Abstract
The aim of the study was to investigate the current practices, training, and concerns of a group of hospital-based speech therapists regarding the area of dysphagia practice. Questionnaires were posted to 75 speech therapists working in the major hospitals around Gauteng, Kwa-Zulu Natal and the Cape Province and responses were obtained from 50 therapists within the stipulated time. Closed-ended questions were analysed quantitatively using descriptive statistics, while open-ended items were subjected to content analysis of themes articulated by respondents. Results indicated that the overwhelming majority of the respondents were involved in assessing and treating dysphagia patients. Specific problems faced by respondents included limited staff to share their workloads, large caseloads, restricted access to supervision/mentor systems and poor knowledge by other health personnel of their role in dysphagia. Almost half of the respondents also reported that they were involved in student training which included the area of dysphagia. Investigation of respondents' undergraduate and postgraduate training in dysphagia suggested that there were gaps in the theoretical content of these courses as well as a limited focus on practical training. Another finding was that respondents showed an awareness of the specific roles of the speech therapist in dysphagia intervention as well as the roles of the professionals constituting a multidisciplinary dysphagia team. Most of the respondents reported that they had access to dysphagia team members as well as to diet modification services. However, many of the respondents showed decreased knowledge of and awareness regarding accessibility of diagnostic procedures and suctioning methods used in dysphagia. The majority of the respondents rated their knowledge about specific theoretical areas as well as their counselling abilities to be better than their actual skills and confidence in assessing and treating dysphagia patients. Implications of the study included the need for clinicians, universities and professional organizations to work together to improve the existing situation.
Highlights
Of all the areas of work of a speech-language pathologist (SLP), dysphagia constitutes the most prominent single area where improper management places patients at risk for physical impairment or even death (Cannito, 1995)
Both respondents did report attendance at continuing education courses and workshops, the exact level of this input could not be ascertained. This finding has serious implications as the Code of Ethics (SASLHA, 1997) clearly stipulates that SLPs should provide only those services for which they hold the appropriate qualification and for which they are competent by training
The results of this study suggest that many SLPs in South Africa may be involved in the area of dysphagia intervention
Summary
Of all the areas of work of a speech-language pathologist (SLP), dysphagia constitutes the most prominent single area where improper management places patients at risk for physical impairment or even death (Cannito, 1995). Speech Language Pathologists (SLPs) have been evaluating and managing patients with oropharyngeal dysphagia since the 1930s when clinicians began to work with patients whose oral motor control for speech and swallowing was compromised as a result of cerebral palsy. The involvement of SLPs in dysphagia has grown steadily, in the United States (Logemann, 1998). The 1993 ASHA Omnibus Survey (cited in Martin, 1995) revealed that approximately 60% of practising SLPs in health care settings throughout the United States were involved in dysphagia intervention. The role of the SLP has expanded beyond providing assessment and treatment to the overall management of the patient's nutrition and pulmonary health, thereby dealing with severe and complicated problems (Langmore, 1991)
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