Indian Speech and Hearing Association Scope of Practice in Audiology & Speech-Language Pathology Statement of Purpose This document, drafted by the Indian Speech Language and Hearing Association (ISHA), provides a description of the scope of practice for the health care profession of Audiology and Speech-Language Pathology in India, and highlights the wide range of services provided by the profession. The document is intended to delineate areas of practice for Audiologists and Speech-Language Pathologists, and to serve as a resource for health care professionals, regulatory bodies, Government agencies, educators, consumers and the general public. It serves as a reference for issues concerning service delivery, man power development, employment, third-party reimbursement, legislation, consumer education, regulatory action, professional licensure and inter-professional relations. This document is intended to provide guidance for the development of curricula for educational programs in Audiology and Speech- Language Pathology, and help the practicing Audiologists and Speech-Language Pathologists with their own professional development. This document encompasses the scope of practice for the field of Audiology and Speech-Language Pathology as the undergraduate degree program in India includes an integrated program leading to independent practice of Audiology and/or Speech-Language Pathology. The scope of practice in Audiology and Speech-Language Pathology in India is consistent with the dimensions of the International Classification of Functioning Disability and Health (ICF) prescribed by the World Health Organization (WHO, 2001) and guidelines of the United Nations Convention on Rights of Persons with Disabilities (United Nation, 2006). The practice activities provided in this document are not intended to constitute an exhaustive list and are undertaken by Audiologists and Speech Language Pathologists as part of an interdisciplinary team. Periodic revisions of this document shall be made as and when necessitated. Practice activities that are related to emerging clinical, technological and scientific developments would be considered as part of the scope of practice of an Audiologist and Speech-Language Pathologist. An Audiologist and Speech-Language Pathologist may or may not practice all the activities provided in the document. It is recognized that individual professionals may limit their practice by type of disorder or age group. Additionally, professionals may have the expertise to provide services that do not appear in this document. Audiologists and Speech-Language Pathologists are ethically bound to provide services that are consistent with the scope of their individual training, competence and experience. As laid down in the memorandum of understanding of the Indian Speech and Hearing Association (ISHA, 2007; article 28: section a, b, c), Audiologists and Speech-Language Pathologists shall recognize the limits of their competence and strive to continually update and extend their professional knowledge and skills by attending the Continuing Education Program (CEP), conventions either regional, national and /or international, seminars, workshops and other professional development programmes. Definition An Audiologist and Speech Language Pathologist belongs to an integrated health care profession in India. Page 1 of 7
An Audiologist is a qualified professional who provides a comprehensive array of professional services related to the identification, diagnosis and management of persons with auditory (peripheral and central disorders), balance and related disorders, and the prevention of these impairments. A Speech-Language Pathologist is a qualified professional who provides a comprehensive array of professional services related to the identification, diagnosis and management of persons with communication and swallowing disorders. Speech-Language Pathologists are involved in a number of different activities to promote effective communication and swallowing for the individuals they serve and prevent disorders of communication and swallowing. An Audiologist and Speech Language Pathologist is an independent professional such that his/her services and activities are not prescribed or supervised by another professional. However, he/she often collaborates with other professionals for provision of services. Educational Requirements/ Qualifications Audiologists and Speech-Language Pathologists complete an undergraduate and/or postgraduate degree in the field of Speech, Language and Hearing from a recognized university from India or abroad. The postgraduate and doctoral programmes include a provision for integrated program in Audiology and Speech-Language Pathology as well as specialization either in Audiology or Speech-Language Pathology. Individuals who have completed training in the integrated program of Audiology and Speech-Language Pathology at the undergraduate level and/or post graduate level in India may practice as Audiologists and/or Speech Language Pathologists. In addition to affiliation to recognized universities, the institutions providing the degree program in India are recognized by the Rehabilitation Council of India (RCI; A statutory body under the Ministry of Social Justice and Empowerment, Government of India, New Delhi). Presently registration of professionals with RCI after completion of the degree program, entitles the professionals to practice their profession in any part of India (www.rehabcouncil.nic.in). Professional Roles and Responsibilities The Audiologist and Speech-Language Pathologist provide a broad range of services and related activities including the following: Clinical Services Prevention and Advocacy Research, Training and Manpower development Administration Clinical Services Audiologists and Speech Language Pathologists provide clinical services to individuals across the entire life span from birth through adulthood and old age, belonging to diverse languages, ethnic, cultural, and socioeconomic backgrounds. The clinical services are listed below for Audiology and Speech-Language Pathology individually. Page 2 of 7
Clinical Services: Audiology Clinical and/or instrumental screening, assessment, identification, diagnosis and management of: Hearing disorders in infants, children, adults and geriatrics involving both peripheral and central pathways of hearing Tinnitus, hyperacusis and Balance disorders. To deliver the above clinical services, behavioral, psychoacoustic, and electrophysiological measures related to the peripheral and central auditory systems may be used. Assessment of the vestibular system includes administration and interpretation of behavioral and electrophysiological tests of balance. Assessment, selection, dispensing, validation, verification and servicing of individual amplification devices and ear moulds. The individual amplification devices include individual hearing aids (analogue and digital hearing aids), implantable devices (cochlear implant and brainstem implant), boneanchored devices and frequency altering devices. Assessment, selection and development of other appropriate hearing assistive devices and (re)habilitation regimes for individuals with hearing impairment, balance dysfunction, tinnitus and/or related disorders. The devices include assistive technology such as FM systems, induction loop systems, tinnitus maskers, tinnitus treatment devices, etc. Rehabilitation regimes include adult and child aural (re)habilitation, speech reading, tinnitus re-training, vestibular (re)habilitation, etc. Intraoperative monitoring. Medical legal consultation. Clinical Services: Speech-Language Pathology Speech-language pathologists provide services to children (from neonates through to school age), adolescents, adults and geriatrics with special needs in the areas of communication and swallowing. The clinical services include, but are not limited to the following: Clinical and/or instrumental screening, assessment, identification, diagnosis, treatment, and management of Speech sound production delays and disorders including articulation disorder, phonological disorder, apraxia of speech, and dysarthria Language delays and disorders including comprehension and expression in verbal and/or nonverbal modalities Fluency disorders including normal non fluency, stuttering and cluttering Voice disorders including disorders of phonation quality, pitch, loudness and respiration Resonance disorders including hypernasality, hyponasality and cul-de-sac resonance and mixed resonance Swallowing and feeding disorders Cognitive-communicative disorders including disorders of social communication skills, attention, memory, reasoning, sequencing, problem solving, and executive functions Page 3 of 7
Pre-literacy and literacy skills including phonological awareness, decoding, reading, comprehension, and writing Communication and swallowing disorders in the context of other diagnoses or impairments including but not limited to hearing impairments, traumatic brain injury, dementia, developmental, intellectual or genetic disorders, and neurological impairments Development, assessment and selection of augmentative and alternative communication systems including unaided and aided strategies for individuals who have limited in their ability to communicate verbally, and provision of education and training in their use. Selecting, fitting, and establishing effective use of prosthetic/adaptive devices for communication and swallowing such as tracheoesophageal prostheses, speaking valves, electrolarynx, etc. Medical legal consultation Modifications or improvement of speech and language proficiency and communication effectiveness such as, care and improvement of professional voice. In addition to providing the above clinical services, Audiologists and Speech Language Pathologists are involved in certification of disabilities related to speech, language and hearing, consult with and provide referrals to other professionals as well as coordinate service delivery in collaboration with other professionals. Prevention and Advocacy Screening for hearing, speech and language development for the initial identification of neonates (newborn screening), children (school screening) and individuals with communication disorders requiring detailed assessment and/or referral to other professionals. Prevention, counseling and education services to clients, families, caregivers, other professionals and the public regarding all aspects of hearing and balance function. Promotion, prevention, counseling, and education services to clients, families, caregivers, other professionals, and the public regarding all aspects of speech, language, communication, and disorders of communication and swallowing. Advocacy on behalf of persons with hearing loss, balance dysfunction, tinnitus, and related disorders and individuals who are at risk. Advocacy on behalf of persons with communication and swallowing disorders, and those who are atrisk. Promotion of hearing health. Prevention of hearing disorders in children and adults by conducting appropriate hearing conservation and noise management programs in schools and industries. This also includes selection, counseling and monitoring of the use of hearing protection devices such as ear muffs, ear plugs, etc. Page 4 of 7
Consultation, assessment and management of educational, workplace and other public acoustical environments. Consultation with government, industry and community agencies regarding improvements to noise legislation and implementation of environmental and occupational hearing conservation programs. Consultation with worker s compensation boards and relevant governmental bodies regarding criteria and determination of pension/benefits for individuals with hearing loss and related disorders. Recruiting potential Audiologists and Speech-Language Pathologists into the profession. Active participation in various professional organizations including ISHA to contribute to best practices in the profession. Research, Training and Manpower development Audiologists and Speech-Language Pathologists are involved in conducting basic and applied/translational research related to hearing, balance, communication sciences and disorders, swallowing, and other related disorders. Further they are involved in documentation and decimation of research by various means (e.g., publishing free and/or for a price, articles, books etc., both on-line and as hard copy). Audiologists and Speech-Language Pathologists serve as educators in University and/or college education and training programs related to hearing science and disorders as well as communication sciences and disorders and swallowing. Some of the activities include: Imparting education at undergraduate and postgraduate level, diploma and certificate programmes in the field of Audiology and/or Speech-Language Pathology. Educating, supervising, and mentoring current and future personal and professionals in the field of Audiology and Speech-Language Pathology. Framing syllabi, curricula, clinical modules and policies related to persons with Speech, Language and Hearing disorders. Developing policies, operational procedures, and professional standards in the field of Audiology and Speech-Language Pathology. Administration Audiologists and Speech-Language Pathologists are involved in administrative responsibilities ranging from managing clinics to academic institutions, involve in decision making process at government and non-government organizations. Administering and managing clinical programs. Administering and managing academic institutions running certificate, diploma, and degree programs at undergraduate and postgraduate levels in the field of Audiology and Speech-Language Pathology. Administration in Government (state and central) and non-governmental agencies and institutions related to disability in general and Audiology and Speech-Language Pathology in particular as per the directions of the agencies and institutions. Page 5 of 7
Practice Settings Audiologists and Speech-Language Pathologists work in a variety of settings, including but not limited to: Health care settings (including hospitals, clinics, nursing homes, medical rehabilitation centers, mental health facilities), Regular and special schools, Early intervention programs/ Multi disciplinary rehabilitation centers, Industrial settings, Hearing aid and cochlear implant manufacturers, Manufacturers of devices/prosthesis for individuals with communication and swallowing disorders, Universities/colleges and their clinics, Professional associations, State and central government agencies and institutions, Research centers, and Private practice settings References American Speech-Language-Hearing Association. (2007). Scope of Practice in Speech-Language Pathology [Scope of Practice]. Available from www.asha.org/policy. American Speech-Language-Hearing Association. (2004). Scope of Practice in Audiology [Scope of Practice]. Available from www.asha.org/policy. Canadian Association of Speech-Language Pathologists and Audiologist. (2008). Scope of Practice for Speech-Language Pathology (CASLPA) Ottawa. Canadian Association of Speech-Language Pathologists and Audiologist. (2008). Scope of Practice for Audiology (CASLPA) Ottawa. Indian Speech and Hearing Association. (2007). Memorandum of Association, amended edition, January 2007, Mysore. The Speech Pathology Association of Australia Limited (2003). Scope of Practice in Speech Pathology, Melbourne, VIC. World Health Organization. (2001). International classification of functioning, disability and health. Geneva, Switzerland Copyright 2011 Indian Speech and Hearing Association. All rights reserved. Reference this material as: Indian Speech and Hearing Association. (2011). Scope of Practice in Audiology & Speech-Language Pathology [Scope of Practice]. Disclaimer Page 6 of 7
The Indian Speech and Hearing Association disclaims any and all liability (including liability for negligence) to any party for the accuracy, completeness, or availability of this document, or for any damages arising out of the use of the document and the information provided. The Association recommends that you seek independent professional advice prior to making any decision involving matters outlined in this document. For further information contact Head office: Hon. Secretary The Indian Speech and Hearing Association All India Institute of Speech and Hearing, Manasagangothri Mysore- 570006 For current postal address contact: Email: secretary@ishaindia.org.in Website: www.ishaindia.org.in Page 7 of 7