This Knowledge and Skills document is an official statement of the American Speech-Language-Hearing Association. The ASHA Scope of Practice states that the practice of speech-language pathology includes providing services for swallowing (dysphagia) and feeding problems. The Preferred Practice Patterns are statements that define universally applicable characteristics of practice. Individuals who practice independently in these areas are required to hold the Certificate of Clinical Competence in Speech-Language Pathology and abide by the ASHA Code of Ethics, including Principle of Ethics II Rule B, which states: “Individuals shall engage in only those aspects of the profession that are within their competence, considering their level of education, training, and experience.”
Since 1987, ASHA has developed several policy documents to recognize the role of speech-language pathologists in providing services to individuals with dysphagia and to define current practice, research needs, and requisite knowledge and skills. In order to remain current with new developments in the area of swallowing and feeding, several of the documents have been reviewed and updated. Recognizing the significant potential impact of swallowing and feeding disorders on overall health and quality of life, it is essential that speech-language pathologists possess the knowledge and skills to be proficient in their management of these disorders.
Depending on the individual's work environment and population(s) served, every speech-language pathologist will not necessarily need to develop proficiencies in all roles. Some roles are clinical and the speech-language pathologist will need to develop proficiencies based on the populations served (e.g., adult, head and neck cancer, pediatrics). Some roles are administrative in nature and would be best performed by a person with extensive experience in supervision. Achievement of proficiencies should be documented and systematic plans for attaining proficiency should be in place in settings serving individuals with swallowing and feeding problems.
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The purpose of this document is to outline the knowledge and skills needed by speech-language pathologists providing services to individuals with swallowing and/or feeding disorders. These knowledge and skill areas form the basis for assessing clinical competency in this specialized area of practice. Knowledge and skills applicable to serving one population or one age group of individuals do not presume knowledge to serve individuals of other ages and/or populations.
In addition, speech-language pathologists assessing individuals with potential swallowing and/or feeding disorders and providing treatment to individuals with such disorders should have a basic understanding of the following:
Normal and abnormal anatomy and physiology related to swallowing function.
Signs and symptoms of dysphagia.
Indications for, and procedures involved with, instrumental techniques used to assist in diagnosis and management.
Proper procedures for analyzing and integrating clinical and instrumental information into a formal diagnosis of swallowing and feeding disorders with appropriate written documentation.
Basic management issues, including how to determine candidacy for intervention, as well as how to implement compensations and habilitative/rehabilitative therapy techniques.
How to educate and counsel individuals with swallowing and/or feeding problems and their parents, care providers, or other supporting persons.
Importance of quality of life issues as they relate to the individual and the individual's family.
Ability to identify and use appropriate functional outcome measures.
Understanding of medical issues related to swallowing and feeding disorders.
The specific knowledge and skills required to meet these basic competencies are presented in detail in the remainder of this document.
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Aspiration: entry of secretions, food, or any foreign material into the airway that travels below the level of the true vocal folds. Aspiration may occur before, during, or after the pharyngeal phase of swallowing. It can also occur from reflux of gastric contents.
Bolus: food, liquid, or other material placed in the mouth for ingestion.
Dysphagia: a swallowing disorder. The signs and symptoms of dysphagia may involve the mouth, pharynx, larynx, and/or esophagus.
Enteral Feeding: Delivery of hydration and nutrients anywhere along the gastrointestinal tract.
Feeding Disorder: disordered placement of food in the mouth; difficulty in food manipulation prior to initiation of the swallow, including mastication; and the oral stage of the swallow when the bolus is propelled backward by the tongue. In pediatrics, this term may be used to describe a failure to develop or demonstrate developmentally appropriate eating and drinking behaviors.
Ingestion/Swallow: refers to all processes, functions, and acts associated with bolus introduction, preparation, transfer, and transport.
Management: involves all aspects of evaluation, treating, counseling, and discharge planning.
Oral Intake: placement of food in the mouth; oral gestures used to prepare food for the swallow and gain pleasure from eating; and, tongue movement to initiate the oral stage of the swallow. This sometimes also refers to the amount of food or liquid the individual is able to take in by mouth.
Parenteral Feeding: Administration of nutrients via a vein. Can be through a central vein (total parenteral) or through a peripheral vein (peripheral parenteral).
Team: collection or representation of different disciplines or specialists. May be multidisciplinary, interdisciplinary, or transdisciplinary as approach to assessment and management of complex patients with swallowing and feeding disorders.
Treatment Strategy: Examples: Habilitative/rehabilitative techniques include exercises and movements designed to change swallowing physiology. Compensation strategies impose alteration in behavior (posture, rate), bolus characteristics (volume, consistency) to achieve functional swallowing. These strategies are not intended to alter swallow physiology.
Upper Aerodigestive Tract: the region involved in swallowing and breathing that includes the oral cavity, oropharynx, pharynx, larynx, upper trachea, and upper esophagus.
American Speech-Language-Hearing Association. (1997). Preferred practice patterns for the profession of speech-language pathology. Rockville, MD: Author.
American Speech-Language-Hearing Association. (1999). Code of ethics of the American Speech-Language-Hearing Association. Rockville, MD: Author.
American Speech-Language-Hearing Association. (1990). Knowledge and skills needed by speech-language pathologists providing services to dysphagic patients/clients. Asha, 32(Suppl.2), 7–12.
American Speech-Language-Hearing Association. (2001). Scope of practice for speech-language pathology. Rockville, MD: Author.