Medical Speech-Language Pathology in Clinical Contexts: Environments, Patients, and Practice

Medical Speech-Language Pathology in Clinical Contexts: Environments, Patients, and Practice prepares graduate students and early career clinicians to navigate the complexity of today’s health care systems with confidence. This book equips readers with the practical knowledge and clinical reasoning skills needed to succeed in medical settings without relying on a disorder- or setting-specific approach.

Organized around four core pillars—the medical environment, systems, the patient experience, and the wise and effective medical SLP—this text emphasizes interdisciplinary collaboration and real-world clinical decision-making that is patient- and family-centered. From medical settings and reimbursement structures to pharmacology, respiration, nutrition, and neurology, readers gain a clear, integrated understanding of how speech, language, cognition, and swallowing are managed within complex medical contexts across the lifespan.

Featuring contemporary topics such as medical ethics, health care equity, cultural responsiveness, documentation, leadership, and career sustainability, this book reflects the realities of modern practice. Case studies, patient perspectives, and video content bridge theory and application, helping readers think and act like clinicians from day one.
Concise, practical, and forward-thinking, this text is an essential foundation for graduate medical speech-language pathology courses and for clinicians preparing to enter health care practice.

Key Features

• Unique systems-based approach rather than disorder- or setting-specific organization
• Comprehensive coverage of medical environments and interdisciplinary teams
• Integrated focus on speech, language, cognition, and swallowing across patient populations and the lifespan
• Dedicated content on medical ethics, autonomy, multicultural and multilingual care, and health care equity
• Practical guidance on documentation, clinical reasoning, leadership, and professional resilience

PluralPlus Online Ancillaries

For instructors: Instructor's Manual, PowerPoint Slides, Test Bank, Class Activities, Syllabus, Case Studies
For students: Quizzes, eFlashcards, Videos, Clinical Checklists, Links to Related Resources

Expanded Contents

Preface
Acknowledgments
Contributors
Dedication

Part 1: The Medical Environment

Chapter 1. The Landscape of Care in the Medical Environment
    Mary Beth Clark, Michele Knutson, Tania Riske, Taran Brody, Briana Kenyon, Bre Hansen, Hannah Meyer, and Kylie Recker
        Chapter Outline
        Chapter Overview
        General Patient Populations
            Dysphagia
            Speech, Language, and Cognitive-Communication Disorders
            Specialized Patient Populations
        Discharging to Home and to Rehabilitation
            Returning Home
            Common Rehabilitation Discharge Environments
            Specialized Discharge Environments
            Other Considerations for Post-Discharge
        The Interdisciplinary Team: What Is It, and Why Should We Use It?
        Billing and Reimbursement
            History and Types of Coding
            Payor Sources
            Putting It All Together—Reimbursement in the Daily Life of the SLP
        Social Determinants of Health
            Application of SDOH to Clinical Populations
            Leveraging Electronic Health Records Systems
        Conclusion
        References

Chapter 2. Communication in the Medical Environment
    Heidi Barthels, Kaylee Lanser, and Nicole Wakeman
        Chapter Outline
        Chapter Overview
        Documentation and Effective Writing in the Medical Setting
            The Importance of Clear Documentation
            Legal and Clinical Implications
            Continuity of Care
            Documenting for Follow-Up and Carry-Over
            Principles of Effective Documentation
            Chart Reviews
            Common Documentation Formats
            Goal Writing: Measurable, Relevant, and Achievable Goals
            Strategies for Efficient Documentation
            Addressing Challenges in Documentation
            Capturing Subtle Details in Communication and Swallowing Assessments
            Avoiding Bias in Documentation (e.g., Cultural or Linguistic Assumptions)
        Supporting Patient-Provider Communication in the Medical Setting
            Identifying and Addressing Barriers
            Clinical Communication Impairments
            Strategies for Effective Interaction
            Advocacy and Materials
            Targeted Education and Counseling
        Case Examples
            Case 1: Communication Breakdown in the Context of Cognitive Impairment
            Case 2: Accurate Documentation and Regulatory Compliance
            Case 3: Supported Decision-Making in Aphasia
            Conclusion
        References

Part 2: Systems

Chapter 3. Body Systems and Medical Considerations
    Thomas W. Sather and Bilal A. Unar
        Chapter Outline
        Chapter Overview
        The Cardiovascular (Circulatory) System
            Overview
            Monitoring
            Hematology
            Disruptions of the Cardiovascular System
        Respiratory/Pulmonary System
            Overview
            Assessment of Respiratory Function
            Interventions
            Pneumonia
        Immune System
            Overview
            Common Infections Encountered in the Medical Environment
            Antibiotics
        Gastrointestinal/Digestive System
            Overview
            Gastrointestinal Tract Readiness
        Renal System
            Overview
            Fluid Balance
            Dialysis
            Urinalysis
        Other Aspects of Care
            Bowel and Bladder
            Glucose
            Lines
            Drains
        A Case of Coronary Artery Bypass Graft
        Conclusion
        References

Chapter 4. Pharmacology
    Sarah Lynn Clark and Mohammad B. Najib
        Chapter Outline
        Chapter Overview
        Case Study
        Adherence
        Optimal Medication Timing
        Delivery Mechanisms
        Pharmacodynamics: What the Drug Does to the Body
        Pharmacokinetics: What the Body Does to the Drug
        Special Considerations
            Xerostomia
            Patients With Parkinson’s Disease
            Patients With Myasthenia Gravis
            Patients With Dysphagia Due to a Stroke
        Conclusion
        References

Chapter 5. The Respiratory System in Clinical Practice
    Emily J. Axelson and Amy S. Hilbert
        Outline
        Chapter Overview
        Normal Respiration
        Impaired Respiration
        Ventilation Types and the Impact on Communication and Swallowing
            Noninvasive Ventilation
            Invasive Ventilation
        Speaking Valve
            Factors to Consider When Using a Speaking Valve
            Leak Assessment and Safety Checks
        Early Mobility and Mobilization
        Case Study
        Conclusion
        References

Chapter 6. Dysphagia and Nutrition
    Anne E. Kulinski and Alexandra Kirby
        Chapter Outline
        Chapter Overview
        Introduction to Dysphagia
        Introduction to Nutrition
        Evaluating Dysphagia
            Clinical Swallow Evaluations
            Instrumental Swallow Evaluations
        Evaluating Nutritional Status
        Interventions for Dysphagia
            Compensatory Interventions
            Nutritional Interventions
            Rehabilitative Interventions
            Resuming Oral Intake
        The Best Laid Plans
        Case Study
        Conclusion
        References

Chapter 7. Medical Imaging Modalities
    Thomas W. Sather and Scott Cole
        Chapter Outline
        Chapter Overview
        Planes and Terminology
        Contrast
        X-ray
            Fluoroscopy
        Computed Tomography (CT)
            Stroke Evolution on CT Head
        Magnetic Resonance Imaging (MRI)
            Weighting
            Functional MRI
        Angiography
        Nuclear Medicine
            Positron Emission Tomography (PET)
            Single Photon Emission Computed Tomography (SPECT)
        Other Imaging Applications
            Perfusion Imaging
            Interventional Radiology
        Conclusion
        References

Chapter 8. Neurology and Neurologic Considerations
    Timothy J. Young and Thomas W. Sather
        Chapter Outline
        Chapter Overview
            Knowing the Right Amount of Neurology
            Neurology in the Acute Care Setting
            Overview of the Central and Peripheral Nervous Systems
            Neurological Symptoms and Signs
        A Structured Approach to Organizing Neurologic Etiologies
            V: Vascular
            I: Infectious
            N: Neoplastic
            D: Degenerative
            I: Iatrogenic
            C: Congenital
            A: Autoimmune and Paraneoplastic Syndromes
            T: Trauma/Toxins
            E: Endocrine/Metabolic Encephalopathies
            Other
        Conclusion
        References

Chapter 9. Pediatric Medical Speech-Language Pathology
    Hannah C. Patten
        Chapter Outline
        Chapter Overview
        Role of the Medical Pediatric SLP
            Dysphagia
            Communication
            Multidisciplinary Specialty Clinics
        Settings
            Neonatal Intensive Care Unit
            Aerodigestive Clinic
            Others
        Populations
            General Populations
            Gastrointestinal Dysfunction
            Craniofacial Anomalies
            Airway Anomalies
        Assessments
            Dysphagia
            Communication
        Treatment
            Dysphagia
            Communication
        Counseling: Family-Centered Care
        Case Studies
            Case 1: NICU Dysphagia
            Case 2: NICU Dysphagia
            Case 3: Acquired Brain Injury
            Case 4: Aerodigestive Clinic
        Conclusion
        References

Part 3: The Patient Experience 

Chapter 10. Patient Decision-Making and Autonomy
    Elissa Larkin and Lynne C. Brady Wagner
        Chapter Outline
        Chapter Overview
        Negotiating Disagreement in Medical Decisions (Rita’s Case)
            How Do We Determine If a Patient Can Participate in a Health-Care Decision?
            Answering the Question: Does Rita Have the Ability to Participate in This Health-Care Decision at This Time? And/or If Not, Who Speaks for This Patient?
            How Do We Proceed When There Is Disagreement Between Clinical Recommendations and Patient Preferences?
        How Are Decisions Made When a Patient Does Not Demonstrate Decision-Making Capacity?
            Advance Directives
            What Other Support Options Are There for Patients Who Lack the Ability to Make Medical Decisions and Do Not Have an Advance Directive?
        How Are Advance Directives Used in Practice? (John’s Case)
            Do Patients Ever Regain Decision-Making Capacity?
        How Can We Support Communication to Help Reveal a Patient’s Underlying Decision-Making Capacity? (Pedro’s Case)
            Accessible Decision-Making Capacity Assessment for a Person With Aphasia and the Role of the SLP
        Conclusion
        References

Chapter 11. Maximizing Participation and Patient Safety: An Interdisciplinary Approach
    BethAnn J. Riewestahl and Corrine A. Risler
        Chapter Outline
        Chapter Overview
        Introduction to Additional Therapy Team Members
            Physical Therapy
            Occupational Therapy
        The Value of Therapy in the Medical Setting: Reducing Complications and Maximizing Safety
        Terminology and Equipment Used by the Interdisciplinary Therapy Team
            Commonly Used Terminology
            Commonly Used Equipment
        Functional Performance Considerations to Maximize Participation and Safety
            Patient Positioning Considerations
            Optimizing the Environment
            Functional Mobility Considerations
            Additional Considerations to Promote Safety
        Opportunities for Collaboration Within the Interdisciplinary Therapy Team
            Considerations for Co-Treating
            Additional Opportunities for Collaboration Among the OT, PT, and SLP
        Case Study: Interdisciplinary Rehabilitation in the Acute Medical Setting
            SLP Findings, Goals, and Interventions
            Positioning Considerations
            Environmental Considerations
            Mobility Considerations
            Opportunities for OT/PT/SLP Collaborations
        Conclusion
        References

Chapter 12. Culturally Responsive Practice
    Brooke Hallowell and Yina M. Quique
        Chapter Outline
        Chapter Overview
        Increasing Global Diversity and Health Care Disparities
            Dysphagia
            Aphasia
            Hearing Impairment
            Developmental Disabilities
            Voice
        Our Goals as Culturally Responsive Practitioners
        Cultural Responsiveness and Person-Centered Care
        Becoming Aware of and Reducing Cultural Biases
        Attending to Inclusive Language and Terminology
        Advocacy
        Working With Interpreters
        Adapting Assessment and Treatment Practices
        Lifelong Learning for Diversity, Equity, and Justice
        Conclusion
        References

Chapter 13. The Lived Experience
    CeCelia R. Zorn and Thomas W. Sather
        Chapter Outline
        Chapter Overview
        Wayne and CeCelia’s Story
        Entry Into the Medical System
            A Lived Experience
            Link to the Literature
            SLP Roles and Responsibilities
        Communication With Health Care Staff
            A Lived Experience
            Link to the Literature
            SLP Roles and Responsibilities
        Day and Night: Certainty and Uncertainty
            A Lived Experience
            Link to the Literature
            SLP Roles and Responsibilities
        Conclusion
        References

Part 4: The Wise and Effective Medical Speech-Language Pathologist  

Chapter 14. Leading From Where You Are
    Joe Sanfelippo
        Chapter Outline
        Chapter Overview
        The Impact of Leading From Where You Are
        Leading Yourself (Intention: Clarifying Purpose and Values)
        Leading the Room (Connection: Building Trust and Collaboration)
        Leading the Group (Direction: Moving People Forward)
        Conclusion: You Don’t Need a Title to Lead

Chapter 15. Thinking Like a Clinician
    Thomas W. Sather and Rene L. Utianski
        Chapter Outline
        Chapter Overview
        The Nature of Clinical Reasoning
        Approaches to Developing Expertise
            Evolving From Novice to Expert
        Strategies for Clinical Decision-Making
            Structured Frameworks for Clinical Reasoning
            Intentional Reflections
            Organizational Scaffolds
        Challenges in Clinical Reasoning: Cognitive, Relational, and Contextual Factors
            Thinking Like a Clinician Relationally
            Thinking Like a Clinician Contextually
        Case Studies
            Case One: I Think I Know What I Don’t Know. What Can I Do About It?
            Case Two: I Definitely Know What I Don’t Know. How Can I Leverage What I Do?
            Case Three: I Know What We Need to Do, but the Patient Isn’t Interested. Now What?
            Case Four: I’m Doing All I Can and It’s So Incredibly Hard. How Can I Take Care of Myself?
        Conclusion
        References

Chapter 16. Flourishing in the Medical Environment
    Brian Orr, Thomas W. Sather, and James Matthew Orr
        Chapter Outline
        Sandals in the Hospital
        Burnout
        The Principles of Flourishing
        Meaningful Work as a Pathway to Flourishing
            Cultivating Meaningful Work
        Virtue and the Practice of Speech-Language Pathology
            Accountability of the Institution
        Conclusion
        References

Glossary
Index