The term 'speech-language pathology' is an unwieldy one. When I introduce myself as a speech-language pathologist, very few people in the general public have even heard of the profession. This is hardly their fault; speech-language pathologists use a variety of different titles and job descriptions when referring to themselves. Speech teacher; speech therapist; speech teacher; speech pathologist; voice therapist; voice coach; accent coach; the list goes on and on. When there are so many informal variations, it's no wonder that people are unsure of what our profession is!
Let's begin our discussion by defining the term 'speech-language pathology'.
Speech-language pathology: the field of study involving the detection, evaluation, diagnosis, and treatment of speech, language, voice, swallowing, fluency, and cognition-related disorders.
Wow, what a long list of words! Put in more reader-friendly terms: speech-language pathologists work with those who are unsatisfied with their communicative abilities. In graduate school, burgeoning speech-language pathologists are given in-depth instruction in all subjects listed and beyond in order to prepare them for employment possibilities in a wide variety of settings. The primary employers of SLPs are hospitals; outpatient clinics; school districts; skilled nursing facilities; and ear, nose, and throat clinics. We use our diverse skill set to work with clients whose quality of life is currently lower than average due to difficulties with any of the domains listed in the base definition above. The 'quality of life' component is an important one, as not everyone who has a communication disorder, delay or difference feels negatively impacted by their atypical communication style. If someone doesn't feel that their communication style hurts their quality of life, then seeing a speech-language pathologist may not be necessary.
With so many areas of communication (and swallowing) and populations to work with and specialize in, it's no surprise the branding of the field is so vague. Another contributing factor to this difficulty is the lack of public knowledge regarding just how complicated communication (and swallowing) is! Do you know the difference between speech and voice? Language and fluency? Let's address these terms before we proceed. The following is a basic overview of each of these concepts:
Voice
Definition
The production of sound in the larynx. Vocal folds are brought together and vibrate due to air coming up from the lungs. The act of producing sound for speech purposes is referred to as phonation.
Resonance
Another aspect of voicing, which will be discussed in greater detail later. In basic terms, resonance refers to the sound produced by the larynx being amplified and changed in the back of the oral cavity, nasal cavity, and pharyngeal cavity (the area between the nose and mouth in the back of the throat that connects both to the larynx below).
Video
(Volume Warning) Above is a video of the larynx, seen from above, as the client phonates. The clinician has used a fiberoptic camera inserted into a nostril and run down the back of the throat to view the larynx without triggering a gag reflex. In the video, you can see the client phonate by bringing the vocal folds together, then move them apart when they breathe in. At 1:11, you can see the client change pitch by changing how tense the vocal folds are. As the client increases pitch, the vocal folds are pulled tighter to increase the rate of vibration. We will discuss these features in more depth later!
Speech
Definition
The shaping of sound produced in the larynx by using the articulators. The molding of this sound into recognizable patterns is known as articulation.
The Articulators
The tongue, teeth, lips, and soft palate, which manipulate the sound into words. The coordination of these requires very quick, synchronized movement of many facial muscles working together to get the articulators into position.
Video
This is a video of someone producing a standardized speech sample (The Grandfather Passage) while a technician records using Magnetic Resonance Imaging (MRI). You can see the articulators moving very quickly to manipulate the sound. At the upper back area of the throat, you can see a light gray, flexible shape repeatedly moving up and back and back to rest position. That is the soft palate, mentioned before, which lets air pass up to the nose for the sounds /m/ (as in mother), /n/ (as in nose) and /ng/ (as in lung), and lifts up to direct the sound into the mouth in order to produce all other sounds (commonly found in English).
(Verbal) Language
Definition
The recognizable patterns of speech sounds, given meaning by a larger cultural context. Language is the subject of a great deal of study in many disciplines, and can be organized and examined in many different ways. In speech-language pathology, we divide language into five sub-domains.
The Sub-Domains of Language
Phonology, or the study of linking of speech sounds together; morphology, which refers to the study of how the smallest units of language (such as prefixes, suffixes, and root words) are combined to make and modify words; syntax, or the rules that regulate sentence structure; semantics, also known as word meaning; and pragmatics, which is social application of language.
Non-Verbal Language
There are, of course, ways to communicate without speech. Written language and body language are also used by the vast majority of society. Some systems of communication, such as American Sign Language, do not rely on speech at all. For some, language is produced using communication devices or aides. This is referred to as Augmentative and Alternative Communication (AAC). These methods of communication are incredibly important and unique and are heavily relied on by speech-language pathologists who work with individuals who are not prime candidates for working on verbal language.
Fluency
Definition
The rate and ease of planning and executive verbal communication. If one’s speech is fluent, there are no pauses for word finding or difficulty getting the articulators into place. An important note to make is that no speaker is 100% fluent all the time. Everyone stumbles over their speech, interjects “uh”, or has trouble thinking of a word from time to time. When one is feeling tired, excited, nervous, or stressed, chances of producing disfluent speech increase. If someone’s fluency breaks become excessive to the point of decreasing their quality of life, their fluency may be considered disordered.
Disfluencies
Briefly discussed above, disfluencies are moments where the flow of speech is interrupted. Disfluencies can come in many shapes and severities. Some disfluencies, such as revisions and interjections, are considered typical, as they commonly occur in individuals without disordered fluency. Others, such as part-word repetitions (“s-s-s-s-sorry”) and prolongations (“I tr-tr-trrrrrrriiiiieeed”), are much more indicative of a fluency disorder. These will be discussed more in a later, in-depth post about fluency.
Secondary Behaviors
As someone with a fluency disorder progresses through life, they may begin to exhibit maladaptive coping mechanisms to either lessen or prevent disfluency. The list of secondary behaviors is infinite. However, some more common behaviors are grimacing, facial or body tension, head turning, audible inhalation/exhalation before or after stuttering, etc. They may begin avoiding speaking or going out in public. Because of this, fluency therapy typically involves a great deal of counseling and emotional support.
Swallowing
Definition
The coordination of articulators, larynx, and lungs to masticate (chew up) food and move food down the back of the throat, into the esophagus and finally, the stomach. Besides breathing, swallowing is one of the most important functions of the mouth and larynx. If the system is not properly coordinated, very serious consequences may follow, including aspiration , which is when foreign material enters the lungs instead of the stomach. This can result in aspiration pneumonia, and in some cases, death.
Cognition
Definition
As applied to speech and language production, cognition is the usage of the brain for speech and language production. Typical cognition for communication involves the usage of memory, organization, attention, perception, and executive function. Difficulties with cognition may be congenital or acquired through trauma.
There is so much more to say about all of these areas; unfortunately, I am out of time. I must begin packing for my adventure to Philadelphia for the 47th Annual Voice Foundation Symposium! Next week, I'll discuss my time at the symposium and everything I learned there. I hope you enjoyed my brief overview of what speech-language pathology is and who we work with! As always, leave any questions or comments and I will do my best to respond in a timely fashion. Thank you for reading!
I just wanted to thank you for helping me learn more about speech-language pathology. I didn’t know that they can usually help those who aren’t satisfied with how they communicate. It sounds like they can help those who don’t necessarily struggle with communicating, but who want to be better.
Hello Taylor! Thank you so much for reading, and for leaving your kind comment! I’m so happy my article was helpful to you. Let me know if there are any other questions you have which I can help answer! -Kevin Dorman, MS, CCC-SLP
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I just wanted to thank you for helping me learn more about speech-language pathology. I didn’t know that they can usually help those who aren’t satisfied with how they communicate. It sounds like they can help those who don’t necessarily struggle with communicating, but who want to be better.
Hello Taylor! Thank you so much for reading, and for leaving your kind comment! I’m so happy my article was helpful to you. Let me know if there are any other questions you have which I can help answer!
-Kevin Dorman, MS, CCC-SLP
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