance for safe eating and quality of life in individuals with dysphagia. Dysphagia often varies with the individual’s general health status (for example more difficulties later during the day), when having pain or being fatigued, why individuals with dysphagia need frequent follow-ups in order to update their recommendations for safe eating and swallowing.