By: Nancy B. Swigert*, M.A., CCC-SLP, BCS-S
[Editor’s note – We asked Ms. Swigert to write this article in response to the inquiries we receive weekly from people who feel they have been pushed aside by their physician when searching for assistance with a swallowing issue. There is a common set of themes… my doctor doesn’t believe me, he doesn’t see anything wrong (it’s in your head; have you seen a psychiatrist), and he can’t refer me to someone who might help. Although not every swallowing disorder can be addressed; there are science-based assessment tools and therapeutic techniques that can alleviate many swallowing issues. This article is a resource to help you find a clinician who is right for you.]
If you or your loved one has a swallowing problem, you may have experienced frustration as you looked for the right person to help. Often, the first call should be to a speech-language pathologist (SLP), but not just any speech-language pathologist. Because speech—language pathologists have a wide scope of practice, not every speech-language pathologist knows about swallowing.
Speech-language pathologists have at least a master’s degree and provide evaluation and treatment for all types of communication disorders in addition to swallowing disorders. They have the education and training, for example, to see a preschool child whose speech is difficult to understand, an adult whose ability to communicate was affected by a stroke, a school-age child who stutters, an adult who sings professionally whose voice is now too hoarse to sing. These are just a few of the types of communication disorders SLPs treat.
Not all speech-language pathologists have experience in helping adults or children with swallowing disorders. How, then, do you find the right speech-language pathologist? There are speech-language pathologists who have gone through a rigorous process of becoming board-recognized specialists in swallowing and swallowing disorders. This distinction is granted by the Specialty Board for Swallowing and Swallowing Disorders, a board created by the American Speech-Language-Hearing Association (ASHA). ASHA is a national professional, scientific, and credentialing association with more than 166,000 audiologists, speech-language pathologists, speech, language, and hearing scientists, audiology and speech-language pathology support personnel, and students.
To be eligible to apply as a swallowing specialist, the SLP must have worked at least four years since obtaining their SLP master’s degree and must demonstrate that many of those hours were spent in treating individuals with swallowing disorders. In addition to submitting documentation that substantiates their focus in treating patients with swallowing disorders, they must have 75 hours of continuing education related to swallowing. Plus, they must demonstrate that they have excelled in at least one of the following areas: education/mentorship (e.g. teaching courses in swallowing, training new staff); leadership (e.g. developing a dysphagia program at their facility; serving in a leadership role on a committee); research (e.g. participating in clinical research on swallowing). They must submit three letters of reference attesting to these advanced skills.
If their application is accepted, they are eligible to sit for an examination that tests their knowledge of: cranial nerves and the central nervous system control of swallowing, evidence of various intervention strategies and rehabilitative techniques and diagnostic procedures. The exam also tests the ability to integrate information to plan care for patients. If they pass the test, they are granted specialty recognition by the Board for a period of five years. Then the specialist has to re-apply, again demonstrating that they are spending the required number of hours with patients, have continued their leadership, education and/or research endeavors, and have continued to take continuing education related to swallowing (approximately 25 hours/year).
These SLPs are recognized with the designation BCS-S (Board Certified Specialists in Swallowing and Swallowing Disorders) and can be found on the Board’s web site at www.swallowingdisorders.org. Each board recognized specialist will indicate in their profile if they specialize in working with children and/or adults. They may also indicate if they specialize in working with patients who have a swallowing disorder due to an underlying adverse health event (e.g., stroke, cancer, neurologic). They will list their location, contact information, and in most instances the medical institution with whom they are affiliated. With only one-tenth of one percent (.1%) of ASHA’s membership having earned a BCS-S designation, it’s important when seeking help to find the individual most likely to provide the relief desired.
The speech-language pathologist will assess the swallowing problem and make recommendations for further evaluations that might be needed. For example, the SLP might suggest a visit to a medical specialist (e.g. otolaryngologist, gastroenterologist, neurologist), They might also suggest more in-depth testing of the swallow using specialized tests like a modified barium swallow or an endoscopic exam. They can develop a plan of care and provide therapy as needed.
Many insurance companies will cover the evaluation and treatment services. The speech-language pathologist can help you figure out the specifics of your plan.
*In addition to Nancy Swigert’s many accomplishments and long term commitment to this field of research and treatment, she is the current Board Chair of the Specialty Board on Swallowing and Swallowing Disorders. She is also on the Medical Advisory board of the National Foundation of Swallowing Disorders.