Regularly my classmates ask me what specialty area I would like to end up in. This post looks at many, if not all, specialty areas I could dig up.
The major divide in the profession appears to be between the education system / community SLPs and the medical SLPs. This division is significant enough that there are even programs in the U.S. that cater to one or the other, though they’re not as common. These programs appear to give the same qualifications, but the medical SLP programs have more preparation for medical environments, such as hospitals, clinics, and private practices.
School SLPs are perhaps the best-known and most common among us. They work in one, several, or many schools to identify and treat children who show signs or risk of disorder. Often they work one-on-one with students, though in-class assessment and treatment is more common. These SLPs are employed by the school board, or in the case of much of Alberta, the health care authority. Child Language and Language Disorders is a recognized specialty area for those who work primarily with children who have language difficulties. The other side of the coin are clinicians who specialize in Phonological and Articulation Disorders. A fusion of these two skillsets are required for any school SLP, and certainly competence to at least recognize disorders in other specialty areas would be beneficial.
A challenging area is that of Fluency and Fluency Disorders; these specialists work with those who stutter, both in early intervention and the especially challenging area of adult fluency disorders.
For those SLPs who work in hospitals and rehabilitation facilities, much time will be spent working with Swallowing and Swallowing Disorders. This area requires the ability to judge a client’s success with swallowing using bedside and instrumental techniques, such as videofluoroscopy. Related areas are that of Motor Speech Disorders and Voice / Resonance Disorders. Those who suffer damage to their nervous system, due either to injury or disease, may exhibit difficulties with their speech, known as motor speech disorders. Alternatively, when the speech mechanism or the physical structure of the head and neck changes, speech may sound notably different in what are termed voice and resonance disorders.
Aural Rehabilitation specialists are those who work with clientswho have lost part or all of their hearing, either very early in life or acquired sometime later. This involves much collaboration with audiologists and medical specialists to best use amplification devices and implants, and to help integrate the client into their environment. This discipline is shared with audiology and teachers for the deaf and hard-of-hearing.
SLPs who work in pediatric hospital settings sometimes specialize in working with Neonatal Intensive Care Unit (NICU) patients, or may become feeding specialists, clinicians who work with children and parents to overcome breastfeeding and bottle feeding difficulties.
Lastly are the Augmentative and Alternative Communication (AAC) specialists; these clinicians help clients who have a temporary or permanent loss of the ability to communicate in a traditional way. They use a range of technology, ranging from gestures and blinks, to pen and paper, to electronic voice synthesizers.
SLPs can also work in highly specialized settings that work with particular disorders: aural rehabilitation, brain injury, learning delays / disorders, mental retardation, cerebral palsy, head and neck cancer, accent reduction, gender-reassignment voice therapy, autism, and more.
For those who are more research-inclined, there is really no limit to what you could study within the field, but here are a few sample areas:
Hearing science and aural rehabilitation
Autism and other developmental disorder
Language and literacy
I’m still unsure of where I will end up. Which specialty did you or do you hope to get into? Why?
This update steps a little outside of speech-language pathology’s typical scope, but it is still something that affects us and our clients.
In 2007 the American Academy of Pediatrics suggested that all infants with increased risk for hearing loss receive hearing screening between 24 and 30 months of age. One significant risk factor is the use of ototoxic drugs, particularly with premature neonates. The development of the cochlea occurs relatively late during gestation, as demonstrated by higher frequencies (1000 – 3000 Hz) only being detectable within the womb after about 33 weeks. When born prematurely, the infant may be exposed to the hearing world before they’re ready; the NICU is noisy and confusing, with sounds from a plethora or machines and people reaching peaks of 120 dBA. Expectedly, the exposure to such intense sound even occasionally can have long-lasting effects on hearing.
The immune system of premature infants is also not at peak efficiency. Common in NICU infants is a body-wide septic infection, for which one or a series of broad-spectrum antibiotics will be used. Aminoglycosides — most commonly the affordable gentamicin — are commonly used for their efficacy against Gram-negative bacteria. Unfortunately, one of the side-effects of this drug type is toxicity to the auditory nerve. Animal studies have suggested that children are significantly more prone than adults to ototoxicity of aminoglycosides.
Although the results in the literature prevent definite conclusions — largely due to variations in dosage, noise levels, and duration — the pairing of noise and ototoxic drugs potentiates the risk to early hearing loss. Loud noise may in fact directly increase the effects of aminoglycosides: Louder noises cause mechanoelectrical transduction (MET) to take place in hair cells, opening the cell to the expected electrolyte and also the unexpected ototoxic drug. The effect is further increased by certain mitochondial mutations, though the prevalence of this in premature infants is not well known.
The implications and recommendations accumulated from the references below are as follows:
- Create a quieter NICU environment by using silent alarms, sound-level checks, private bed suites, and more.
- Genetic testing to determine elevated risk to aminoglycoside ototoxicity.
- Expand the research in aminoglycoside use and safety.
- Advise regular hearing screening in the first few years of life.
More information on ototoxicity: http://www.asha.org/public/hearing/Ototoxic-Medications/
White RD. Designing environments for developmental care. Clin Perinatol 2011; 38:745–749.
White RD. The newborn intensive care unit environment of care: how we got here, where we’re headed, and why. Semin Perinatol 2011; 35:2–7.
Joint Committee on infant hearing. Year 2007 position statement: principles and guidelines for early hearing detection and intervention programs. Pediatrics. 2007;120:898–921.
So, T. Y. (2009). Use of Ototoxic Medications in Neonates—The Need for Follow-Up Hearing Test. The Journal of Pediatric Pharmacology and Therapeutics: JPPT, 14(4), 200.
Zimmerman, E., & Lahav, A. (2012). Ototoxicity in preterm infants: effects of genetics, aminoglycosides, and loud environmental noise. Journal of Perinatology, 33(1), 3-8.
Part of being a good clinician is knowing what your clients are experiencing, and being able to empathize in order to provide them with the best service possible.
For our very first Audiology and Hearing Science lab, we were instructed to wear earplugs for an entire day to simulate a 32 dB conductive hearing loss. One student shares a bit about her experience with us:
Were there certain things that you are used to hearing that were missed?
- I couldn’t hear the train approach when I was waiting for the lrt.
- While eating breakfast at Ikea, it felt weird that I couldn’t hear the background noise from all the other conversations going on around me.
- Everything seemed too quiet when I was driving because I couldn’t hear the sound of traffic.
What was most difficult about this experience?
- The hardest thing was talking. My ears weren’t giving me accurate feedback regarding the appropriate volume to use while talking so I erred on the side of caution and spoke in a much softer tone. Unfortunately, that caused people to ask me if I was sick or whether there was something wrong with my voice.
What did you learn from this experience?
- I learned how invisible a hearing impairment can be. It’s not like having a broken leg, where you carry around crutches, so everyone immediately knows what’s wrong. I became aware that I would not automatically be given special accommodation just because I couldn’t hear clearly with my ear plugs. This thought especially terrified me as I was returning something at the mall since I was afraid I wouldn’t be able to comprehend what the salesperson was saying to me.
- I also realized that even a simple conversation required a lot of effort on my part. Sometimes it was just easier to tune out of the conversation rather than try to get the others to repeat what they were saying. And because I couldn’t just rely on auditory cues to jump in at the appropriate time when talking with a group of people, I found myself weighing the importance of what I had to say before deciding if it was worth the trouble.
This experience was accurately named “Empathy Modeling” because it gave all of us firsthand experience with some of the challenges that people with a hearing impairment often encounter in their everyday lives.
While we may never know exactly what it feels like to have a hearing loss, this experience will hopefully bring us closer to our future clients, help us understand the difficulties they may have, and ultimately make us better clinicians.
Authors: APL & BY
Thank you to Dr. Hodgetts for having us do this assignment.
Fetal Alcohol Spectrum Disorder (FASD) is a pattern of conditions that SLPs are bound to encounter during their careers; it is the leading cause of developmental disability in Canada, affecting nine of every thousand children. Many sectors and disciplines of society may be needed to provide services to persons with FASD, speech-language pathology being one of them. (PHAC, 2012)
An article was published recently in the Canadian Journal of Speech-Language Pathology and Audiology that described the language profile you may expect from school-aged children with FASD. Read it here.
Firstly, one must recognize that “FASD” is not a medical diagnosis in itself, but rather it has many manifestations, such as Fetal Alcohol Syndrome (FAS), partial FAS (pFAS), and alcohol-related neuro-developmental disorder (ARND) or birth defects (ARBD) (PHAC, 2012). As with any other umbrella of diagnoses, we can’t expect there to be uniform signs and symptoms.
The study, conducted by Winnipeg team of two SLPs and an epidemiologist, looked at CELF-4 Core Language Index scores from 124 children, age 5 – 18. Note that no participants had an FAS diagnosis. Two-thirds of the group received a severe rating, one-tenth both for moderate and mild, and 14% received an average rating. The researchers also found a difference between age groups; the youngest children (5 – 8 years) were more likely to have a near-average score in individual test categories, there was a drop in scores around age 9, followed by relatively higher scores thereafter. Males and females were not significantly different, both within and between the diagnostic categories. The children with a pFAS diagnosis received lower scores than the ARND, but they were not significantly different, which the researchers suggests for further exploration (Proven, Ens & Beaudin, 2014).
Summary points from the article:
- 80% of children with FASD in the sample had a language impairment; nearly 70% were severe
- Only 33% of the children received intervention from an SLP, suggesting that SLPs could play a bigger role, along with more typical intervention for attention, sleep problems, and behaviour.
- Age is a factor; there may be less severe impairment at younger age, affecting global language, whereas at an older age the language disorder may be more severe and specific. This area is not clear, but the effects are common, and early intervention may be helpful.
- Some children with FASD may receive average ratings, though this may not adequately consider written or social language skills.
Although there is more to learn about the language profilesof children with FASD, it is clear there is a role for SLPs from a very early age.
Have a story about a client with FASD or advice for your colleagues? Please leave a comment!
Public Health Agency of Canada. Fetal Alcohol Spectrum Disorder (FASD): A Framework for Action. Ottawa: PHAC, 2003.
Proven, S., Ens, C., & Beaudin, P. (2014). The Language Profile of School-Aged Children with Fetal Alcohol Spectrum Disorder (FASD). Canadian Journal of Speech-Language Pathology and Audiology, 37(4), p 268 – 279.
It’s been a month since the 2013 Oasis Conference, and University of Alberta undergraduate student, Rebecca, who is planning on applying to the program next fall, tells us about her experience.
1. Why did you attend Oasis?
“I attended Oasis for two reasons:
1) to get more knowledge about the application process and
2) to hear the great seminars.”
2. What did you think of the “How to Survive the Application Process” seminar?
“This was my second time attending the seminar. The first time, in 2010, I found it super helpful. The second time around I found that I didn’t learn a whole lot more, but it was a nice confirmation of what I already knew.”
3. Which was your favourite session?
“My favourite session was definitely the one about adults with autism - Transitioning into Adulthood.”
4. What topic would you like to see presented at the conference next year?
“I think the great thing about the conference is that it covers a wide range of topics. So what I want to see next year is the same great variety that there has been in the past to keep things interesting.”
Thanks a lot to Rebecca for sharing her thoughts with about the Oasis Conference!
If you attended the conference, what did you enjoy most?
If you were to attend, what would you be interested in hearing about?
- Author: B.Y.
This past August a group of three SLP students – Emily, Candice, and Liam – from the University of Alberta attended Aphasia Camp Northwest in Portland, Oregon as part of their capstone project. They were invited to attend this camp while they were researching different models for camps. Aphasia Camp Northwest has been in operation for 15 years, making it one of the longest-running camps of its kind in North America. With the assistance of funding from the university’s Green and Gold Grant, the three students were able to attend and learn the workings of a successful aphasia camp.
The camp involves building strategies for both the person with aphasia and their loved ones; there are outdoor and indoor recreational activities as well.
As Emily puts it, “I was expecting to spend the majority of my time playing the role of an observer in order to learn some of the logistical details that go into organizing and running a camp. However, from the minute I arrived, I was fully integrated into camp activities and had many of the same responsibilities as the student volunteers. This involved helping families get settled into camp, running recreational activities for the campers, such as gardening and fishing, interacting with campers during mealtime and helping to
facilitate conversation groups.” It was also an opportunity for advanced disciplinary learning learning; Candice writes that they were “able to sit in at a professor-student meeting from a leadership point of view learn about how to explain some of the therapeutic activities and the rationale behind them”
Currently, Alberta doesn’t have a camp of this type. The input provided by the three students will help therapists and administrators in Alberta to plan and implement similar camps in the future. They
were able to “gather important logistical information… share information about what activities have been was useful to hear about different ways this can be accomplished.” the most successful, how to organize and structure conversation groups and crucial points to consider when first starting a camp, but they also helped guide us in determining the overall goals for our own camp… we were also able to participate in a brainstorm about how to continue providing resources to those with aphasia once camp has ended. This is something we would like to do in Edmonton as well, so it
To learn more about Aphasia Camp Northwest, please visit http://www.strokecampnorthwest.org/index.htm
Special thanks to Emily, Candice, and Liam for their contributions.
Photos used with permission.