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Organic and neurogenic disorders are on the rise due to two key reasons. The first is an aging population resulting in a vast number of elderly. The elderly are more susceptible to diseases and illnesses such as strokes, hearing loss, and dementia which can lead to a variety of communication related disorders. The second factor is the new technology available today that allows very ill infants to live when they once would have died at birth or soon after. These infants however are very much at risk for many difficulties later in life including communication disorders. The effects of these disorders, for many of these individuals, can be significantly minimized by receiving health and communication services. All of these individuals, the elderly and the once medically fragile newborns will need to seek services in a variety of settings including hospitals, schools, and in the home. These are only a few factors helping to broaden the scope of practice for speech and language pathologists. In fact, in 11, the number of people in the United States affected by communication disorders reached nearly 4 million. Every year 6 million of these cases are due to neurological conditions. Nearly 1.5 million of these were related to strokes. Dementia is the cause in almost 10% of all the cases of the population of those 65 and over and nearly 80% of those individuals who are 85 and older.
Other reasons the scope of clinical practice for speech and language pathologists has greatly expanded are the various technical and theoretical advances that have been made. This expansion includes sophisticated instrumentation to analyze and examine physiological and acoustic elements of communication. These advances broaden the scope of practice in various ways. Such advances include video fluoroscopy which aids in assessing and treating those adults and children who have dysphasia, stroboscopic endoscopy is used to examine normal and disordered vocal fold functions, and Positron Emission Tomography and Magnetic Resonance Imaging are two types of brain imaging techniques that help in examining neural networks and processing language in context.
In the last twenty years there have also been various legal mandates that have helped to shape the nature of service delivery, the type of patient receiving service, and the setting where these services are provided. There are several federal legislations relating to the provision of basic educational services to children with disabilities. The Education for all Handicap Children Act, PL 4-14 went into effect in 175. This act entitles every child in the US a free public education and requires that it is at a level that compliments the child's level of development. This mandate affects all children including those who are handicapped or developmentally delayed from the age of to 1. The scope includes those individuals with speech and language impairments. Each child is to be placed in the "least" restrictive environment and provided any and all of the additional related services required for them to receive benefit from their education. The Educational of the Handicapped Amendment, PL -457, was signed in 186 to provide services for handicap children and those at risk for developmental delay age birth to . States who serve these children are offered assistance through this amendment. PL 101-476 amended PL 4-14 by adding two new categories. These were psychiatric disorders and brain trauma. In the amendment the term "handicapped children" was also changed to "children with disabilities." The American with Disabilities Act of 10 was designed to offer individuals with disabilities protection from discrimination. The purpose of the ADA is to mandate the mainstreaming of these individuals into societal and economic settings. Through this the federal government becomes responsible for enforcing the standards addressing discrimination against such individuals.
Speech and language pathologists serve to assist a variety of organic and neurogenic disorders that can affect a wide range of ages. Early intervention had broadened to include the services of speech-language pathologists in such capacities as feeding therapy and intervention for those who are at risk of possible developmental delay. In the public and private school settings therapists serve as a part of an educational team who see a variety of students such as those who are medically fragile, those at risk for delay, those with autism, those with severe handicaps and hearing losses among many others. Services also include the acute care setting. These services include assessment and short term treatment for patients with such problems as head trauma, stroke, and laryngectomies. In this type of setting the family in usually included in the counseling. Long term rehabilitation centers also enlist the services of speech and language pathologists. The goal is to maximize the patient's communication and help them in readjustment to society.
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