Meeting the Occupational Therapy and Speech-Language Pathology Needs of Patients in the 21st Century LCDR Jodi A. Tanzillo, OTR/L LT Erik Cala, MA, CCC-SLP
Goals • Identify areas of application for Occupational Therapy treatment. • Identify areas of application for Speech-Language Pathology treatment. • Identify pertinent demographic trends affecting the delivery of OT and SLP services.
OT on U.S. News and World Report’s List of “Best Careers 2008” • The career of occupational therapist has made U.S. News & World Report's list of 31 "Best Careers 2008." It also listed the job of an occupational therapy consultant as a "smart specialty." • In selecting the most promising careers, U.S. News considered job satisfaction, training difficulty, prestige, and job market outlook. • Factors that make occupational therapy such a promising career include the shortage of occupational therapists, an aging population, and general job satisfaction. U.S. News described the job of occupational therapist as a "challenging career that's best for creative, practical people who find satisfaction in small successes." • Occupational therapy also appeared on the "Best Careers" list in 2007.
Audiologist Biomedical equipment technician Clergy Curriculum/training specialist Dentist Editor Engineer Firefighter Fundraiser Genetic counselor Ghostwriter Government manager Hairstylist/cosmetologist Higher education administrator Investment banker Landscape architect Librarian Locksmith/Security system technician Management consultant Mediator Occupational therapist Optometrist Pharmacist Physician assistant Politician/Elected official Professor Registered nurse School psychologist Systems analyst Urban planner Usability/User experience specialist Best Careers of 2008
Domains of Occupational Therapy Practice • Directs the focus and actions of services • Patient/client-centered treatment that engages in meaningful, purposeful daily life activities • Utilize occupation to enable an individual to improve participation in ADLs
Domains of Occupational Therapy Practice #1 Services provided to those who have or are at risk to develop an: • Injury • Disease • Disorder • Impairment • Disability • Activity limitation • Participation restriction
Domains of Occupational Therapy Practice #2 Collaborative Process Model #3 Assessment of risk factors that impede optimal functioning. #4 Occupational Therapy services are provided for the purpose of promoting health and wellness.
Domains of Occupational Therapy Practice #5 General Service Provisions • Consultation • Education • Critical Inquiry • Administrative Services
Process Elements in Occupational Therapy • Examination • Evaluation • Diagnosis • Prognosis • Intervention • Outcome Measures
Process Elements in Occupational Therapy • Evaluation • Clinical judgments based on examination results • Determine current level of functional performance • Develop an Occupational Profile and Analysis of Occupational Performance that describes: • Patient/client occupational history • Patterns of daily living • Interests, values, needs, and priorities • Observe actual performance in context
Occupational Therapy Evaluation: Occupational Profile “The initial step in the evaluation process that provides an understanding of the client’s occupational history and experiences, patterns of daily living, interests, values, and needs. The client’s problems and concerns are about performing occupations and daily life activities are identified, and the client’s priorities are determined.” -The AOTA: OT Practice Framework: Domain & Process, 2002.-
Occupational Therapy Evaluation:Analysis of Occupational Performance “The step in the evaluation process during which the client’s assets, problems, or potential problems are more specifically identified. Actual performance is often observed in context to identify what supports performance and what hinders performance. Performance skills. Performance patterns, context or contexts, activity demands, and client factors are all considered, but only selected aspects may be specifically assessed. Targeted outcomes are identified.” -The AOTA: OT Practice Framework: Domain & Process, 2002.-
Occupational Therapy Evaluation Process Elements • Areas of Occupation: • ADL = self-care activities (bathe/dress/feed/toilet) • IADL = home mgt (cook/clean/laundry), financial mgt, childcare, driving, shopping • Education • Work • Play/Leisure • Social Participation
Performance Skills and Patterns Motor Skills Process Skills Communication/ Interaction Skills Habits Routines Roles Contexts Cultural Physical Social Personal Spiritual Temporal Virtual Occupational Therapy Evaluation Process Elements
Occupational Therapy Evaluation Process Elements • Activity Demands • Objects used and Their Properties • Space Demands • Social Demands • Sequencing and Timing • Required Actions • Required Body Functions • Required Body Structures • Patient/Client Factors • Body Functions • Body Structures
OT/PT Intervention Overlap • Therapeutic exercise • Gross motor coordination • Functional training in self-care, home, community, or work reintegration • Manual therapy techniques to include joint mobilization • Therapeutic massage • Prescription, application, and fabrication of assistive and adaptive orthotic, prosthetic, protective and supportive devices and equipment • Wound care and Debridement (mechanical, sharp, chemical) • Physical Agent Modalities (requires additional training) • Ergonomics • Patient related instruction
OT Specific Interventions • Functional training in self-care, child-care, home management, leisure, community, and work reintegration Activities of Daily Living (ADLs) • Energy conservation/work simplification (ECWS) and Ergonomic methods through personal and environmental adaptation • Therapeutic Activities • Fine Motor Coordination and handwriting • Communication and Assistive Technology • Neurological/Cognitive: memory, visual-perceptual, sensory integration, psychosocial skills • Mental health interventions • Driver Rehabilitation • Fall Prevention through environmental adaptation
Occupational Therapy References • American Occupational Therapy Association –AOTA- http://www.aota.org/ • Evidence-Based Occupational Therapy http://www.otevidence.info/ • OT Seeker http://www.otseeker.com/
What do Speech and Language Pathologists do? • Evaluate, Diagnose and Treat speech, language, cognitive-communication and swallowing disorders in individuals of all ages. In addition, speech-language pathologists may: • Teach in post-secondary programs. • Manage agencies, clinics, organizations, or private practices. • Conductresearch in human communication processes. • Supervise and direct clinical or public school programs. • Develop new SLP methods and products.
What are speech and language disorders? • Speech and language disorders affect one's ability to talk, understand, read, and write. Such disorders have different causes, and may range from a few speech sound errors to a total loss of the ability to communicate effectively.
“[Speech Language Pathologists] know how important clear communication is to health and wellbeing. [Speech Language Pathologists] see patients struggling to speak, to hear, to understand basic health information. … As communication professionals, [Speech Language Pathologists] have a tremendous relevance to what we do and how we do it.” RADM Ken Moritsugu, at the time Acting U.S. Surgeon General: Address to speech- language pathologists at the American Speech-Language Hearing Association’s Health Care Conference, 2007.
How many persons have speech and language disorders? • The prevalence of speech sound disorders in young children is 8-9%. By the first grade, roughly 5% of children have noticeable speech disorders; the majority of these speech disorders have no known cause. • Between 6 and 8 million people in the United States have some form of language impairment. • About one million people in the United States have aphasia (partial or complete impairment of language comprehension and expression caused by brain damage, most often from stroke). Approximately 80,000 individuals acquire aphasia each year. • It is estimated that more than 3 million Americans stutter. • Approximately 7.5 million people in the United States have a voice disorder. Voice disorders affect as much as 10% of the U.S. population. Source: National Institute on Deafness and Other Communication Disorders (NIDCD)
Speech • Fluency disorder • Articulation disorder • Voice disorder and Alternative forms of Phanation: esophageal speech, electrolarynx, etc. for individuals who have undergone a partial or total laryngectomy.
Language • 1. Form of Language • 2. Content of Language • 3. Function of Language Language disorders may include: • Impaired language development • Aphasia • Auditory processing disorders Cognitive-communication disorders • attention, • memory, • abstract reasoning, • awareness, and • executive functions (e.g., self-monitoring, planning and problem solving).
Alzheimer’s Disease • “Approximately 5 million Americans have AD, a number projected to be 14 million by 2050 unless a cure is found.” • “An estimated one-quarter of the 5 million affected persons at the end of the current decade will be members of racial or ethnic minority populations.” -Enwefa, Regina, Director/Coordinator of Preschool special Education Programs at Canton Public School and Enwafa, Stephen, Associate professor at Jackson State University.-
The Number of People with AD, by Age Group, in Millions -Alzeimer’s Assocoation-
Prison Population • Prevalence for Articulation and Fluency Disorders are comparable to the general population. –Belenchia & Crowe- • Incidence of deficient language skills is considerably greater than in non-institutionalized adult groups. – Bountress & Richards- • Language and Communication problems among female juvenile delinquents is approximately three times greater than for adolescents in the general population. –Sanger & Decker- • Approximately 66% of individuals have a Voice Disorder characterized by vocal abuse. –Sample & Montague; Belenchia & Crowe-
“[Speech Language Pathologists] help people across the lifespan to communicate. [They] help break down barriers in the community. They literally give them their voice and ability to hear. … As a discipline and as individual clinicians, [Speech Language Pathologists] dignify the lives of those whom we serve.” RADM Ken Moritsugu, then Acting U.S. Surgeon General: Address to speech- language pathologists at the American Speech-Language Hearing Association’s Health Care Conference, 2007.
Dysphagia • Oral Phase • Pharyngeal Phase • Esophageal Phase ********** • Prevalence of Dysphagia may be as high as 22% in those over 50 years of age. -ASHA- • 10 million Americans are evaluated each year with swallowing difficulties. -ASHA-
What else do speech-language pathologists do? • Accent modification for individuals without communication disorders. • Voice and Socio-Pragmatic modification for individuals who have undergone gender re-assignment surgery. • Voice maintenance and training for professional voice users.
Migrant Workers • Daily, about 500 Agricultural workers suffer lost-work-time injuries; about 5% of these result in permanent impairment. –National Center for Farm Worker Health, Inc.- • Most common principle diagnoses are upper respiratory infection, hypertension, dental disease, cancer and various ear disorders. –Rautiainen &Reynolds; Hansen & Donohoe; Dever- • Significantly elevated risk for lip cancer development within the farm worker population. –Khuder- • High prevalence of hearing loss and associated communication problems due to excessive noise exposure; Noise-related hearing impairment is the third most common occupational impairment recognized in agriculture. Karlovich, Wiley & Tweed; Hwang, et al.; Leszek-
List Resources of On-Line Resources: • American Speech-Language Hearing Association-ASHA http://www.asha.org/default.htm • Canadian Association of Speech-Language Pathologists and Audiologists/ Association Canadienne des Orthophonistes et Audiologistes – CASLPA-ACOA: http://www.caslpa.ca/ • Speech Language Pathology Web Sites: provides pointers to where you can find information in the field of Speech Language Pathology as opposed to providing the information itself: http://www.herring.org/speech.html
“Communication is at the core of what we do in the Public Health Service or the Commissioned Corps.” RADM Ken Moritsugu, then Acting U.S. Surgeon General: Address to speech- language pathologists at the American Speech-Language Hearing Association’s Health Care Conference, 2007.
Demographic Trends • Aging American Population • Survival Rate of Premature Infants/Trauma/CVA • Co-morbidity and Death Rates • Growth in Minority Populations • Poverty and Access to Health Care
Projected Growth Trend of equivalent Therapist Category Fields in the U. S. -U.S. Dept of Labor, Bureau of Labor Statistics-
Comparison of Therapist Category Disciplines between U.S. Employment 2006 and USPHS CC