how do speech therapists evaluate patients

Therapies and Interventions

What does a speech therapy evaluation involve?.

Tackling language skills in a speech therapy evaluation unveils hidden barriers and opens doors to transformative interventions – want to know more?

Key Takeaways

• Speech therapy evaluations identify specific communication challenges for personalized treatment.
• Assessments highlight strengths and weaknesses crucial for setting targeted therapy goals.
• Evaluation process includes observing social communication skills, articulation, and language comprehension.
• Tailoring therapy plans based on assessments ensures effective intervention and progress monitoring.

Importance of Speech Therapy Evaluation

Initial Assessment Process

• Individualized Approach: Each child is unique, and the assessment process is personalized to address their specific communication challenges.
• Interactive Activities: Engaging the child in interactive tasks helps assess their speech and language abilities in a natural setting.
• Goal Setting: Collaboratively establishing goals with the child and family guides the therapy process towards meaningful outcomes.
• Baseline Data: Gathering baseline data during the assessment aids in tracking progress and adjusting therapy interventions as needed.

Areas of Communication Assessed

Key Communication Skills

• Receptive Language: Understanding language.
• Expressive Language: Using language to communicate.
• Pragmatic Language: Social communication skills.
• Articulation: Clarity and accuracy of speech sounds.

Evaluation Process Details

Speech Sounds Evaluation

• Assessing Articulation : We observe how the child pronounces different sounds and words to identify any articulation difficulties.
• Phonemic Awareness Activities : Engaging in tasks that focus on recognizing and manipulating individual sounds in words helps us gauge their phonemic awareness.
• Error Identification : Through sound imitation and word repetition exercises, we can pinpoint specific speech sound errors.
• Informing Intervention Plans : The results of the evaluation provide crucial insights for creating tailored therapy goals and interventions to address any challenges discovered.

Language Comprehension Assessment

Social Communication Skills Evaluation

• Observing Social Interactions: We watch how the child engages with others, uses gestures, and maintains eye contact.
• Understanding Social Cues: We look for the child's ability to interpret social cues and respond appropriately.
• Role-Playing and Games: Through interactive activities, we assess the child's social communication in structured settings.
• Identifying Disorders: We search for signs of social communication disorders such as challenges with turn-taking or understanding emotions.

Identification of Strengths and Weaknesses

Skill Assessment Methods

• Receptive language
• Expressive language
• Pragmatic language
• Articulation

Observations and Interviews

Communication goals setting.

• Identifying Strengths and Weaknesses : Assessing communication abilities through various tests and observations.
• Setting Communication Goals : Tailoring specific goals based on individual needs and areas of improvement.
• Developing a Tailored Treatment Plan : Using evaluation results to create a personalized plan addressing communication challenges.
• Establishing a Roadmap for Therapy : Goal setting to enhance overall communication skills and abilities.

Tailoring Treatment Plans

Personalized Communication Challenges

Identify Specific Needs

• Expressive Language: Assessing how the individual expresses thoughts and ideas.
• Receptive Language: Evaluating the ability to understand and process language.
• Articulation: Identifying speech sound production difficulties.
• Pragmatic Language: Observing social language use and interactions.

Tailor Therapy Approach

Essential first step.

• Identifying Speech and Language Challenges: Speech therapy evaluations pinpoint any difficulties the child may have in communicating effectively.
• Assessing Strengths and Areas for Improvement: The evaluation provides valuable insights into the child's communication abilities, highlighting both strengths and areas needing development.
• Establishing a Baseline for Progress: By conducting evaluations, therapists can measure progress over time and set achievable treatment goals.
• Customizing Therapy Plans: Evaluations allow therapists to create personalized therapy plans that cater to the individual needs of each child.

Improving Communication Abilities

Detailed Components of Evaluation

• Reason for Referral Discussion: Understanding concerns that led to the evaluation.
• Observations and Assessments: Utilizing play-based and behavioral assessments.
• Standardized Testing: Providing in-depth insights into speech and language skills.
• Informal Assessments: Complementing formal evaluation methods for a comprehensive view.

Frequently Asked Questions

How do you prepare for a speech evaluation?, what are areas that are typically assessed during a speech and language evaluation?.

• Receptive language skills for understanding
• Expressive language skills for expressing thoughts
• Pragmatic language for social communication
• Articulation for speech sounds
• Voice/resonance for speech quality

What Is the Difference Between a Speech Screening and a Speech Evaluation?

What is included in a comprehensive speech evaluation?.

Alex leads our content strategy and ensures that all information presented is accurate, insightful, and empowering. With a keen eye for detail and a deep understanding of the community’s needs, Alex guides the team in creating meaningful content that educates, inspires, and connects.

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What does auditory bombardment mean in speech therapy?.

Open the door to understanding auditory bombardment in speech therapy, unraveling its impact on language development and speech clarity.

• Auditory bombardment in speech therapy involves repeated exposure to target words or sounds for improved language and articulation skills.
• Techniques like playing audio files and engaging in sound discussions enhance auditory processing and language comprehension.
• Auditory bombardment benefits communication skills by intensifying auditory input and supporting speech sound accuracy and fluency.
• Speech sound exposure and language repetition aid in developing phonological awareness, articulation, and language structure understanding.

Definition of Auditory Bombardment

Importance in Speech Therapy

Techniques for Implementation

• Playing audio files with targeted words or sounds through headphones for repeated exposure.
• Engaging in extended auditory bombardment activities like drawing pictures of target words.
• Incorporating sound discussions into daily routines to further support language development.

Role in Speech and Language Development

Auditory Processing Skills

Language comprehension development, speech sound discrimination.

• Speech sound discrimination enables accurate perception and production of speech sounds.
• Difficulty in speech sound discrimination can affect language comprehension and production.
• These skills are vital for phonological awareness, which predicts reading and spelling abilities.

Benefits for Communication Skills

Application in Therapy Sessions

Auditory Input Intensification

• Repetition: Repeat target words or sounds multiple times during the session.
• Variability: Use a variety of activities to repeat the sounds, such as games, songs, or stories.
• Consistency: Ensure that the repetition is consistent across sessions to reinforce learning and retention.

Speech Sound Exposure

Language Exposure Repetition

• Provides intense and repeated exposure to specific language targets
• Aims to improve the child's understanding and use of language structures
• Reinforces correct language patterns through consistent exposure

Key Considerations for Therapists

What Is Auditory Bombardment in Speech Therapy?

What is auditory discrimination?, what is focused auditory input?, what is the auditory input?.

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Decoding the Abbreviation for Speech Therapy: A Comprehensive Guide

Linguistic puzzle or key to professional success? Discover the importance of unraveling speech therapy abbreviations in this comprehensive guide.

• Speech therapy abbreviations enhance communication efficiency and professionalism.
• Efficient communication saves time and supports interdisciplinary teamwork.
• Standardized abbreviations streamline documentation and interdisciplinary collaboration.
• Clear communication in speech therapy improves clinical efficiency and patient outcomes.

Understanding Speech Therapy Acronyms

Importance of Speech Therapy Abbreviations

Role in Communication

• Efficient documentation and collaboration
• Enhanced communication accuracy and clarity
• Support for interdisciplinary teamwork
• Demonstration of expertise and professionalism
• Facilitation of seamless communication within the professional community

Clinical Efficiency Measures

Therapist-Patient Relationship

• Facilitates Clear Communication: Abbreviations streamline discussions and ensure clarity.
• Promotes Active Participation: Patients feel more engaged when they grasp the terminology.
• Builds Trust: Knowing the abbreviations shows dedication to the patient's progress.
• Encourages Open Dialogue: Patients can ask informed questions about their treatment.
• Strengthens Therapeutic Alliance: Shared understanding enhances the partnership between therapist and patient.

Key Acronyms in Speech Therapy

AAC: Augmentative and Alternative Communication

• AAC tools can be a lifeline for individuals who struggle to communicate verbally, giving them a voice they may have never had.
• Witnessing someone successfully express themselves through AAC can be incredibly rewarding and heartwarming.
• AAC interventions not only facilitate communication but also foster a sense of independence and autonomy in individuals who rely on them.
• The personalized nature of AAC strategies underscores the commitment to honoring each individual's unique communication needs and preferences.
• Research demonstrating the effectiveness of AAC in improving communication across various conditions highlights the transformative power of these interventions.

SLP: Speech-Language Pathologist

SLP Training Requirements

• Embrace clinical practicum hours for invaluable hands-on experience.
• Prepare diligently for the Praxis exam, a crucial milestone for licensure.
• Commit to continuous learning through ongoing education to stay updated.
• Explore specialized certifications to deepen your expertise.
• Consider advanced degrees for personal growth and enhanced skills.

SLP Role in Education

Iep: individualized education program.

• Personalized Support: The IEP ensures that each student receives customized educational support to meet their unique needs.
• Collaborative Effort: The process of developing an IEP involves a team effort, including parents, teachers, and specialists, to ensure comprehensive support.
• Annual Review: Regular review and updates to the IEP allow for tracking progress and making necessary adjustments.
• Legal Protection: Mandated by the Individuals with Disabilities Education Act (IDEA), the IEP provides legal protection to students with disabilities.
• Speech Therapy Inclusion: IEPs commonly include speech-language therapy goals, highlighting the importance of this service in supporting students' communication needs.

CAS: Childhood Apraxia of Speech

ASD: Autism Spectrum Disorder

• Tailored Techniques: Therapists customize techniques to the individual's needs, ensuring personalized care.
• Empowering Communication: Speech therapy empowers individuals with ASD to express themselves effectively.
• Building Confidence: Through speech therapy, individuals with ASD can build confidence in their communication abilities.
• Enhancing Social Skills: Therapy sessions focus on improving social interactions, fostering meaningful connections.
• Early Intervention Benefits: Early initiation of speech therapy can lead to significantly improved outcomes for individuals with Autism Spectrum Disorder.

VOCA: Voice Output Communication Aid

VOCA Functionality Explained

• Empowerment: VOCAs empower individuals to express themselves effectively.
• Independence: They promote independence in daily interactions and decision-making.
• Customization: Users can customize messages to reflect their unique personalities.
• Accessibility: Various input methods ensure accessibility for users with different needs.
• Evolution: Continuous advancements in VOCA technology enhance user experiences and communication efficacy.

Benefits of VOCA Devices

Voca implementation tips.

• Personal Connection : Build a strong relationship with the user to enhance their comfort and trust.
• Customization : Individualize the device settings to best suit the user's unique needs and preferences.
• Consistent Practice : Encourage regular practice sessions to improve proficiency and confidence.
• Family Involvement : Involve family members in the learning process to create a supportive environment.
• Continuous Evaluation : Regularly assess progress and make necessary adjustments to maximize the device's effectiveness.

FEES: Fiberoptic Endoscopic Evaluation of Swallowing

Dysphagia: Difficulty Swallowing

• Swallowing is a natural and essential function that we often take for granted until it becomes a challenge.
• Individuals with dysphagia may experience fear and frustration during mealtimes, impacting their quality of life.
• Proper assessment and therapy can lead to improved swallowing function and safety, enhancing overall health and confidence.
• It's crucial to approach dysphagia with empathy, patience, and a multidisciplinary team to address all aspects of the disorder effectively.
• With the right support and interventions, individuals with dysphagia can regain control and enjoyment of mealtimes, promoting a better quality of life.

ABA: Applied Behavior Analysis

CVA: Cerebrovascular Accident

• The impact of a CVA goes beyond physical limitations; it can deeply affect one's ability to communicate effectively.
• SLP intervention aims not only to restore speech but also to provide emotional support during this challenging time.
• Each individual's recovery process is unique, requiring personalized therapy plans tailored to their specific needs.
• We're here to offer guidance, encouragement, and expertise to help individuals regain their communication skills and confidence.
• Through collaboration and dedication, we strive to empower individuals to overcome the communication barriers imposed by a CVA.

ICD: International Classification of Diseases

What Is the Acronym for Speech Therapy?

What is the acronym slp?, what is the medical abbreviation for speech pathology?, what is the difference between slp and aud?.

So let's embrace the challenge of learning these abbreviations, knowing that they hold the key to unlocking the potential for meaningful progress and success in speech therapy.

How to Use Auditory Stimulation Therapy Toys for Sensory Therapy

Uncover the innovative ways auditory stimulation therapy toys can revolutionize sensory therapy, leaving you eager to dive deeper into their transformative potential.

• Enhance sensory experiences and promote relaxation with calming auditory toys.
• Improve focus and concentration by engaging in multi-sensory activities.
• Support language development and cognitive skills through auditory stimulation.
• Utilize music therapy and soothing sounds for stress relief and sensory regulation.

Benefits of Auditory Stimulation Toys

Types of Auditory Stimulation Toys

Incorporating Auditory Toys in Therapy

• Enhancing Focus : Auditory toys can help individuals focus by providing engaging sounds that capture their attention and promote concentration during therapy sessions.
• Encouraging Relaxation : The soothing sounds from auditory toys can create a calming atmosphere, helping individuals relax and feel more comfortable in the therapy environment.
• Promoting Engagement : By incorporating auditory toys in therapy, individuals can participate in multi-sensory activities that encourage interaction and engagement, leading to improved sensory regulation and overall well-being.

Auditory Stimulation for Relaxation

Calming Sounds for Relaxation

• Creating a Tranquil Atmosphere : Soft background music or nature sounds can mask distracting noises, fostering a calming atmosphere for sensory therapy activities.
• Improving Focus and Attention : Calming auditory stimulation aids in improving focus, attention, and overall sensory regulation for both children and adults.
• Enhancing Emotional Well-being : Using calming sounds during therapy sessions can help individuals manage stress and anxiety, promoting emotional well-being.

Stress Relief Through Music

Using Auditory Toys for Focus

Enhancing Concentration With Sound

Improving listening skills, engaging the auditory senses.

• Enhanced Focus : Auditory stimulation therapy toys can help individuals block out distractions and focus on tasks.
• Improved Language Skills : By engaging with auditory toys that promote language development, individuals can enhance their communication abilities.
• Sensory Integration : These toys offer a unique way to combine auditory and visual stimulation, aiding in sensory integration for improved cognitive function.

Enhancing Sensory Integration With Auditory Toys

Tips for Effective Toy Use

• Set Specific Goals : Define clear objectives for each therapy session using auditory stimulation toys to monitor progress and tailor the activities to the child's needs.
• Utilize Variety : Engage different senses by incorporating a range of auditory stimulation toys to promote sensory exploration and keep the child interested and motivated.
• Incorporate Music Therapy : Enhance the therapeutic experience by integrating music therapy elements into auditory stimulation sessions, which can help improve communication skills and emotional expression.

Auditory Stimulation in Professional Settings

Auditory Toy Selection Guide

• Price Range : Consider the budget you have for auditory stimulation toys. Options range from the Sound & Light Panel at $1,699.00 to the Vibroacoustic Therapy Chair at $2,399.00, catering to different financial abilities.
• Product Features : Look for advanced auditory therapy products like the Vibroacoustic Therapy Chair in the Sensory Toys Products group. These items offer specialized features to meet specific sensory needs effectively.
• User Experiences : Explore customer reviews to gain insights into user experiences. Products like the Vibrating Sensory Pad, with a 3.2 out of 5 stars rating and priced at $499.00, can provide valuable information to aid in decision-making.

What Are the Examples of Auditory Sensory Seeking?

• Seeking out loud noises or music

How Do Toys Soothing Sounds and Other Sensorial Stimulation Contribute to Child's Development?

How do sensory toys help?, what are the tools for sensory overload?.

Remember, in the world of sensory therapy, auditory stimulation toys can be the key to unlocking new levels of growth and development.

The content provided is for entertainment and informational purposes only and should not be considered a substitute for professional legal, medical, or mental health advice, diagnosis, or treatment. It is not a replacement for a formal consultation with a qualified legal, medical, or mental health professional. If you have any legal concerns, medical issues, or mental health questions, please seek the advice of a licensed attorney, healthcare provider, or mental health provider respectively. Never disregard professional legal, medical, or mental health advice or delay in seeking it because of something you have read or seen in this content. Additionally, for specific legal issues, always consult with an attorney licensed to practice law in your jurisdiction.

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What Is a Speech Therapy Evaluation for Adults, and How Should You Prepare?

If you think you or your loved one might benefit from speech therapy, you may be wondering what’s involved with a speech evaluation for adults. Here’s everything you need to know to get started on the path to clearer communication.

What is a speech evaluation for adults?

The main purpose of a speech and language evaluation is to determine if a person needs speech therapy, and if so, what kind and how often. The evaluation is conducted by a speech-language pathologist, commonly known as a speech therapist. The evaluation can be done in person or online via a video platform like Zoom.

During the evaluation, the speech therapist will ask about your concerns and goals. They will assess a variety of speech, language, and cognitive areas that may benefit from therapy. This is a crucial step in determining the right course of treatment to address your areas of concern. 

The main purpose of a speech and language evaluation is to determine if a person needs speech therapy, and if so, what kind and how often.

In some cases, your speech therapist may ask in advance that a caregiver or communication partner attend the session with you. 

Before the evaluation, the speech therapist will send you an intake questionnaire with general questions about your medical history, communication concerns, and any past treatments. This is an important step that guides the therapist in preparing for the evaluation and knowing which testing materials to use. It also helps them determine whether referrals to another professional may be needed.

The questionnaire is a chance for you to express your specific concerns about your communication and describe any therapy or techniques you’ve tried in the past. You can also share any history you’ve had with hospitalization. The more detailed you can be, the better the speech therapist can prepare for your evaluation.

How can you prepare for your speech evaluation?

Follow this checklist for the most successful online speech evaluation: 

Find a quiet space free of distractions and with good lighting. This should be a place where you’ll feel comfortable answering personal questions.

Make sure you’re in a location with reliable internet. 

Using a computer is your best option. A tablet or smartphone should be considered a “backup” option. 

Bookmark the Zoom link so it’s easy to find. Check that you have the most up-to-date version of Zoom.

Check to ensure your microphone is working, as well as your headphones if you’re using them.

Close out any other running programs on the computer and silence notifications.

Feel free to log on to your session 5 to 10 minutes early so you can be fully ready at the start time.

Position the camera so the speech therapist can see your face.

Depending on your area of concern, the speech therapist may ask that you bring specific items to your evaluation, such as food, utensils, or objects from around the house. Be sure to have those with you.

What happens during a speech evaluation for adults?

1 the speech therapist will verify the information in your questionnaire and ask you related questions.

After introductions, the speech therapist will ask you a series of questions. As you respond, they will be observing your speech, listening, communication, and cognition abilities. This is the time for you and your therapist to discuss your goals and what you’d like to get out of speech therapy. This conversation may also uncover additional areas of concern. 

If you have a communication partner present, do not rely on them to answer these questions. The speech therapist wants to see how you communicate. If the therapist is unclear on your responses, they may ask your communication partner for clarification.

2 The next step is for the speech therapist to conduct formal assessments

These are designed to look at your concern within speech , language , swallowing , voice , stuttering , or cognition . Depending on your area of focus, the therapist has a wide variety of assessments from which to choose.

Because some of these assessments are standardized, the speech therapist may read specific instructions for you to follow. At times, they may not be able to answer questions you have about the assessment. If the speech therapist was to stray from the written instructions, the results of your evaluation would be unreliable. Your speech therapist will do the best they can to clearly explain each activity.

3 Your speech therapist will also examine your mouth itself

This is called an oral motor exam. It reveals how your muscles move and whether these muscles need retraining in therapy. The therapist will ask you to make various facial postures such as smiling, sticking out your tongue, or puffing up your cheeks. They may also ask to observe you chewing and swallowing various items.

What happens after a speech evaluation?

At the end of your session, the speech therapist will explain their observations and summarize the results. In some cases, the therapist will need more time to score an assessment. 

The therapist will tell you whether speech therapy is recommended. In some cases, the therapist may need input from other professionals before starting a speech or voice therapy program. For example, if you are experiencing sudden onset of vocal hoarseness , the therapist will recommend you see an otolaryngologist to make sure you don’t need a different type of treatment.

Due to time constraints, the therapist may not provide specific feedback about your performance, but they will review what they observed.

If speech therapy is recommended, the therapist will briefly explain how therapy will work and what it will cover. Due to time constraints, the therapist may not be able to provide specific feedback about your performance during the evaluation, but they will review what they observed. For example, if your evaluation was for concerns with the clarity of your /s/ sound, the therapist may say: “I noticed that when you were attempting to say the /s/ sound, your tongue would tense in the middle. Instead of the air traveling down the center, as we would expect with this sound, it went out the sides. This is what’s affecting your /s/ sound, and in fact, it’s also affecting your /z/ sound. In our sessions, we’ll work on training your tongue to achieve the correct position, then slowly move that into saying words, phrases, sentences, and conversations."

The speech therapist will take the last few minutes of the evaluation to answer any questions, determine your schedule, and ensure you have access to the patient portal , if applicable. They will also explain the importance of practicing at home between sessions and offer guidance for doing this. Regular practice will get you on the path to success as quickly as possible.

What is in a speech evaluation report for adults?

After the session, the speech therapist will write up an evaluation report. This report documents your performance on all the areas of speech, language, voice, fluency, oral motor function, and cognition that were tested.

The evaluation report will include long-term goals that should be reached by the end of your program, as well as short-term goals that build toward achieving your long-term goals. These are based on your desired goals, along with what the therapist believes is realistic to accomplish.

As you can see, when it comes to a successful speech evaluation, your input and effort are just as important as the speech therapist’s! Your speech therapist is there to listen to your concerns and determine how you can get as close to becoming the communicator you hope to be.

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The Benefits of Speech Therapy

What to expect, frequently asked questions.

A speech-language pathologist (SLP) can help you with speech, language, and swallowing. They provide speech therapy to children and adults who may have speech or language disorders.

People with certain medical conditions may also benefit from speech therapy. Medical conditions that may cause speech or swallowing impairment include traumatic brain injury , stroke (brain damage due to a blood vessel blockage or bleed), and dementia (decline in memory and thinking functions).

This article looks at the various uses for speech therapy, what to expect during a session, and the techniques involved in this type of therapy. 

Verywell / Theresa Chiechi

Speech therapy can help with a variety of conditions.

Speech Disorders

Speech therapy may help with speech disorders like:

• Stuttering : Stuttering may involve repeating parts of words, prolonging words, or struggling to get out certain words. You may be more likely to have a stutter if you have a family history of stuttering.
• Apraxia : This motor speech disorder makes it difficult to move the tongue and lips to make sounds required for speech. In some cases, people with apraxia cannot speak at all. Causes for this disorder include brain tumors, dementia, stroke, and any other condition that causes brain injury.
• Voice : Voice disorders can be temporary or permanent and make it hard to speak. Chronic voice disorders include chronic cough, vocal fold paralysis, vocal polyps (growths on the vocal cords), and spasmodic dysphonia (vocal cord spasms).
• Dysarthria : People with this speech disorder have muscle weakness that makes it difficult to talk. They may slur or mumble their words. Dysarthria can happen due to brain injury or chronic degenerative conditions like Parkinson’s disease or Huntington’s disease .

Language Disorders

A language disorder ( aphasia ) is a condition that makes it difficult for a person to read, write, speak, or understand speech or other modes of communication. 

Someone with this type of disorder may struggle to:

• Use incorrect words for things
• Say complete sentences 
• Understand what other people say
• Understand jokes
• Read or spell 

Brain tumors, traumatic brain injuries, and degenerative disorders that affect cognitive function can all cause aphasia.

Feeding and Swallowing Disorders

Feeding and swallowing disorders can occur in both children and adults. A feeding disorder involves trouble with eating, sucking, drinking from a cup, or chewing. The specific term for swallowing disorders is dysphagia . Children or adults with dysphagia have trouble swallowing food or drink. 

Problems swallowing or feeding may or may not be related to a medical condition. Conditions that may cause a swallowing or feeding disorder include:

• Cleft palate or cleft lip
• Asthma and other breathing issues
• Heart disease
• Premature birth
• Nervous system disorders
• Reflux 
• Muscle weakness 
• Sensory issues
• Autism  
• Behavior problems
• Certain medications

Speech therapy begins with an evaluation to assess your difficulties and whether any structural issues contribute to your speech, language, feeding, or swallowing problems. An evaluation may involve a standardized test to help determine what you most need help with. Informal conversations may also help figure out your needs. 

A speech-language pathologist will then work with you to help improve your ability to speak, converse, or swallow. This may involve:

• Educating you on how to do certain things like articulating or pronouncing sounds
• Teaching you language skills
• Providing you with educational materials
• Giving you exercises to help strengthen your muscles 
• Giving you exercises that help you breathe better
• Participation in group therapy sessions 

You should also expect to practice the skills and exercises you learn in speech therapy sessions at home. Your speech-language pathologist may provide you with workbooks, worksheets, or virtual apps for at-home practice.

Speech Therapy for Adults

Depending on the reason you’re seeking out speech therapy, a speech-language pathologist may:

• Help you learn to move your muscles correctly to make sounds if you have apraxia or dysarthria
• Teach you how to use your breath to speak louder if you have dysarthria
• Help you learn to manage stuttering by teaching you to lower stress levels in certain situations
• Help you strengthen your mouth muscles to make it easier to swallow and eat if you have a feeding or swallowing disorder due to a brain injury or disease

Speech Therapy for Children

A speech-language pathologist’s approach will depend on the child. When working with a child who has a feeding or swallowing disorder, they might focus on:

• Strengthening the muscles of the mouth
• Helping the child with chewing
• Encouraging the child to try new food and drink
• Changing food texture to make it easier to swallow food 
• Helping with sensory issues related to food

Other skills a speech-language pathologist may work on with a child include:

• Language complexity : For example, they might teach words like "and" and "or" to connect ideas within sentences.
• Conversation skills : This may include role-playing to help the child with socialization and improve their read of social cues. 
• Vocabulary : They may use games or storytelling to help build the child’s vocabulary. 
• Phonological awareness : This recognition of the sounds that make up words is an important skill for reading. The SLP may work on helping the child identify sounds and rhymes in words to build this skill.

Healthcare professionals will also test your child’s hearing to see if hearing loss may be contributing to language and speech issues.

If you or your child is getting speech therapy from a qualified speech-language pathologist, you might wonder how likely it is that you’ll see improvement in speech, language, or feeding. 

Results will depend on the individual. It’s also essential to follow the exercises, tips, and strategies provided by the speech-language professional. Regular visits and keeping up with practice activities and exercises make it more likely to see an improvement in yourself or your child. 

A speech-language pathologist works with children or adults who have speech, language, or feeding and swallowing disorders. Typically the first session will involve an evaluation to determine the areas that are causing you the most problems. 

From there, they may teach you exercises and strategies to improve your speech, language, or ability to swallow and eat. 

A Word From Verywell

Think you or your child would benefit from speech therapy? Get in touch with your primary healthcare provider and ask for a recommendation. You can also use the American Speech-Language-Hearing Association’s (ASHA)  Find a Certified SLP Tool . 

Not all children develop at the same rate, but if your child has issues understanding language, doesn’t use gestures, or doesn’t seem to be learning new words, you might consider having them evaluated by a speech therapist. 

While this may depend on the individual and the cause of speech-related problems, research suggests that speech and language therapy can significantly improve speech and language issues.

One example of a typical speech therapy technique is articulation therapy. This technique teaches the person to make specific sounds, sometimes by showing them how to move their mouth or tongue.

A language delay is when a child has difficulty in speaking and understanding speech that is unusual for their age.

American Speech-Language-Hearing Association. Stuttering .

American Speech-Language-Hearing Association. Apraxia of speech in adults .

American Speech-Language-Hearing Association. Voice disorders .

American Speech-Language-Hearing Association. Dysarthria .

American Speech-Language-Hearing Association. Aphasia .

American Speech-Language-Hearing Association. Feeding and swallowing disorders in children .

Brainline. Speech therapy .

Understood for All. What is speech therapy .

Centers for Disease Control and Prevention. Languages and speech disorders in children .

Broomfield J, Dodd B. Is speech and language therapy effective for children with primary speech and language impairment? Report of a randomized control trial . Int J Lang Commun Disord . 2011;46(6):628-640. doi:10.1111/j.1460-6984.2011.00039.x

Nemours Children's Health. Speech-language therapy .

By Steph Coelho Steph Coelho is a freelance health and wellness writer and editor with nearly a decade of experience working on content related to health, wellness, mental health, chronic illness, fitness, sexual wellness, and health-related tech.She's written extensively about chronic conditions, telehealth, aging, CBD, and mental health. Her work has appeared in Insider, Healthline, WebMD, Greatist, Medical News Today, and more.

What to Expect During an Speech Evaluation and Therapy Session

Are you worried about whether your child has speech difficulties? You may want to address your concerns with a trip to a speech-language pathologist(SLP)! With that, you might have so many questions about what to expect during a speech evaluation and therapy session. No need to worry! We got it for you. Here is some information that can help you better understand the SLP evaluation, SLP session process, and how speech therapy works for you and your child.

In this article we will discuss:

Why do Children need Speech Therapy?

What Happens During an SLP Evaluation?

What Happens During an online SLP Evaluation?

What happens during an slp session, how speech therapy works, the better speech program, the proven and effective solution to improving your speech.

Speech and language skills are integral to your child's development. These skills allow children to communicate their needs, share information, and express thoughts and ideas. When children have difficulty with speech and language, it can impede their ability to interact socially, perform well in school, and ultimately reach their full potential. This is why speech therapy is important! Speech Therapy can help children express their emotions and live a better life!

Children may need a speech therapy evaluation if they:

Have difficulty imitating sounds.

Appear to have difficulties comprehending new words.

Struggle to communicate their wants and needs.

Have difficulties responding to questions or directions.

Struggle to start a conversation with peers and unfamiliar people.

Make limited or poor sounds of quality.

Is not producing words together by 18 months.

Cannot be understood by strangers after 24 months.

Do not speak in sentences by 3 years of age.

Experiences communicative or cognitive changes after a surgery or injury.

If your child is having difficulty with any of these skills, it may be time to consult with a speech-language pathologist.

Do not hesitate to seek help for your child

What Happens During an Speech Evaluation?

During an SLP evaluation, the SLP will assess your child’s speech and language skills. This may involve observing your child’s production of sounds, words, and sentences. This also includes testing their understanding of spoken language. Additionally, an SLP will ask you questions about your child’s development and any concerns you may have. This includes your child's medical history, developmental history, and educational background.

It is also important to evaluate the child's learning environment. This includes who the child is with the most. Another factor includes who the child interacts may it be peers of family members.

What to do first?

First, you have to find a speech therapist near you. The good thing about Better Speech, we offer online speech therapy which means that you can get help from the comfort of your home. But, finding a local SLP is also an option. The American Speech-Language-Hearing Association (ASHA) has a Find a Professional tool that can help you search for speech therapists in your area. It is important to know your speech therapist’s credentials to make sure you are getting qualified help.

Once you find a speech therapist, the next step is to schedule an SLP evaluation. During a speech evaluation, the therapist will assess your child’s speech and language skills holistically. This usually includes:

Case history, including medical history and status, educational background, socioeconomic status, cultural heritage, linguistic backgrounds, and information from other service providers such as teachers and occupational therapists.

Patient, client, student, and family interview

Review of auditory, visual, motor, and cognitive status

Standardized and/or non-standardized assessments of particular aspects of speech, spoken and non-spoken language, cognitive communication, and swallowing function, as well as observations and analysis of professional samples

Identification of potential for effective intervention strategies and compensations

Standardized measures for speech, language, cognitive-communication, and/or swallowing evaluation that is introduced according to documented ecological validity and cultural sensitivity

Follow-up procedures to assess communication and swallowing status, as well as ensure that individuals with identified speech, language, cognitive-communication, and/or swallowing issues receive the appropriate treatment and support.

Based on the evaluation findings, the SLP will develop a treatment plan. Treatment plans will vary depending on your child’s needs. During the first SLP sessions, it is expected for your child to be slightly uncomfortable as they get used to the new surroundings and the therapist.

Together with different language and speech techniques, the therapist will work on activities that are designed to help your child improve their needs. Techniques such as verbal and nonverbal communication, sound production, voice projection, and articulation will be used during therapy.

Most SLP sessions will involve:

Activities to help your child practice using their new skills. These activities may include language goals, speech goals, or swallowing goals that can target the specific needs of each patient.

Games and other fun activities to keep your child engaged. Games, not only does it motivate children to learn, but it also serves as a mode of teaching new skills such as social rules and following instructions and rules.

Parent education so you can support your child’s progress at home. Well, it is really important to teach parents how to incorporate his/her child’s current goals at home.

When will my child start seeing results?

The length of time for therapy will depend on the severity of your child’s speech disorder. Some children improve quickly and only need a few sessions while others may need long-term therapy. The therapist will work with you to determine how often your child should come in for therapy. Others may need one-hour sessions twice or thrice a week and others may just need 30 minutes once a week. It depends and varies from child to child.

Your child’s speech therapist will reassess your child’s progress and revise the treatment plan as needed. Some children may only need therapy for a short period of time, while others may need long-term support.

If you are wondering how speech therapy works, let’s talk about its benefits! Speech therapy helps individuals with speech disorders to improve their ability to produce sounds and improve their articulation skills. It also helps them become more aware of how the sounds are produced and how the mouth, teeth, tongue, and lips are used to make certain sounds.

Speech therapy may also help individuals with communication disorders such as difficulty understanding others (receptive language), difficulty expressing themselves (expressive language), or difficulty with social skills. Speech works also in individuals who have trouble swallowing (dysphagia).

Research shows how speech therapy works! It is highly effective in treating communication and swallowing disorders. Speech therapy can be provided in individual or group sessions. It can be provided in a clinic, hospital, school, or the individual’s home. Speech therapy may last for a few weeks or months, or it may be ongoing.

At Better Speech, we provide online speech therapy that can be accessible to everyone anywhere! Let’s talk about what to expect during your session with us!

Speech rehabilitation may be expensive and time-consuming. A customized program just for you is what Better Speech provides. Your therapist will evaluate your child from the comforts of your home.

1. Your First SLP Session Sets You on the Path

During your first session, you will be acquainted with your speech therapist. He/She will evaluate your child just like an in-person evaluation. This will help the therapist understand what your child’s speech goals are. From there, a treatment plan will be put into place that is best suited for your child.

2. Regular SLP Zoom Sessions Keep You Progressing

Depending on how many sessions your child needs per week, weekly or bi-weekly sessions will be scheduled. During these sessions, your child will participate in different activities and games that are designed to help them with their speech goals. These activities will be based on your child’s age, interests, and abilities. It also includes:

Interactive Games

One-on-One Interaction

Printable Practice Exercises

Progress Reports

Parent Coaching (when needed)

3. Practices Between Sessions Help You Accelerate

A session of speech therapy is not enough to stimulate your child’s speech and language development. Speech works better if you do more activities at home to maximize speech outcomes. With Better Speech, we will give you links for more exercises to achieve faster results.

4. Your Success Chart Maps Your Journey

To help you and your child track his/her progress, we will be providing a success chart. This allows you to follow your or your child’s progress. We even give a badge each time your child reaches another 10% toward their speech goal. This will help them stay motivated in their speech journey!

5. Tracking Your Progress On Your Member Dashboard

At the end of each session, you may check on your progress using your Success Chart. You can also access your Member Dashboard, where you may see session notes and get monthly progress reports to monitor your or your children’s progress.

6. Celebrate Reaching Your Speech Goal!

When you reach 100% of your speech goal, you’ll get your final badge, plus a printable Certificate of Achievement, signed by our Clinical Director, and with a place for you to sign, as a parent or coach. After all, completing the Better Speech program is a shared achievement that we want to celebrate!

At Better Speech, we provide evidence-based and affordable speech therapy for every family. Our skilled therapists are

7. Better Speech Follow-Up Program

It’s a wonderful thing to be able to talk. After you’ve reached your speech goal, you’ll be given the opportunity to acquire follow-ups and refresher sessions, as well as other appropriate practice materials, to keep up and maintain your progress.

Are you ready to get started on your speech journey? Join the Better Speech program to achieve faster results in a fun, engaging, and affordable way. At Better Speech, we offer online speech therapy services convenient for you and tailored to your child's individual needs. Our services are affordable and effective - get Better Speech now. Speech works for thousands, and it will work for you!

About the Author

Mikee Larrazabal

I am a Speech-Language Pathologist with 14 years of experience working with children and adults who have communication difficulties. I completed my Bachelor of Science degree in Health Science at Cebu Doctors' University and have been helping people overcome their communication challenges ever since.

I have worked with individuals of different ages, including toddlers, preschoolers, school-aged children, adults and seniors. I'm passionate about speech therapy and take great satisfaction in helping people overcome their communication challenges and improve their lives through better communication skills. In my spare time I like reading books, going hiking in nature and taking care of my dog Locas.

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by Patricia D. Myers

I'm not an English native speaker and I wanted to improve my speech. Better Speech onboarding process is AWESOME, I met with different people before being matched with an AMAZING Therapist, Christina. My assigned therapist created a safe place for me to be vulnerable and made all the sessions fun and helpful. Thanks to her, I received great feedback from my clients.

by John L. Wilson

​ Better Speech is a great program that is easy to use from home and anywhere online. Shannon was amazing at engaging our shy son - and building on their relationship each session! Her commitment to knowing him improved his confidence to speak and practice more. Truly appreciate her dedication. She cares for her clients.

by Christy O. King

​ Better Speech is an excellent opportunity to improve your speech in the convenience of your home with flexible scheduling options. Our therapist Miss Lynda was nothing short of amazing! We have greatly appreciated and enjoyed the time spent together in speech therapy. Her kind, engaging and entertaining spirit has been well received. She will surely be missed.

by Patricia W. Lopez

This service is so easy, i signed up, got a therapist and got to set up an appointment right away that worked with my schedule. so glad to see that services like speech therapy are finally catching up to the rest of the convenience age! therapy is great, i can't believe how many good tips, exercises and methods in just the first session. really recommend it!

(801) 443-7775

What to Expect During a Speech Therapy Evaluation

The word ‘evaluation’ can sound intimidating, especially for parents and children who have never before experienced a pediatric speech therapy evaluation. There can be apprehension in not knowing what to expect when something is new. In reality, an evaluation for therapy is not intimidating or scary. This article aims to explain what a typical speech therapy evaluation will look like to ease any potential anxiety.

Before the speech therapy evaluation, you will likely receive paperwork to fill out about your child’s history, your concerns, and insurance information. This is frequently sent to you ahead of time so that you can fill it out at your leisure and bring it completed to the evaluation so you have less to worry about on the evaluation day. This information seeks to help you to better understand your insurance benefits in regards to therapy, to allow you to express the concerns that you have for your child, and gives the therapist valuable information to guide their evaluation.

At the Clinic

When you arrive at the clinic, the speech therapist will greet you and your child. Sometimes it takes a few minutes (and maybe a toy or two!) for your child to warm up to the therapist. Most of the time, the kids are excited to play with new toys and have no problems separating from their parents. It is important for the therapist to have time alone with your child to begin to create the vital therapeutic alliance that will help them improve quicker. This time alone also allows the therapist to see what the child can do without the child wanting to rely on their parent.

Once the therapist takes your child to the therapy room, the formal speech therapy evaluation begins. The speech therapist will have chosen a formal standardized assessment tool ahead of time based on the presenting diagnosis and concerns. If your child has speech sound concerns, the therapist will frequently begin the evaluation with an oral-mechanism exam. This means they will examine the structures involved in speech sound production (lips, teeth, tongue, palate, etc.) and make note of any difficulties and/or abnormalities. This is a quick and non-invasive external examination. Sometimes children have low tone or increased tone, a short lingual frenulum (the ‘tie’ holding the tongue to the bottom of the mouth), or other physical factors that may contribute to or be responsible for speech deficits.

After the oral-mechanism examination, a formal assessment is typically administered. For speech sound errors, the test consists of having your child name pictures while the therapist transcribes the child’s speech sounds using phonetics. For receptive and expressive language concerns, the test consists of structured situations with specific questions targeting language skills using toys and materials to keep your child engaged. Fluency and pragmatic language can also be assessed through standardized tests. No matter the skill, the test will be chosen based on your child’s age, presenting concerns, and skill level.

Throughout the evaluation, the speech and language therapist also informally evaluates your child using observation and play. Many speech and language skills can be observed through a simple activity such as rolling a ball back and forth or playing with pretend food. If needed, the therapist also uses parent interview to obtain further information about the child’s skills.

After the Evaluation

Once the formal evaluation is finished, the therapist will bring your child back to you. The next 10-15 minutes are spent discussing the preliminary results of the evaluation. At this point therapist will be able to tell you if there are delays with your child’s speech and/or language, and what the next step should be. Sometimes the next step is further testing, while other times it is appropriate to begin skilled therapy sessions. Every child is different, so evaluation and therapy plans are based on each individual child’s skills, needs, and the parent’s desires.

Be cautious of a therapist who does not discuss the results of the evaluation with you or include you in deciding on priorities. The family is a large part of a successful therapy program and you are crucial to your child’s success in therapy. If you feel that the results of the evaluation do not match the skills and needs of your child, consult another therapist to obtain a second opinion.

If you have any concerns about the evaluation, before, during, or after the appointment, always feel free to contact your therapist or therapy clinic with questions!

Contributed By:  Rachel Jacob, CCC-SLP

Reference : ASHA.org

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What Happens During an Initial SLP Assessment

January 1, 2021 

Speech pathology assessments are conducted to establish whether an individual has any specific speech and language disorders. They can also be conducted to diagnose potential communication disorders. In this article, we discuss speech pathologist assessment practices for the screening of speech and communication disorders.

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NYU Steinhardt’s online master of science program in Communicative Sciences and Disorders prepares aspiring speech-language pathologists with a comprehensive professional education.

• Prepares students to pursue SLP licensure 
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• As few as six terms to complete 
• Full-time and part-time plans of study

What Is a Speech Pathologist Assessment?

There are multiple avenues to conduct a speech pathology assessment. SLP assessments are conducted by a speech language pathologist. To become a certified speech language pathologist, you typically need at least a  speech pathology master’s  degree from an accredited program, the  Bureau of Labor Statistics  notes. 

If you’re wondering  what are speech disorders,  or  what are language disorders,  both are important to an SLP assessment. In fact, an SLP assessment determines whether a person has any communication disorders,  speech language disorders , swallowing disorders or feeding disorders. Information is gathered from different sources to fully grasp the individual’s speech pathology needs and determine the best course of treatment. 

Different tools and measurements are used during a speech therapy assessment for toddlers and children than for adults. For example, a speech therapy assessment for children may  involve the child’s parents and/or teachers. This helps the speech therapist gain a thorough understanding of the child’s needs. Specialized pediatric speech and language assessment tools may also be used during the initial assessment. 

Special considerations may also be taken when working with people who are bilingual, who have learning difficulties or developmental disabilities, or who have physical disabilities or impairments that could influence their speech. The cost of a speech therapy assessment generally varies.

What to Expect During an Initial Screening by a Speech Therapist

During an initial speech pathology assessment (which could take more than one session), the  speech language pathologist  interviews the patient. They might also speak to friends, family members or other medical professionals who are treating the patient. The speech language pathologist may use a variety of methods during the initial SLP screening to determine whether the person has any speech and language disorders. They might also screen for any other communication disorders.

Why do some children need speech therapy? Some reasons to seek speech therapy, according to the  Children’s Hospital of Orange County , include if the child:

• Has difficulty imitating sounds.
• Appears slow to comprehend new words.
• Struggles to communicate their foundational needs.
• Struggles to or does not respond to questions or directions.
• Has difficulty starting conversation with others.
• Makes limited or poor sounds of quality.
• Is not stringing words together by 18 months.
• Cannot be understood by strangers after 24 months.
• Does not speak in sentences by 3 years of age.
• Lacks verbal fluency by 3 ½ years .
• Experiences communicative or cognitive changes after a surgery or injury.

The SLP practitioner may also review the individual’s case history before the SLP assessment. This includes medical records, education, and socioeconomic, cultural and linguistic background. They assess the individual’s cognitive, motor, visual and auditory function using both standardized and non-standardized measures, the  American Speech-Language-Hearing Association  reports. The SLP practitioner also observes and analyzes the patient’s swallowing function, cognitive communication, and spoken and unspoken language. If the SLP is a  child speech therapist , they may use specialized pediatric speech assessment tools.

During the initial SLP assessment, the speech language pathologist identifies where the patient needs assistance. Once they have identified these needs, they develop strategies for intervention.

Challenges During a Speech Pathology Assessment

There might be some unique situations that pose challenges for speech pathologists when they are performing an SLP assessment. These may include working with patients who have language barriers, developmental disabilities or learning difficulties, and/or physical disabilities. Let’s analyze each of these and why they might add challenges during a speech pathologist assessment.

Language Barriers and Multicultural Considerations

There could be some difficulty and need for adjustment of both the SLP assessment and intervention processes if a child speaks more than one language and is not assessed by a  bilingual speech pathologist . Of SLPs who reported being bilingual speech therapists, nearly 65% were Spanish-language providers, the  American Speech-Language-Hearing Association  reports.

In some cases when a patient speaks English as a second language, the  American Speech-Language-Hearing Association  notes that it can be challenging to identify whether speech irregularities are due to a speech disorder or because the patient isn’t yet fluent in English. In these instances, the speech pathologist may rely more on information they gather from the patient’s family, friends and medical practitioners to make recommendations. 

Bilingual speech pathologists might also look at other factors that could indicate that the person has a speech disorder. The practitioner may assess the patient’s ability to perform bilabial sounds (sounds that require both lips to be spoken correctly). They may also look out for echolalia (where the patient repeats another’s words), how quickly or easily they learn new words in both languages, and whether learning a second language has caused them to develop syntactic errors in their first language.  

Similarly, multicultural factors could influence the assessment process.  Phonemic inventories  that span different languages and  alternative assessments  could be used to assist in the assessment and planning of interventions. 

Learning Difficulties or Developmental Disabilities Considerations

Speech pathologist assessment and intervention may need to be adjusted for individuals with learning difficulties and/or developmental disabilities, such as autism. In these cases, the SLP practitioner familiarizes themselves with the patient’s medical history and developmental status to identify whether any speech or language difficulties are due to these factors.

During  speech therapy for children with autism , the SLP practitioner may also use specialized tools created to assess speech disorders in individuals with developmental disabilities. For example, the  FCP-R  (Functional Communication Profile – Revised) can be used to assess the individual communication abilities of the patient. It may include an interview with the parents, the direct assessment of the patient or observing recordings of the patient.

Physical Disabilities Considerations 

Physical disabilities that may affect a person’s speech include  hearing impairments  and cleft lips. When conducting hearing screenings for children, the  American Speech-Language-Hearing Association  notes that SLPs will likely work with audiologists and other practitioners. During this kind of speech pathologist assessment for hearing-impaired patients, the speech pathologists may help establish what the patient’s (and their parents’) goals are for therapy. 

When conducting an SLP assessment for someone who has hearing loss beyond early childhood, a speech therapist seeks to understand how the loss of hearing impacts the patient’s communication. The SLP may help determine whether or not a device is needed to aid communication, the  American Speech-Language-Hearing Association  reports. While conducting the initial assessment, SLP practitioners and audiologists also take the individual’s everyday environments into consideration to create a realistic plan for intervention and treatment.

Next Steps After an Initial Assessment from a Speech Therapist

Speech therapy assessment for toddlers, speech therapy assessment for children and speech therapy assessment for adults—along with treatment and intervention plans—may look different. Regardless, the initial SLP assessment gives the speech pathologist a clear understanding of the patient’s needs. It may also show how parents can help SLPs throughout the treatment and continued evaluation process. 

Are you wondering how to find a speech language therapist job? If the SLP assessment process interests you, you may enjoy exploring  speech pathology careers . 

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What to Expect At Your Child’s Speech Therapy Evaluation

A common question we often hear as speech therapists both in and out of the clinic setting is, “Does my child need speech therapy?” The most common concerns prompting this question can range from “I can’t understand my child,” to “My child is not talking as much as their peers,” to “My child just doesn’t seem to understand what I am saying,” and even “My child has difficulty eating.” If you have found that you have similar concerns about your child’s speech and language development it may be time to consider a comprehensive speech and language evaluation. Oftentimes having your child evaluated can seem daunting and overwhelming. And that’s ok! Read on to learn what to expect from your child’s evaluation and how a speech therapist can help. 

What Does a Speech Therapist Do?

Speech Therapists or Speech-Language Pathologists (SLP’s) can help with so much more than just producing sounds correctly. While that can be a big part of a speech therapist’s job, SLP’s can work with your child in many other areas including:

Expressive Language : how your child uses words to express himself/herself Receptive Language : your child’s ability to hear and comprehend spoken language Articulation : the production of speech sounds Fluency : refers to the continuity, rate, smoothness in speech (ex. stuttering) Voice : this can include voice quality, vocal hygiene, pitch, loudness, or vocal effort Auditory Processing : your child may have difficulty processing what they hear AAC (Augmentative Alternative Communication) : AAC refers to various communication methods used to help one communicate without talking (ex. Picture communication, communication devices) Feeding/Oral Motor Skills : if your child has difficulty chewing, swallowing, or advancing their diet an SLP may be able to help

How To Schedule a Speech Therapy Evaluation for your Child:

If you are ready to take the next steps in having your child seen for a speech therapy evaluation, contact your child’s primary care doctor for a speech therapy referral. You may also call our office and one of our patient coordinators can assist you with next steps and help get your child scheduled for an evaluation. 

What To Expect From Your Child’s Evaluation: 

Believe or not, speech therapy evaluations are actually FUN! Prior to your evaluation date, your child’s therapist may contact you in order to find out any additional information they might need in order to complete a thorough and comprehensive evaluation which addresses all of your concerns. 

At your evaluation appointment, your therapist will talk further with you about your concerns, what goals you and your child have for therapy, and review pertinent medical history. The therapist will interact with your child through play or movement activities in order to understand their communication skills in a more natural context. If your child is able, the therapist will administer a speech assessment to formally evaluate their skills in your area of concern. 

Don’t be alarmed if your child’s evaluation looks a lot like they’re “just playing”. This is sometimes how an SLP can learn the most about your child! You can be assured that your therapist is constantly evaluating and assessing your child’s skills. Our goal is to make the evaluation fun and comfortable for your child. Finally, the therapist may take a look inside your child’s mouth to simply ensure that all of the structures needed for speech and communication are intact and functioning properly. 

Once the assessments and evaluation are complete the therapist will review their findings and make recommendations as to whether further treatment is necessary and answer any questions you may have about the evaluation process.  

What Happens After the Evaluation:

At your evaluation, your therapist will let you know if weekly therapy appointments are recommended. If ongoing treatment is recommended and you have not already scheduled a weekly appointment time, your therapist and patient coordinator will help you through that process. Your therapist may also provide you with activities and strategies to implement at home to target any areas of concern outside of the clinic environment. 

If after the evaluation, your therapist does not recommend treatment, they may ask you to continue to monitor your child’s development and check back in six months to a year, for example, if concerns persist. 

As a parent or caregiver, you know your child best. If you have any concerns about their speech and language development do not hesitate to pursue an evaluation. SLP’s are here to guide you, answer any questions, and make sure that your child receives the best care possible! We can’t wait to see you! 

Elizabeth Vincent, M.S., CCC-SLP

CDC speech therapy guidelines have changed, but early intervention is still the goal

When the CDC updated the developmental milestones for its “ Learn the Signs. Act Early ” initiative for the first time since 2004, a controversy erupted, confusing pediatricians, speech therapists and parents.

The initiative details when children from birth to 5 years should reach milestones on how they play, learn, speak, act and move. The updated developmental tracker, published in 2022, pushed some speech milestones previously set at 24 months back to 30 months.

In this article, we’ll talk about how developmental milestones are meant to be used, what the updates mean for parents and caregivers, and what you should do if you’re worried your child might have a speech delay.

Developmental milestones and early intervention

The CDC launched “Learn the Signs. Act Early” in 2004 because they recognized that people didn’t always have the information they needed to catch developmental delays – such as speech disorders or speech delays – at the earliest stages. The earlier you can identify a developmental problem and start treating it, the better the outcomes for patients.

“We always want to intervene as early as possible, whether it’s strategies to help with communication, or help with a delay or disorder,” says Alison Barclift , a speech-language pathologist at Sentara Therapy Center - Pediatrics Newtown . “The sooner we’re in there the better.”

In addition to assisting parents, the developmental milestones checklist in “Learn the Signs. Act Early” is primarily used by pediatricians to identify children who might have a developmental issue so they can be referred to a specialist for a more thorough screening.

“Pediatricians are generalists for ages 0-18; they know a little bit about a whole lot of things,” Barclift says. “This checklist helps guide them, to give them a basis for saying ‘you know what, let me refer them.’”

New guidelines stir up controversy

The CDC’s developmental milestones are one of the primary tools that providers and parents use to determine if a child might need help. So the changes in speech milestones from 24 months to 30 months perplexed parents and providers.

According to the CDC, the new guidelines shift the expectation to the age when most children reach a specific milestone rather than when the average child has reached a specific milestone. For instance, the previous guidelines said children should be able to say 50 words at 24 months. That was based on research that showed that about 50 percent of children could do that by age 2. The new guidelines have moved this milestone to 30 months. Experts have determined that’s when 75 percent, or the majority, of children can say 50 words.

While this shift does seem to have the potential to delay the start of treatment for children with speech disabilities, the CDC’s checklist is not the only tool that pediatricians use to make referrals. For example, the communication milestones checklist created by the American Speech-Language-Hearing Association (ASHA) places children speaking at least 50 words in the 19-24 month range.

“I have not noticed a change in the referrals that we’re seeing, and I don’t think that I’m that surprised by that,” says Barclift.

Normal is a spectrum

Ultimately, the CDC’s checklist and similar tools are just the starting point. Once a child has been referred to a speech therapist, more in-depth testing is done to determine the exact nature of the delay, disability or needed support.

This data is then used to decide whether the child qualifies for services through state early intervention programs and/or in the outpatient setting. A simple checklist can only really serve as a starting point because ‘normal’ is a spectrum – all children develop differently.

“There’s a large range of normal,” says Barclift. “A 4-year-old who can speak in complete sentences and a 4-year-old who’s putting only three words together to make only simple sentences are both within that normal range.”

According to Barclift, the testing that professional speech therapists conduct is meant to get a more thorough picture of where the patient is having problems.

“For early intervention evaluations, we spend up to two hours with the child and most of the time in the home,” says Barclift. “That helps because the pediatrician's office is not always where your child is going to act the way they normally act. In the clinic setting, therapists may have less time to complete evaluations and take detailed histories from parents and caregivers to make sure they are capturing the whole child and any concerns.”

Parents know their children best

Parents know their children better than anyone and are well positioned to spot developmental issues before anyone else does. But that’s only if they know what to look for. Fortunately, the CDC has resources targeted specifically to parents that can help you screen your child while going about your daily lives.

“The CDC has children's books and parent resource guides that parents can get for free that help the checklist become more natural and understandable,” says Barclift. “These resources help parents bring this conversation into their daily lives, instead of making it this scary thing that only happens when they go to the pediatrician.”

If you think your child might have a speech delay or other developmental disability, speak to your child’s pediatrician as soon as possible. The earlier a problem is identified, the better, but even if a problem isn’t spotted until later, therapy can still help.

“There’s also no such thing as too late either,” says Barclift. “Any time a parent is concerned we want them to come in.”

Reach out to your pediatrician today to get your child screened for developmental delays.

By: Andrew Perkinson

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StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan-.

StatPearls [Internet].

Speech assessment.

Yasmin Naqvi ; Ryan Winters .

Affiliations

Last Update: May 1, 2023 .

• Definition/Introduction

Speech is a communicative skill that enables us to understand each other and to interact. It becomes a means of communication, allowing us to share ideas, beliefs, and opinions. When this process is disrupted, and the normal flow of receptive and expressive aspects of speech is compromised, a speech assessment is carried out to assess a disturbance in any part of this process. Disturbances of speech can come in the form of content formation (i.e., the patient has difficulty expressing the desired ideas in the form of spoken words) or of articulation (i.e., the patient can express their ideas in spoken form but has one or more problems physically producing the sounds necessary for intelligible speech). A speech assessment, together with formal neurological evaluation, can identify specific speech problems or patterns of speech problems, as well as propose solutions. [1]

Speech assessment is a method to evaluate and diagnose problems in adults and children of speaking, swallowing, comprehension, and writing. Such evaluation may be warranted due to neurological diseases, stroke, trauma, injury, tumors, cerebral palsy, cleft palate, orofacial musculature, hearing impairment, stammering, articulation errors, motor speech disorders, and many other conditions. [2]

Formal speech assessment is performed by a trained speech and language pathologist, and begins with a consultation in the office with the patient and potentially with family members. Reviews of prior records and treatment will be conducted, and formal characterization of receptive and expressive speech will be conducted, including articulation, fluency, content, and clarity of speech, and potentially evaluate breathing and swallowing. Objective testing such as videostroboscopy, nasometry, or rhinomanometry may be obtained, depending on the specific disorder under investigation. [3]

• Issues of Concern

Speech is the verbal expression of thoughts and ideas. In many cases, speech is used to communicate via a shared language. Language is an agreed-upon rule-based code we use to communicate. Parents may present with a range of concerns regarding their children when they choose to consult a speech-language pathologist (SLP). These may include but are not limited to, the child’s patterns of speech, cognitive, and social skills in contrast to their peer group. Some parents may be concerned that their child does not match up to other children their age and appears to be lagging in milestones. These may include behavioral and hearing issues also.

Multiple tests have been devised to assess oral motor disorders. One of them is the Fletcher time-by-count test of diadochokinetic syllable rate. The diadochokinetic (DDK) rate is an assessment tool used by SLPs to measure the repetitions of sounds within a set period of time. It measures how rapid one can correctly repeat a series of rapid, alternating sounds. These are called 'tokens.' Words with one, two, or three syllables are included in tokens. For e.g. 'puh', 'puh-tuh', or 'puh-tuh-kuh'. DDK rates vary between different age groups and patients with varying neurological conditions. [4]

Normal speech depends on the functional and structural integrity of the velopharynx. This is a complex and dynamic structure that uncouples the oral and nasal cavities during sound production. Dysfunction of the velopharyngeal valve leads to hypernasality, nasal air emission, and compensatory articulation errors, all of which may impair speech intelligibility. Functional voice disorders also come under speech pathology and therapy services, in both professional and casual voice-users.

When we speak or swallow, a thin sheet of musculo-mucosal tissue called velum disunites the oropharynx and nasopharynx during speaking and swallowing. Cleft palate is a congenital deformity commonly causing velopharyngeal insufficiency (VPI), though VPI can exist independent of cleft palate also. VPI compromises speech sounds, decreases the comprehension of speech and swallowing efficacy due to improper closure of soft palate that is closed during swallowing and speaking. If the velum is not closed fully against the posterior wall of the pharynx at Passavant's ridge, this poor closure will result in nasal regurgitation and resonance disorders (hypernasality and/or hyponasality). [5]  

Speech pathologists continue to develop rehabilitative strategies under swallowing management programs also. As speech and swallowing rely on many of the same sensory and motor facilities, they are necessarily related. Oral medications may also need modification in texture so the patient can swallow them safely. Likewise, daily diet modifications may be required in patients suffering from dysphagia. As patients progress through such swallowing management programs, nasogastric tube feeding, a percutaneous endoscopic gastrostomy may also be suggested via speech assessment depending on the type and severity of swallowing difficulty. Swallowing difficulties are also very common in neonatal populations, and there is a distinct sub-specialty of speech pathology dedicated to neonatal feeding. Since speech assessment is a multifactorial process, it is inclusive of the individual, their family history, health, and socio-economic status enabling insight into the circumstances relevant to individual patients' needs. For example, a child who is not responsive to the parents' or the clinician’s verbal commands may be suffering from hearing impairment, or other auditory dysfunctions. Autism Spectrum Disorder and other disorders might also be underlying issues that have not been diagnosed prior, but can be elucidated through a thorough speech assessment. Clinical conditions and communication disorders are coexisting conditions in cases of cleft palate, hearing deficit, traumatic or congenital brain injury, and anomalies of the orofacial structure and difficulty in deglutition (dysphagia). [6] [7]

Milestones are the markers that represent a standard of normal development, and there are well-defined speech, swallowing, and language skills milestones. If a child’s speech, understanding, cognition is not age-appropriate or is not like their peer group, then further investigation is warranted. There are many potential culprits, and a formal assessment of the child's hearing ability, cognition, anatomy, and home/family environment will be investigated.

• Clinical Significance

Speech assessment, through its multifactorial approach, includes the child or individual’s family history, health, and socioeconomic status. It gives an insight into the circumstances they stem from, including cultural and ethnic backgrounds, which is especially relevant in multi-lingual households. [8]

A child, for example, who is not responsive to the parents or the clinician’s verbal command, may be suffering from hearing impairment or other auditory dysfunctions. Autism Spectrum Disorder and other disorders might also be underlying issues that have not been diagnosed but can be done so through thorough speech assessment. Clinical conditions and communication disorders are coexisting conditions in cases of cleft palate, hearing deficit, traumatic or congenital brain injury, and anomalies of the orofacial structure and difficulty in deglutition (dysphagia). [9]

SLPs are trained in the management of swallowing disorders as well, and there is a significant overlap with speaking difficulties. In addition to the phonatory functions of the vocal folds, they serve a protective function during deglutition. Impaired oropharyngeal phase leads to aspiration of saliva or other pathogens, including liquids/food. Poor bolus control or weak oral musculature can affect the optimum intraoral pressure that is essential for food propulsion in the esophagus. Patients with neurologic deficits may have poor oral hygiene, which acts as a medium for bacterial and fungal growth. Oral thrush is a common finding in hospitalized patients that have suffered from cerebral vascular accidents or have other neurological conditions that have impaired their speaking and swallowing ability. SLPs are consulted before a patient is started on a solid or semi-solid diet. A proper bedside swallowing test can give a general risk of aspiration in the patient. [10]

Acquired swallowing disorders are prevalent among intensive care unit (ICU) patients. Such patients face potential malnutrition, as well as problems with the administration of medications. A speech-language pathologist assesses all stages of the swallowing mechanism. In the case of poor oral hygiene, there is an increased chance of vulnerability for developing dysphagia. Early detection of oropharyngeal dysfunction will improve the prognosis and outcome of patients as they say early intervention leads to an early cure in most cases.

In the ICU, when patients are extubated, the first oral intake trial for the assessment of intact swallowing efficacy is conducted by the speech-language pathologist, after which they give the go-ahead for the provision of safe and smooth oral feeding. If any physical symptoms of deglutition are found like coughing, throat clearing during or after the oral trial, or drop in saturation, other ways of feeding are then recommended to fulfill nutritional requirements and medication intake. Rehabilitative strategies are also guided to improve the strength of oral musculature. [11]

Silent aspiration is another important feature when dysphagia is addressed. Patients suffering from dysphagia do not exhibit noticeable symptoms of swallowing difficulties. The observers that include nursing staff, attendants, and even primary consultants are not unaware of the fact that food particles and liquids have entered in patient’s lungs. Specially trained speech pathologists can suggest videofluoroscopy, also known as a modified barium swallowing test. [12]

Stroboscopy is a method of examination of a fast-moving vibrating object, such as the vocal folds. A bright flashing light lasting a fraction of a second (10 microseconds) illuminates the vocal folds. It 'freezes' the movement of the vibrating vocal folds when synchronized with a known frequency of vibration of normal vocal folds. SLPs are trained in the management of swallowing disorders as well, and there is a significant overlap with speaking difficulties. The diagnostic practice of SLPs has been revolutionized by high-speed digital imaging. This method runs at 4000 frames per second. This rate is fast enough to easily visualize the complete movement and behavior of the vocal tract. Multiple procedures like nasometry, stroboscopy, videofluoroscopy, vital stimulation therapy aid in the assessment of speech and swallowing disorders, and improving patient outcome. [13] [14]

Nasometry is a method or term used to describe noninvasive techniques for measuring the size of the velopharyngeal opening. During the articulation of speech using vowel sounds, nasometry measures the nasalance of speech. The nasality of speech is usually determined by the size of the velopharyngeal opening. [15]

• Nursing, Allied Health, and Interprofessional Team Interventions

Speech-language pathologists are essential components of the interprofessional team caring for patients with voice or swallowing complaints. This team will often include one or more physicians, nurses, occupational therapists, physical therapists, mid-level providers, and many others. [16]  Working in collaboration and communication with each other will help in early identification of patients in need of SLP evaluation and therapy, and help improve patient outcomes. [Level 5]

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Disclosure: Yasmin Naqvi declares no relevant financial relationships with ineligible companies.

Disclosure: Ryan Winters declares no relevant financial relationships with ineligible companies.

This book is distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International (CC BY-NC-ND 4.0) ( http://creativecommons.org/licenses/by-nc-nd/4.0/ ), which permits others to distribute the work, provided that the article is not altered or used commercially. You are not required to obtain permission to distribute this article, provided that you credit the author and journal.

• Cite this Page Naqvi Y, Winters R. Speech Assessment. [Updated 2023 May 1]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan-.

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Speech and Language Therapy

Speech and language therapy or pathology is a type of health care that addresses communication and swallowing disabilities and issues. Professionals in this field are highly-trained experts in working with both children and adults who struggle to speak, communicate, comprehend or use language, or eat and drink because of any number of conditions and disabilities.

The care that speech and language therapists provide is important in many ways. For children who cannot swallow easily, they help ease eating and drinking. For adults with impaired communication from illnesses or accidents, they can help restore speaking. And for kids with disabilities and speech difficulties, they can aid in making communication more effective and easier. Be sure to choose a therapist who is licensed and comes recommended by a doctor or previous patients.

What is Speech and Language Therapy?

Speech and language therapy, also sometimes referred to more simply as speech therapy or as speech and language pathology, is a type of therapy that helps patients of any age who struggle with communication, speaking, swallowing, eating, and drinking. Speech and language therapists or pathologists evaluate, diagnose, and treat people with communication, cognitive, voice, and swallowing disorders or conditions that affect communication, speaking, and swallowing.

A speech-language therapist is an allied health professional, skilled health care with specific training. These therapists have earned undergraduate degrees as well as advanced graduate degrees in speech and language pathology. They are licensed by the state they practice in and are often certified by professional organizations like the American Speech-Language-Hearing Association.

Childhood Disorders Treated with Speech Therapy

There are many conditions that can be treated with speech and language therapy, including those that affect adults, children, or both. Many of these are more common in children, who can improve the ability to communicate or swallow. Some of the conditions that may lead a child to need speech and language therapy include:

• Articulation disorders, which cause a child to mispronounce words or sounds.
• Resonance and voice disorders that cause issues with pitch, quality, and volume.
• Fluency disorders, like stuttering.
• Expressive disorders, which cause a child to have difficulties with expressing or using language.
• Receptive disorders that make processing and understanding language difficult.
• Cognitive disorders that affect communication.
• Dysphagia, and other swallowing or feeding disorders that make eating and drinking difficult.
• Mental illnesses, behavioral disorders, and developmental disorders that interfere with the ability to communicate.

Speech pathologists guide these sessions with activities and exercises that are designed to help the patient meet their goals. They also evaluate patients on an ongoing basis to assess progress and then adjust the treatment as needed. Therapists work with parents and patients and teach them exercises they can use at home to further improve communication.

Speech Therapy for Adults

When speech and language therapists work with adults, it is often for rehabilitation or to improve the communication or swallowing symptoms caused by illnesses, accident, or progressive illnesses. For example, a stroke may leave someone with speech difficulties and therapy can help restore some or all of the ability to speak and communicate. Other illnesses and conditions that may require speech therapy include Parkinson’s disease, Alzheimer’s disease, brain or throat cancer, and brain injuries.

Adults may also need speech therapy for voice and communication disorders that were not treated in childhood, like stuttering or expressive disorders that are not so severe as to make communication impossible. Mental illnesses, learning disabilities, and behavioral disorders may also require treatment with speech and language therapy to improve communication.

What Happens in Speech Therapy Sessions?

Speech and language therapy sessions include a variety of elements and differ based on the needs of the individual patients. The first thing a pathologist does with a patient is a thorough evaluation to assess their needs and abilities. They also can make a diagnosis at this point, which can then lead to the development of goals and a treatment strategy. Elements of treatment vary depending on the patient, but may include:

• Teaching the patient how to make specific sounds.
• Using games and toys with children to help improve speech.
• Guiding patients to develop vocabulary and sentence structure.
• Using exercises to strengthen muscles used to swallow or speak.
• Working with patients and their families about how to work on goals at home and how to improve communication.
• Counseling patients with emotional or behavioral issues to help improve communication.

Where Speech and Language Therapy is Offered

Speech and language therapists work in many different settings. Because they often work with children, speech and language pathologists are often found in schools and pediatric units in hospitals, clinics, and medical centers. They also work in private practices, in community health clinics and programs, in prisons, in children’s homes, in nursing homes, and in speech and language clinics. They may work along with other health professionals as part of a multi-disciplinary team that helps patients with a variety of strategies.

How to Get High Quality Speech and Language Care

To ensure that you or your child gets the best quality of care for speech or swallowing conditions and symptoms, it is important to take care when choosing a therapist. Getting a referral from your physician or pediatrician is a great place to start, but also be sure to check the qualifications of the therapist you choose. The therapist should be licensed and associated with a professional organization. You may also want to get references to determine if past patients were satisfied with the results. Look specifically for qualifications and references that are relevant to your or your child’s specific issues and goals.

Speech and language pathology is an important type of care. For people who struggle to communicate, functioning in school, at work, and in relationships with other people can be very challenging. These therapists are trained to help individuals communicate better and in doing so also improve their quality of life measures. Many patients needing speech therapy are children, but there are many adults who can benefit from this type of care too. If you are seeking care for communication or swallowing difficulties, select a qualified and skilled therapist to ensure you get the best possible treatment and outcomes.

• http://kidshealth.org/en/parents/speech-therapy.html#
• https://www.rcslt.org/speech_and_language_therapy/docs/factsheets/what_is_slt
• https://www.bls.gov/ooh/healthcare/speech-language-pathologists.htm#tab-2
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Esophageal Disorders: What is the role of the speech pathologist?

Introduction.

Understanding the scope of esophageal disorders and the affect of such disorders on oropharyngeal function as well as having the knowledge and skills to recognize abnormalities in esophageal structure and function require additional training, knowledge and skills beyond the completion of traditional graduate coursework and practicum in swallowing and swallowing disorders.

Get “Manual of Diagnostic and Therapeutic Techniques for Disorders of Deglutition” by Shaker R., Easterling C., Belafsky P.C., Postma G.

Most of the education in the area of esophageal disorders may be obtained from post graduate continuing education or if you are fortunate to be able to work closely with a gastroenterologist. Ideally study should include awareness of clinical symptoms of esophageal dysphagia and recognition of the presence of esophageal dysfunction from instrumental evaluations performed such as the esophagram.

The key to choosing the appropriate diagnostic exam: Patient medical history, clinical interview and clinical exam

The clinical examination includes noting pertinent signs and symptoms in the medical history associated with oropharyngeal and or esophageal dysphagia. Cook and colleagues indicated that a detailed history will elucidate the anatomical site and the likely cause of dysphagia in 80% of cases (1). Such signs and symptoms of possible esophageal dysphagia may include but are not limited to: food “sticking” during swallowing, difficulty swallowing solid food, sensation of discomfort or fullness anywhere from mid-chest to neck region, coughing up food/pills after the swallow, requiring liquid swallows to follow solids through the swallow, complaints of dysphagia without overt signs of swallowing difficulty, odynophagia (at base of throat/chest/sub-sternal), complaints of heartburn, chronic cough, throat clearing, excessive secretions or saliva, voice change, chronic sore throat, chronic respiratory problems, acidic taste or sinus problems, and regurgitation.

Perhaps it is time for a multi-disciplinary group of deglutologists to define the purpose, methodology and value of the esophageal screen.

Based on medical history, clinical examination, and in the presence of symptoms of esophageal dysphagia as listed above or in the absence of oropharyngeal findings after completion of the instrumental examination, an esophagram is the appropriate first step in diagnosing esophageal disorders and should be requested.

Many Speech Pathologists use the esophageal screen when the oropharyngeal swallow evaluation fails to yield findings that correlate with the patient’s symptoms. However there is no consistent protocol or rationale for completion of the esophageal screen. A screening protocol would dictate the rationale for: patient position, bolus viscosity and size administered, number of swallows performed by the patient per bolus to achieve the optimal representation of esophageal motor function and structural integrity. How do we interpret the findings from an esophageal screen? Do we perform the esophageal screen only in the absence of oropharyngeal dysphagia or is this screen done during every exam? Will the radiologist consent to assisting with an esophageal screen? Will the radiologist document the findings of an esophageal screen? If not, why not?

ASHA professional practice documents do not define the criterion or the elements of an esophageal screen (2). Additionally the American College of Radiology (ACR) Practice Guidelines for the Performance of the Modified Barium Swallows do not mention or define the esophageal screen for patients with dysphagia (3). Perhaps that is why we are not able to persuade the radiologist with whom we work to perform an esophageal screen or report the findings. The ACR guideline state that; “A complete patient evaluation may also include spot films of the pharynx for structural assessment and an esophagram, as symptoms of dysphagia are often poorly localized”. This guideline focuses on assessment of the pharynx but recommends performance of an esophagram if warranted (3). The guideline is an excellent reference supporting the inclusion of an esophagram in the absence of oropharyngeal findings and/or if the patient’s symptoms are suggestive of an esophageal origin for the swallowing disorder. Again, there is no mention in this document of an esophageal screen.

ACR Practice Guideline for the Performance of Esophagrams and Upper Gastrointestinal Examinations states; “the indications for performance of an esophagram include a pertinent history and symptoms. The symptoms include but are not limited to; chest pain without cardiac origin, symptomatic or suspected gastroesophageal reflux, dysphagia and odynophagia”. Further patient history indicators; “…motility disorders, esophagitis, strictures, varices, neoplasms, esophageal obstruction and postoperative assessment” (4).

The confirmatory radiographic procedure to evaluate esophageal motility and structure is the esophagram. The esophagram is performed in prone position so the esophageal motor function can be assessed without influence of gravity. Single, double barium contrast, gas producing effervescent crystals, and an optional marshmallow challenge are used during this evaluation.   Large volumes of barium must be taken to evaluate the distension of the esophageal body. Double contrast barium is used to outline mucosal integrity and to optimize visualization of abnormalities.   The patient must be able to consume quantities and varied types or densities of contrast for an accurate assessment of motor function and structure of the esophageal body and sphincteric function. Positive findings from the esophagram may result in further evaluation with endoscopy, manometry, impedance, combined impedance and pH testing, depending on the patient symptoms and findings from the esophagram.

Has the esophageal screen protocol been described?

Allen and colleagues (2012) described the esophageal screen as the administration of a single 20 ml liquid bolus swallowed and viewed in the anteroposterior view after completion of the oropharyngeal evaluation. The position of the patient was in upright, standing position with instructions that the patient swallow the bolus in one swallow. Esophageal screen findings were compared to the results of a full esophagram in the patients studied. They found the esophageal screen identified 44/70 (63%) patients with esophageal disease. Sensitivity and specificity were 63% and 100% respectively. The authors noted they may have had increased identification of esophagopharyngeal reflux and gastroesophgeal reflux with the esophageal screen. They also note that hiatal hernia and esophageal ring identification are best visualized with esophageal distention (use of large volumes of barium). Thus the sensitivity of the esophageal screen had limited identification of structural abnormalities such as hernias and rings because of the use of the 20 ml bolus.   Conclusion of this study; “if clinical suspicion is high, a formal esophagram should be considered” (5). The conclusion supports the need to evaluate patients with esophageal disorders with the appropriate procedures and instrumentation.

Oropharyngeal Findings Associated with Esophageal Disorders

Blair and Martin-Harris (2010) found significant correlation between delayed pharyngeal swallow response time and abnormal esophageal clearance observed on an esophageal screen. The esophageal findings were confirmed by combined esophageal manometry and impedance (8).

In conclusion, do we as a profession have a consistent rationale, standardized methodology and predicted outcomes to support the performance of the esophageal screen? Perhaps it is time for a multi-disciplinary group of deglutologists to define the purpose, methodology and value of the esophageal screen.

Links of Interest

Dr. Easterling has two textbooks:

• “Principles of Deglutition: A Multidisciplinary Text for Swallowing and its Disorders” by Shaker, R., Belafsky P.C., Postma G.N, Easterling C. (Springer Pub. 2012)
• “Manual of Diagnostic and Therapeutic Techniques for Disorders of Deglutition” by Shaker R., Easterling C., Belafsky P.C., Postma G., (Springer Pub., 2012)
• Cook, I. J. (2008). Diagnostic evaluation of dysphagia. Nature Clinical Practice:       Gastroenterology & Hepatology. 5, 393-403.
•  American Speech-Language-Hearing Association. (2004). Guidelines for Speech-Language  Pathologists Performing Videofluoroscopic Swallowing Studies . Available: http:// www.asha.org/policy retrieved 2-01-12.
• American College of Radiology (ACR) Practice Guideline for the performance of the Modified Barium Swallow (2011). Available: http://www.acr.org/SecondaryMainMenuCategories/quality_safety/guidelines/dx/gastro/modified_barium_swallow.aspx retrieved 2-01-12.
• American College of Radiology (ACR) Practice Guideline for the performance of Esophagrams and Upper Gastrointestinal Examinations in Adults (2008). Available: http://www.acr.org/SecondaryMainMenuCategories/quality_safety/guidelines/dx/gastro/esophagrams_upper_gi.aspx retrieved 2-01-12 .
• Allen, J.E. , White, C., Leonard R., & Belafsky P.C. (2012). Comparison of esophageal screen findings on videofluoroscopy with full esophagram results. Head & Neck . 34, 264-9.
• Blair, J., Martin-Harris, B. (2010, November). MBSImp and Combined MII/Esophageal Manometry . Paper presented at ASHA Annual Convention, Philadelphia.

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