Preferred Practice Patterns for the Profession of Speech-Language Pathology [Preferred Practice Patterns]

American Speech-Language-Hearing Association. (2004).

Rockville (MD): American Speech-Language-Hearing Association, Available from: http://www.asha.org/policy/PP2004-00191/.

This Preferred Practice Patterns for the Profession of Speech-Language Pathology document is a description of recommended practice for many areas of assessment and management in the scope of practice for SLPs. The guiding principles for each clinical service are discussed in terms of service provider, expected outcome, clinical indication, clinical processing, setting, equipment, safety precautions, and documentation.

American Speech-Language-Hearing Association

<p>"Assessment is prompted by referral, by the individual's medical status, or by failing a speech screening that is sensitive to cultural and linguistic diversity" (p. 99).</p> <p>"All patients/clients with voice disorders are examined by a physician, preferably in a discipline appropriate to the presenting complaint. The physician's examination may occur before or after the voice evaluation by the speech-language pathologist" (p. 99).</p>

<div>"Intervention is long enough to accomplish stated objectives/predicted outcomes. The intervention period does not continue when there is no longer any expectation for further benefit" (p. 103).</div>

<div>"Audiologic screening services [by speech-language pathologists] are limited to pure-tone air conduction screening and screening tympanometry for initial identification and/or referral purposes. These are pass/fail procedures to identify individuals who require referral for further audiologic assessment or other professional and/or medical services" (p. 12).</div>

<div>The results of the assessment dictate the focus of intervention. Intervention may involve alteration of lingual and labial resting postures, muscle retraining, and modification of solids, liquids, and saliva.</div>

<p>Depending on the results of assessment, intervention may address:</p> <ul> <li>the individual's preferences, goals, and special needs to enhance participation and functioning in life activities;</li> <li>appropriate voice care and conservation;</li> <li>proper use of respiratory, phonatory, and resonatory processes; and</li> <li>patient/client-directed selection of preferred alaryngeal speech communication.</li> </ul> <p>Intervention may include materials and approaches that are appropriate for the client's age, status, and background and follow-up including interdisciplinary referrals.</p>

<p>"Voice assessments are conducted by appropriately credentialed and trained speech-language pathologists" and may result in the following:</p> <ul> <li>diagnosis of a voice disorder or laryngeal disorder affecting respiration,</li> <li>description of perceptual phonatory characteristics,</li> <li>measurement of aspects of vocal function,</li> <li>examination of phonatory behavior,</li> <li>identification of a communication difference, possibly co-occuring with a voice or laryngeal disorder,</li> <li>prognosis for change,</li> <li>recommendations for intervention and support,</li> <li>identification of the effectiveness of intervention and supports, and</li> <li>referral for other assessments or services (p. 99).</li> </ul>

<div>"Swallowing screening is conducted in a clinical or natural environment conducive to obtaining valid screening results" (p. 7). Settings may include bedside, home, or hospice.</div>

<p>"[Orofacial myofunctional] assessment may be static (i.e., using procedures designed to describe current levels of functioning within relevant domains) or dynamic (i.e., using hypothesis testing procedures to identify potentially successful intervention and support procedures) and includes the following:</p> <ul> <li>Review auditory, visual, motor, and cognitive status.</li> <li>Relevant case history, including review of medical history and status (including any structural or neurologic abnormalities), medical and dental treatment, education, vocation and socioeconomic and cultural and linguistic backgrounds.</li> <li>Observation of orofacial myofunction patterns.</li> <li>Structural assessment including observation of face, jaw, lips, tongue, teeth, hard palate, soft palate, and pharynx.</li> <li>Perceptual and instrumental diagnostic procedures to assess oral and nasal airway functions as they pertain to orofacial myofunctional patterns, swallowing, and/or speech production (e.g., speech articulation testing, aerodynamic measures).</li> <li>Articulatory phenomena that may be causally related to orofacial myofunctional disorders.</li> <li>Collaboration with physicians, dental specialists, and other professionals, which is advantageous to assessment and treatment planning.</li> <li>Follow-up services to monitor status and ensure appropriate treatment for patients/clients with identified orofacial myofunctional disorders.</li> <li>Selection of standardized measures for orofacial myofunctional assessment with consideration for documented ecological validity.</li> <li>Follow-up services to monitor status and ensure appropriate intervention and support for individuals with identified orofacial myofunctional disorders" (pp. 110-111).</li> </ul>

<div>Depending on the assessment results, intervention may focus on supporting hydration and nutrition, minimizing risk for pulmonary complications, facilitating oral/pharyngeal/respiratory coordination, and modification of behavioral and sensory issues.</div>

<p>Swallowing screening may involve:</p> <ul> <li>interview/questionnaire;</li> <li>observation of signs and symptoms;</li> <li>observation of typical feeding/eating situation;</li> <li>formulation of recommendation and referral for full swallowing or other evaluation, if appropriate; and</li> <li>communication of the results and recommendations to the multidisciplinary team.</li> </ul>

<p>Static or dynamic assessments should be conducted, including the following aspects:</p> <ul> <li>review of auditory, visual, motor, and cognitive status;</li> <li>relevant case history;</li> <li>perceptual, acoustic, and physiological aspects of vocal production/behavior;</li> <li>client's ability to modify vocal behavior;</li> <li>emotional/psychological status;</li> <li>observation or review of articulation, fluency, and language;&nbsp;</li> <li>functional consequences of the voice disorder;</li> <li>use of perceptual rating scales, acoustic analysis, aerodynamic measures, electroglottography, and imaging techniques,&nbsp;</li> <li>standardized measures with ecological validity; and</li> <li>follow-up services to monitor voice status, intervention, and support.</li> </ul>

<p>Evaluation may be static or dynamic, and includes:</p> <ul> <li>Observation of auditory, visual, motor, and cognitive status</li> <li>Relevant case history, including medical and educational history and socioeconomic, cultural, and linguistic background</li> <li>Standardized and nonstandardized assessments of facial muscles and structures, posture, control, and reflexes, as well as functional assessment of feeding and swallowing (including suckling, sucking, mastication, oral containment, and bolus manipulation), and assessment of airway function and saliva function. Behavioral factors, such as acceptance of pacifier, nipple, utensil, and foods/liquids of different textures should also be assessed.</li> <li>Instrumental diagnostic procedures such as videofluoroscopic swallow study, endoscopic evaluation of swallowing, and ultrasound with consideration for positioning, presentation, and viscosity.</li> <li>Interdisciplinary and family collaboration and interaction</li> <li>Follow-up services</li> </ul>

<div>"Voice interventions are conducted by appropriately credentialed and trained speech-language pathologists, possibly supported by speech-language pathology assistants under appropriate supervision" and "may perform interventions as members of collaborative teams" (p. 102).</div>