It wasn't long after graduate school that I discovered what my lifelong battle would be as a Speech-Language Pathologist (SLP): no one knows what we do. In every setting I worked in, not only was I explaining myself to patients, but also other medical providers. Patients would sometimes laugh when I entered the room, "My speech is fine!." Usually I could win them over with a little education. And in their defense, our job title is a total misnomer!
I have had the opportunity to work in multiple settings prior to starting my private practice, so I thought I would go through each of those and tell you how we fit into the picture. In short, we evaluate and treat cognitive, communication, and swallowing disorders. I like to phrase it as everything from the neck up!
Acute care: In this setting, dysphagia (swallowing disorders) are the highest priority. SLPs assist with diagnostics of dysphagia, which usually looks like a clinical bedside swallowing evaluation following by either a Modified Barium Swallow Study (MBSS) or a FEES (Flexible Endoscopic Evaluation of the Swallow). An MBSS is performed in a radiology suite, while the FEES is performed at the bedside and involved a small camera going up the nose. Diagnosis and treatment of swallowing disorders is important for obvious reasons... we have to eat! Ultimately, we are trying to determine if the patient can achieve airway protection (aka, no food or liquids are entering the lungs). Lower on the priority list is assessment and treatment of cognitive or communicative disorders, frequently after a stroke or brain injury. Typically these patients aren't in the hospital long enough to make substantial progress in these areas.
Inpatient Rehabilitation: This is an intensive therapy program where patients usually come and stay for anywhere from 1-3 weeks. In this setting, cognition was the primary impairment I dealt with. Oftentimes patients would be hospitalized for an issue unrelated to cognition, however cognitive deficits would be identified while in inpatient rehab. Other prominent diagnoses include: aphasia (loss of language), dysphagia (disorder of swallowing), dysarthria (motor speech impairment), all frequently seen post stroke.
Skilled Nursing Facility: My first job was in a skilled nursing facility (SNF), and I found that this was where I was the least understood. In this setting, SLPs deal not only with rehabilitation but also end of life situations. Again, swallowing is a great concern as many long term patients have progressive diseases such as Parkinsons or dementia. For those in long term care, cognitive therapy is more of a maintenance program versus rehabilitative. For those on the rehab unit, the goal is rehabilitation for return home.
Home health: SLPs in home health are typically performing more of a rehabilitative therapy versus maintenance. Usually patients are medically compromised and not very mobile, having just been discharged from acute care. This may include patients post: stroke, brain injury, anoxic brain injury, encephalopathy, or even patients with head/neck cancer.
Outpatient: This is where I currently reside! I still see an array of cognitive, communication, and swallowing related issues, however an added bonus is that I get to see my patients for an extended amount of time (possibly months, depending on what their needs are). Diagnoses I am currently seeing include: ALS, primary progressive aphasia, Parkinsons, stroke, primary progressive apraxia, mild cognitive impairment, and early onset dementia. Throughout my career I have worked in some very fast paced settings and always wondered if I would be bored in outpatient. I've found this is my favorite of all of them. I truly feel like I am able to give the patients the time they need (45 minutes to an hour), as well as the frequency. I love the relationships I'm able to build with my patients over the course of several weeks. Usually by discharge, I know all the ins and outs of their life, family, and hobbies.
So not only do we not just work with kids, but there is a place for us in MOST if not ALL settings! I feel very fortunate to be an SLP and not a day goes by that I'm not learning something new.