Knowledge and Skills Needed by Speech-Language Pathologists Providing Services to Individuals With Swallowing and/or Feeding Disorders

1.0 Role: Identification of individuals at risk for swallowing and/or feeding disorders.

Knowledge:

• 1.a. Knowledge of normal anatomy, physiology, and pathophysiology of swallowing in a developmental framework across the age continuum;

• 1.b. Knowledge of the medical diagnoses, language skills, and mental status characteristics contributing to swallowing and/or feeding disorders across the age continuum;

• 1.c. Knowledge of nutritional intake methods (oral and nonoral) and the problems associated with each that may contribute to dysphagia or be exacerbated by dysphagia;

• 1.d. Knowledge of signs and symptoms of swallowing and/or feeding disorders in the individual's behavior, medical history, and medical status;

• 1.e. Knowledge of methods of communicating results of dysphagia screening and/or need for swallowing and feeding assessment to individual and care providers; and

• 1.f. Knowledge of assessment strategies for use with individuals with swallowing and/or feeding disorders.

Skills:

• 1.1 Recognize signs and symptoms of swallowing and feeding disorders;

• 1.2 Train caregivers to identify the presence of dysphagia and refer for swallowing and/or feeding assessment;

• 1.3 Identify cognitive, communication, behavioral, and psychological factors contributing to swallowing and/or feeding status; and

• 1.4 Determine current nutritional intake (e.g., positioning, feeding dependency, environment, diet modification, compensations).

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2.0 Role: Conduct a clinical examination of the upper aerodigestive tract.

Knowledge:

• 2.a. Knowledge of normal upper aerodigestive tract structure;

• 2.b. Knowledge of normal upper aerodigestive tract function;

• 2.c. Knowledge of significance and implications of abnormal findings as they relate to swallowing and/or feeding;

• 2.d. Knowledge of strengths and limitations of the clinical examination, specifically with regard to detecting aspiration and risks for aspiration and determining treatment strategies for pharyngeal swallowing disorders;

• 2.e. Knowledge of how to provide documentation that is concise, thorough, objective, and interpretive; and

• 2.f. Knowledge of any special medical condition (e.g., pulmonary dysfunction, tracheostomy, neuromotor involvement) that may have an impact on an individual's feeding and swallowing.

Skills:

• 2.1 Identify abnormal structure;

• 2.2. Identify abnormal function;

• 2.3 Identify significant signs, symptoms, medical conditions, and medications pertinent to dysphagia;

• 2.4 Conduct an oral, pharyngeal, laryngeal, and respiratory function/expiration examination as it relates to functional assessment of swallowing and feeding;

• 2.5 Interpret examination findings;

• 2.6 Document of examination findings; and

• 2.7 Communicate examination findings to individuals, caregivers and other professionals.

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3.0 Role: Conduct instrumental examination.

Knowledge:

• 3.a. Knowledge of existing instrumental techniques, including their advantages and limitations;

• 3.b. Knowledge of the variability of normal swallowing behaviors (e.g., bolus volume, viscosity, age, or gender);

• 3.c. Knowledge of techniques to modify sensory input that can be introduced during the instrumental assessment(s) to ensure a reliable and valid examination; and

• 3.d. Knowledge of how to provide documentation of results that is concise, thorough, objective, and interpretive, and involves other professionals as appropriate.

Skills:

• 3.1 Identify available and appropriate testing resources (e.g., equipment, personnel);

• 3.2 Recommend appropriate instrumentation techniques when indicated.

• 3.3 Perform appropriate instrumental assessments according to protocols used by various facilities.

• 3.4 Interpret instrumental assessment;

• 3.5 Document instrumental assessment; and

• 3.6 Communicate results of instrumental assessment to individuals, caregivers and other professionals.

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4.0 Role: Determination of individual's management decisions regarding methods of oral intake; risk precautions and candidacy for intervention.

Knowledge:

• 4.a. Knowledge of oral versus nonoral (e.g., parenteral and enteral) intake methods and medical risks;

• 4.b. Knowledge of existing treatment procedures;

• 4.c. Knowledge of advances in treatment procedures and potential application from other fields;

• 4.d. Knowledge of appropriateness and safety for specific intervention procedures;

• 4.e. Knowledge of ethical and quality of life issues to incorporate into decisions concerning swallowing and/or feeding management;

• 4.f. Knowledge of cognitive, communication, behavioral, psychological, cultural, and social issues that may impact swallowing and/or feeding;

• 4.g. Knowledge of the status of various medical conditions causing swallowing and/or feeding disorders and their impact on recovery, maintenance of skills, or deterioration of function.

• 4.h. Knowledge of documentation procedures; and

• 4.i. Knowledge of roles of appropriate support personnel and services.

Skills:

• 4.1. Identify acceptable and appropriate oral intake methods;

• 4.2. Develop intervention strategies appropriate to individual's medical condition, swallowing and/or feeding disorder, cognitive status and behavioral status;

• 4.3. Identify potential risks of aspiration and appropriate precautions to minimize those risks;

• 4.4. Identify measurable short- and long-term treatment goals targeting functional outcomes;

• 4.5. Document management decisions and changes in decisions over time; and

• 4.6. Identify relevant support personnel services and skills in accessing, educating, and utilizing support personnel and referral services.

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5.0 Role: Provide treatment for individuals with swallowing and feeding disorders.

Knowledge:

• 5.a. Knowledge of principles and procedures pertaining to learning and behavior modification;

• 5.b. Knowledge of the anatomy and physiology of the individual's swallowing and/or feeding disorder appropriate to age and/or developmental stage;

• 5.c. Knowledge of the individual's cognitive, communication, behavioral, psychological, cultural, and social issues;

• 5.d. Knowledge of treatment strategies described in the literature including habilitative/rehabilitative techniques and compensatory strategies;

• 5.e. Knowledge of techniques to quantify change in swallowing performance and/or feeding behaviors;

• 5.f. Knowledge of outcomes data collection methods and tools;

• 5.g. Knowledge of appropriate diet choices at various points in treatment; and

• 5.h. Knowledge of different methods of food and liquid presentation, including utensils, and their impact on feeding and/or swallowing.

Skills:

• 5.1 Consult with registered dietitian concerning oral intake;

• 5.2 Identify the individual's need for habilitative/rehabilitative treatment of swallowing and feeding management;

• 5.3 Interpret the individual's response to treatment;

• 5.4 Quantify the individual's response to treatment;

• 5.5 Apply learning and behavior modification procedures;

• 5.6 Collect outcomes data for comparison to benchmark;

• 5.7 Communicate the individual's progress/status in treatment;

• 5.8 Revise treatment when appropriate;

• 5.9 Identify the individual's need for re-evaluation; and

• 5.10 Determine criteria for discharge/dismissal from treatment.

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6.0 Role: Additional knowledge and skills in assessment and management of swallowing and feeding problems in infants and young children.

Knowledge:

• 6.a. Knowledge of embryology, anatomy, swallowing physiology, and neurophysiology, as well as postural and sensory bases underlying swallowing and feeding in a developmental framework;

• 6.b. Knowledge of etiologies (e.g., genetic syndromes, brain injury, metabolic disorders, gastrointestinal tract disorders that affect premature and term infants) that cause or contribute to swallowing and feeding disorders;

• 6.c. Knowledge of nutrition and consequences of undernutrition in the first 2 years of life and throughout childhood;

• 6.d. Knowledge of medical tests and procedures as they affect swallowing and feeding;

• 6.e. Knowledge of pulmonary implications and complications resulting from aspiration;

• 6.f. Knowledge of dehydration implications and complications resulting from dehydration; and

• 6.g. Knowledge of infant and early childhood development as it relates to parent-child interactions and communication.

Skills:

• 6.1 Recognize signs and symptoms of suck, swallow, and respiratory organization and disorganization;

• 6.2 Demonstrate understanding of etiologies in discussions with parents and other professionals and incorporate into the case history;

• 6.3 Demonstrating nutrition knowledge by incorporating information into the case history, communicating with team members, and making appropriate referrals;

• 6.4 Demonstrate awareness of risks for aspiration consequences through management decisions that do not place infants and young children with complex dysphagia issues at increased health risks;

• 6.5 Identify and interpret cognitive and communication levels of function as a basis for management decisions in a holistic approach to the child's environment;

• 6.6 Perform instrumental assessment appropriate for the specific age and developmental level of the infant/child;

• 6.7 Interpret instrumental assessment with regard to appropriate developmental milestones; and

• 6.8 Carry out treatment for swallowing and feeding disorders appropriate for the specific age of the infant/child.

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7.0 Role: Provide education, counseling, and training to individual with a swallowing and/or feeding disorder, family, significant others, dysphagia team, health and education professionals.

Knowledge:

• 7.a. Knowledge of principles of instruction;

• 7.b. Knowledge of counseling principles; and

• 7.c. Knowledge of behavior modification principles.

Skills:

• 7.1 Identify educational and training needs;

• 7.2 Provide educational and training programs;

• 7.3 Adjust content and delivery to the level of the person being educated, counseled, or trained;

• 7.4 Develop in-service educational programs;

• 7.5 Provide counseling regarding swallowing and/or feeding disorders;

• 7.6 Provide advocacy for individuals with swallowing and/or feeding disorders;

• 7.7 Instruct non-speech-language pathology staff and other caregivers in treatment techniques, problem solving, and monitoring of the status of the individual with a swallowing and/or feeding disorder;

• 7.8 Document education, counseling, and training provided; and

• 7.9 Evaluate teaching effectiveness.

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8.0 Role: Manage and/or participate in swallowing and/or feeding team.

Knowledge:

• 8a. Knowledge of the roles and responsibilities of team members in management of individuals with swallowing and/or feeding disorders;

• 8.b. Knowledge of the specialized expertise of interdisciplinary team members pertinent to evaluation and treatment of individuals with swallowing and/or feeding disorders;

• 8.c. Knowledge of techniques or processes in effective facilitation and maintenance of team communication and interaction;

• 8.d. Knowledge of team management and service delivery models;

• 8.e. Knowledge of specialized consultation needs and procedures for referral;

• 8.f. Knowledge of appropriate methods of documentation that delineate team decisions and recommendations;

• 8.g. Knowledge of data and procedures that administrators need so they can support a swallowing and/or feeding team (e.g., cost accounting and productivity factors); and

• 8.h. Knowledge of basic management and administrative procedures.

Skills:

• 8.1 Identify core team members and supportive services;

• 8.2 Facilitate team communication;

• 8.3 Maintain team focus, communication, and interaction;

• 8.4 Document team activity; and

• 8.5 Use appropriate consultation procedures to and from other team members and other services.

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9.0 Role: Maintain quality control/risk management program.

Knowledge:

• 9.a. Knowledge of quality improvement policies established by accrediting bodies;

• 9.b. Knowledge of institution-specific risk management policies and procedures;

• 9.c. Knowledge of appropriate performance indicators that are evidence-based with focus on outcomes for quality improvement program development;

• 9.d. Knowledge of methods used for measuring and monitoring quality improvement goals and processes;

• 9.e. Knowledge of processes for resolution of identified problems that include collaborative team efforts;

• 9.f. Knowledge of infection control procedures;

• 9.g. Knowledge of risks and consequences of aspiration;

• 9.h. Knowledge of causes of and precipitating factors for aspiration;

• 9.i. Knowledge of ways to reduce risk of aspiration;

• 9.j. Knowledge of ASHA 's Code of Ethics and Scope of Practice for the Profession of Speech-Language Pathology;

• 9.k. Knowledge of institution-specific policies and procedures concerning professional liability;

• 9.l. Knowledge of professional and institution-specific documentation policies and procedures; and

• 9.m. Knowledge of patient safety measures and universal precautions as pertinent to specific setting and institution guidelines (e.g., CPR, suctioning, radiation safety).

Skills:

• 9.1 Identify quality improvement indicators that are appropriate to meet requirements or standards for specific accrediting bodies;

• 9.2 Perform systematic measurements and monitoring of quality improvement indicators;

• 9.3 Resolve identified problems that include collaborative team efforts;

• 9.4 Identify and communicate risk factors to individuals, family, and team members;

• 9.5 Utilize appropriate risk management procedures (e.g., resolution of identified risk factors, routine revision of quality improvement monitors); and

• 9.6 Document quality improvement plans, goals, and processes for reaching desirable outcomes.

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10.0 Role: Provide discharge/dismissal planning and follow-up care.

Knowledge:

• 10.a. Knowledge of discharge criteria;

• 10.b. Knowledge of discharge needs, how to establish a team-oriented discharge plan, and coordinate required services;

• 10.c. Knowledge of determining criteria for follow-up care and establishing policies and procedures to meet identified needs;

• 10.d. Knowledge of appropriate documentation of discharge criteria, discharge plan, and follow-up care; and

• 10.e. Knowledge of how to access team recommendations pertinent to follow-up care and procedures for swallowing and/ or feeding disorders and developing procedures for implementation.

Skills:

• 10.1 Identify discharge/dismissal criteria;

• 10.2 Identify discharge needs for patient and care providers;

• 10.3 Participate in team-oriented discharge planning;

• 10.4 Identify need for follow-up care, including frequency of treatment monitoring and/or re-evaluation; and

• 10.5 Document discharge criteria, discharge plan, and follow-up care.

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11.0 Role: Teach and supervise persons, clinical fellows, supportive personnel, and students-intraining.

Knowledge:

• 11.a. Knowledge of previous coursework and current proficiency of the trainee;

• 11.b. Knowledge of education principles;

• 11.c. Knowledge of supervision principles;

• 11.d. Knowledge of requisite documentation requirements; and

• 11.e. Knowledge of methods of evaluating trainee performance.

Skills:

• 11.1 Identify education and clinical training needs;

• 11.2 Apply education techniques;

• 11.3 Provide supervision;

• 11.4 Document teaching and supervision; and

• 11.5 Evaluate teaching effectiveness.

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12.0 Role: Provide public education and advocacy for serving individuals with swallowing and/or feeding disorders.

Knowledge:

• 12.a. Knowledge of public education sources and procedures for increasing awareness of groups with special needs;

• 12.b. Knowledge of available education resources designed to assist pertinent education and advocacy positions; and

• 12.c. Knowledge of advocacy, legal, and regulatory procedures that affect the needs of individuals with swallowing and/or feeding disorders; and

• 12.d. Knowledge of funding sources pertinent to swallowing and/or feeding disorders.

Skills:

• 12.1 Demonstrate skills in methods for public education and advocacy regarding the needs of individuals with swallowing and/or feeding disorders;

• 12.2 Provide testimony to various governmental, regulatory, and educational agencies; and

• 12.3 Provide assistance in obtaining funding for services from appropriate sources.

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13.0 Role: Conduct research.

Knowledge:

• 13.a. Knowledge of existing literature in normal and disordered swallowing and/or feeding;

• 13.b. Knowledge of research design:

• 13.c. Knowledge of appropriate methods for protecting human and animal subjects and obtaining informed consent;

• 13.d. Knowledge of accurate data collection techniques;

• 13.e. Knowledge of procedures for statistical analyses and interpretation; and

• 13.f. Knowledge of scientific writing for dissemination of research findings.

Skills:

• 13.1 Obtain and interpret literature;

• 13.2 Develop and apply research design;

• 13.3 Collect data;

• 13.4 Skills in procedures for statistical analysis; and

• 13.5 Skills in writing dissemination of research findings.