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Meeting the Occupational Therapy and SpeechLanguage Pathology Needs of Patients in the 21st Century

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Title: Meeting the Occupational Therapy and SpeechLanguage Pathology Needs of Patients in the 21st Century


1
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

2
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.

3
OT on U.S. News and World Reports 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.

4
Best Careers of 2008
  • 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

5
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

6
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

7
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.

8
Domains of Occupational Therapy Practice
  • 5 General Service Provisions
  • Consultation
  • Education
  • Critical Inquiry
  • Administrative Services

9
Process Elements in Occupational Therapy
  • Examination
  • Evaluation
  • Diagnosis
  • Prognosis
  • Intervention
  • Outcome Measures

10
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

11
Occupational Therapy Evaluation
Occupational Profile
  • The initial step in the evaluation process that
  • provides an understanding of the clients
  • occupational history and experiences,
  • patterns of daily living, interests, values, and
  • needs. The clients problems and concerns
  • are about performing occupations and daily
  • life activities are identified, and the clients
  • priorities are determined.
  • -The AOTA OT Practice Framework Domain
    Process, 2002.-

12
Occupational Therapy Evaluation Analysis of
Occupational Performance
  • The step in the evaluation process during which
  • the clients 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.-

13
Occupational Therapy Evaluation Process Elements
  • Areas of Occupation
  • ADL self-care activities (bathe/dress/feed/toile
    t)
  • IADL home mgt (cook/clean/laundry), financial
    mgt, childcare, driving, shopping
  • Education
  • Work
  • Play/Leisure
  • Social Participation

14
Occupational Therapy Evaluation Process Elements
  • Performance Skills and Patterns
  • Motor Skills
  • Process Skills
  • Communication/
  • Interaction Skills
  • Habits
  • Routines
  • Roles
  • Contexts
  • Cultural
  • Physical
  • Social
  • Personal
  • Spiritual
  • Temporal
  • Virtual

15
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

16
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

17
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

18
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/

19
Speech Language Pathology

20
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.
  • Conduct research in human communication
    processes.
  • Supervise and direct clinical or public school
    programs.
  • Develop new SLP methods and products.

21
  • 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.

22
  • 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 Associations Health Care Conference,
    2007.

23
  • 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)

24
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.

25
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).

26
Alzheimers 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.-

27
  • The Number of People with AD, by Age Group, in
    Millions

  • -Alzeimers Assocoation-

28
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-

29
  • 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
    Associations Health Care Conference, 2007.

30
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-

31
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.

32
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-

33
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

34
  • 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
    Associations Health Care Conference, 2007.

35
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

36
Projected Growth Trend of equivalent Therapist
Category Fields in the U. S. -U.S. Dept of
Labor, Bureau of Labor Statistics-
37
Comparison of Therapist Category Disciplines
between U.S. Employment 2006 and USPHS CC
38
USPHS CC in Therapist Category and USPHS CC
in Clinical Billets
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