Specialized knowledge, skills, and clinical experience related to the evaluation and management of individuals with swallowing and swallowing problems may be acquired on the graduate or postgraduate level, in formal coursework, and/or in a continuing education framework. The standards for ASHA certification effective in 2014 require competence in dysphagia. The American Board of Swallowing and Swallowing Disorders, under the auspices of ASHA's specialty certification program, offers clinical specialty certification in swallowing and swallowing disorders. Board Certified Specialists in Swallowing are individuals who hold ASHA certification and have demonstrated advanced knowledge and clinical expertise in diagnosing and treating individuals with swallowing disorders.
SLPs have extensive knowledge of anatomy, physiology, and functional aspects of the upper aerodigestive tract—including oral, pharyngeal, and cervical esophageal anatomic regions—for swallowing and speech. In addition, SLPs have expertise in all aspects of communication disorders that include cognition, language, and behavioral interactions, many of which may affect the diagnosis and management of swallowing disorders. Because of the complexities of assessment and treatment in most persons with swallowing disorders, SLPs work collaboratively with other professionals, individuals, families and caregivers. Interprofessional practice (IPP) is critical to successfully achieving the desired improvements and outcomes.
SLPs play a central role in the assessment and management of individuals with swallowing disorders. An SLP's roles include
- Identifying the signs and symptoms of dysphagia
- Identifying normal and abnormal swallowing anatomy and physiology
- Identifying indications and contraindications specific to each patient for various non-instrumental and instrumental assessment procedures
- Identifying signs of potential disorders in the upper aerodigestive tract and making referrals to appropriate medical personnel
- Performing, analyzing, and integrating information from non-instrumental and instrumental assessments of swallow function collaboratively with medical professionals, as appropriate
- Providing safe and effective treatment for swallowing disorders, documenting progress, and determining appropriate dismissal criteria
- Identifying and using appropriate functional outcome measures
- Understanding a variety of medical diagnoses and their potential impact(s) on swallowing
- Awareness of typical age-related changes in swallow function
- Providing education and counseling to individuals and caregivers
- Incorporating the client's/patient's dietary preferences and cultural practices as they relate to food choices during evaluation and treatment services
- Respecting issues related to quality of life for individuals and/or caregivers
- Practicing interprofessional collaboration as an integral part of the patient's medical care team
- Educating other professionals on the needs of individuals with swallowing and feeding disorders and the SLP's role in the diagnosis and management of swallowing and feeding disorders
- Advocating for services for individuals with swallowing and feeding disorders
- Advancing the knowledge base through research activities
- Maintaining competency of skills through reading current research and engaging in continuing education activities
- Determining the safety and effectiveness of current nutritional intake (e.g., positioning, feeding dependency, environment, diet modification, compensations).
As indicated in the Code of Ethics (ASHA, 2016), SLPs who serve this population should be specifically educated and appropriately trained to do so. Assessment and management of dysphagia requires training and competence.