States with Specific Instrumental Assessment Requirements
The following states have laws, regulations, or policies related to the use of instrumental assessment for speech-language pathologists:
Alabama
870-X-1-.01 Definition of Terms
(15) "Speech-Language Pathology," the application of principles, methods and procedures related to the development, disorders and effectiveness of human communication and related functions including but not limited to providing prevention, screening, consultation, assessment and diagnosis, treatment, intervention, management, counseling and follow-up services for ... swallowing or other upper aerodigestive functions; .... The practice of speech-language pathology also includes ... selecting, fitting and establishing effective use of prosthetic/adaptive devices for communication, swallowing or other upper aerodigestive functions (does not include sensory devices used by individuals with hearing loss.)
870-X-7-.02 Speech-Language Pathology Scope Of Practice
The overriding principle is that speech-language pathologists will provide only those services for which they are adequately prepared through their academic and clinical training and their experience. The practice of speech-language pathology includes:
(a) Providing screening, identification, assessment, diagnosis, treatment, intervention (i.e. prevention, restoration, amelioration, compensation) and follow-up services for disorders of:
3) oral, pharyngeal, cervical esophageal, and related functions, (e.g. dysphagia, including disorders of swallowing and oral function of feeding; orofacial myofunctional disorders)
(c) Training and supporting family members and other communication partners of individuals with speech, voice, language communication, and swallowing disabilities;
(e) Selecting, fitting, and establishing effective use of appropriate prosthetic/adaptive devices for speaking and swallowing (e.g. tracheoesophageal valves, electrolarynges, speaking valves);
(f) Using instrumental technology to diagnose and treat disorders of communication and swallowing (e.g., videofluoroscopy, nasenodoscopy, ultrasonography, stroboscopy.)
Alabama Rules and Regulations [PDF]
Arkansas
11.1 The practice of speech-language pathology includes:
A. providing prevention, screening, consultation, assessment and diagnosis, treatment, intervention, management, counseling, and follow-up services for disorders of:
3. swallowing or other upper aerodigestive functions such as infant feeding and aeromechanical events (evaluation of esophageal function is for the purpose of referral to medical professionals);
5. sensory awareness related to communication, swallowing, or other upper aerodigestive functions.
E. using instrumentation (e.g., videofluoroscopy, EMG, nasendoscopy, stroboscopy, computer technology) to observe, collect data, and measure parameters of communication and swallowing, or other upper aerodigestive functions in accordance with the principles of evidence-based practice.
F. selecting, fitting, and establishing effective use of prosthetic/adaptive devices for communication, swallowing, or other upper serodigestive functions (e.g., tracheoesophageal prostheses, speaking valves, electrolarynges). This does not include sensory devices used by individuals with hearing loss or other auditory perceptual deficits.
H. educating and counseling individuals, families, co-workers, educators, and other persons in the community regarding acceptance, adaptation, and decision making about communication, swallowing, or other upper serodigestive concerns.
K. addressing behaviors (e.g., perseverative or disruptive actions) and environments (e.g., seating, positions for swallowing safety or attention, communication opportunities) that affect communication, swallowing, or other upper aerodigestive functions.
Arkansas Rules and Regulations [PDF]
California
(d) The practice of speech-language means all of the following:
(1) The application of principles, methods, instrumental procedures, and noninstrumental procedures for measurement, testing, screening, evaluation, identification, prediction, and counseling related to the development and disorders of speech, voice, language, or swallowing.
(2) The application of principles and methods for preventing, planning, directing, conducting, and supervising programs for habilitating, rehabilitating, ameliorating, managing, or modifying disorders of speech, voice, language, or swallowing in individuals or groups of individuals.
(4) Performing suctioning in connection with the scope of practice described in paragraphs (1) and (2), after compliance with a medical facility’s training protocols on suctioning procedures.
(e)(1) Instrumental procedures referred to in subdivision (d) are the use of rigid and flexible endoscopes to observe the pharyngeal and laryngeal areas of the throat in order to observe, collect data, and measure the parameters of communication and swallowing as well as to guide communication and swallowing assessment and therapy. 2) Nothing in this subdivision shall be construed as a diagnosis. Any observation of an abnormality shall be referred to a physician and surgeon.
(f) A licensed speech-language pathologist shall not perform a flexible fiberoptic nasendoscopic procedure unless he or she has received written verification from an otolaryngologist certified by the American Board of Otolaryngology that the speech-language pathologist has performed a minimum of 25 flexible fiberoptic nasendoscopic procedures and is competent to perform these procedures. The speech-language pathologist shall have this written verification on file and readily available for inspection upon request by the board. A speech-language pathologist shall pass a flexible fiberoptic nasendoscopic instrument only under the direct authorization of an otolaryngologist certified by the American Board of Otolaryngology and the supervision of a physician and surgeon.
(g) A licensed speech-language pathologist shall only perform flexible endoscopic procedures described in subdivision (e) in a setting that requires the facility to have protocols for emergency medical backup procedures, including a physician and surgeon or other appropriate medical professionals being readily available.
Colorado
(7)(a) Speech-language pathology means
(III) Feeding and swallowing; and
(7)(b) "Speech-language pathology" also includes
(IV) Using instrumentation such as videofluroscopy, endoscopy or strobobscopy to observe, collect data and measure parameters of communication and swallowing;
(V) Selecting, fitting, and establishing effective use of prosthetic or adaptive devices for communication, swallowing, or other upper aerodigestive functions, not including sensory devices used by individuals with hearing loss or the orthodontic movement of teeth for the purpose of correction of speech pathology conditions.
Georgia
(16) "The practice of speech-language pathology" means the application of principles, methods, and procedures for the measurement, testing, evaluation, prediction, consultation, counseling, instruction, intervention, research, habilitation, or rehabilitation related to the development and disorders of speech or language including but not limited ... swallowing for the purpose of evaluating, preventing, ameliorating, modifying, or otherwise treating such disorders and conditions in individuals or groups of individuals.
Georgia Practice Act [PDF]
Nasoendoscopy: The use of procedures and devise for the purpose of the diagnosis and treatment of speech-language disorders falls within the scope of the practice. It requires adequate training and clearly does not include medical procedures or treatment.
Georgia Policy Statement [PDF]
Illinois
(225 ILCS 110/3)
(h) "The practice of speech-language pathology" is the application of nonmedical methods and procedures for the identification, measurement, testing, appraisal, prediction, habilitation, rehabilitation, and modification related to communication development, and disorders or disabilities of speech, language, voice, swallowing, and other speech, language and voice related disorders. These procedures are for the purpose of counseling, consulting and rendering or offering to render services, or for participating in the planning, directing or conducting of programs that are designed to modify communicative disorders and conditions in individuals or groups of individuals involving speech, language, voice and swallowing function. See the complete Illinois Practice Act.
Indiana
25-35.6-1-2 Definitions
(d) As used in this article, "speech-language pathology" means the application of non-medical and non-surgical principles, methods, and procedures for the following:
(1) The prevention, evaluation, habilitation, rehabilitation, instruction, and research of communication and swallowing disorders
IC 25-35.6-1-9 Patient referral; supervision of certain procedures
Sec. 9. (a) If a speech-language pathologist performs an evaluation and the evaluation suggests the possibility of a condition that requires medical attention, the speech-language pathologist shall promptly refer the patient to an individual licensed under IC 25-22.5.
(b) A speech-language pathologist shall perform instrumental procedures using rigid or flexible endoscopes only under the authorization and general supervision of an individual licensed under IC 25-22.5.
Indiana Practice Act [PDF]
Maryland
§ 2-101. Definitions
(r) Practice speech-language pathology. - "Practice speech-language pathology" means to apply the principles, methods, and procedures of measurement, prediction, evaluation, testing, counseling, consultation, and instruction that relate to the development and disorders of speech, voice, swallowing, and related language and hearing disorders, to prevent or modify the disorders or to assist individuals in cognition-language and communication skills.
The Board endorses the need for a qualified physician’s participation with the speech-language pathologist as the best practice standard for performance of videoflouroscopic swallowing studies (VFSS). If a physician is unavailable, then a competent speech-language pathologist may perform the instrumental assessment. In this situation, the study should be limited to the observation and documentation of swallowing physiology and function only. The speech-language pathologist should arrange for a radiologist or other qualified physician to review the study afterward.
Board Policy Statement – Videofluoroscopic (VFSS) [PDF]
Speech Language Pathologists provide diagnostic and treatment services that may call for the use of endoscopy to complete swallowing, voice, and/or velopharyngeal diagnostic and treatment procedures. For example, rigid and flexible endoscopy are techniques used to visualize the vocal tract and larynx during voice and swallowing assessments. See the complete SLP Guidelines for the Use of Endoscopy.
Speech-Language Pathologists provide diagnostic and treatment services that may call for the use of topical anesthetics to complete certain diagnostic and/or treatment activities. For example, a patient may require the use of a topical anesthetic while undergoing a Fiberoptic Endoscopic Examination of Swallowing (FEES) procedure. See the complete SLP Guidelines for the Use of Topical Anesthesia.
Speech Language Pathologists (SLPs) provide diagnostic and treatment services that may call for the use of tracheal suctioning. For example, during clinical swallowing evaluations and during tracheal occlusion activities, the patient may need to be suctioned as part of the procedure. See the complete SLP Guidelines for the Use of Tracheal Suctioning.
Michigan
333.17601 Definitions; limitation on scope of practice
(1) As used in this part:
(a) "Practice of speech-language pathology," subject to subsection (2), means the application of principles, methods, and procedures related to the development of disorders of human communication including the following:
(ii) Identifying by history or nonmedical physical examination, assessing, treating with therapy, rehabilitating, and preventing disorders of oral-pharyngeal function and disorders related to swallowing dysfunction.
333.17607 Speech-language pathology; license required; exceptions
(3) A licensee shall perform assessment, treatment or therapy, and procedures related to swallowing disorders and medically related communication disorders only on patients who have been referred to him or her by a person licensed in the practice of medicine or osteopathic medicine and surgery.
(4) Limited diagnostic testing, such as endoscopic videolaryngostroboscopy, shall only be performed by a licensee in collaboration with or under the supervision of a person licensed in the practice of medicine or osteopathic medicine and surgery.
Missouri
345.015. Definitions
(1) "Practice of speech-language pathology":
(a) Provides screening, identification, assessment, diagnosis, treatment, intervention, including but not limited to prevention, restoration, amelioration and compensation, and follow-up services for disorders of:
c. Oral, pharyngeal, cervical esophageal and related functions, such as dysphagia, including disorders of swallowing and oral functions for feeding; orofacial myofunctional disorders;
(c) Trains and supports family members and other communication partners of individuals with speech, voice, language, communication and swallowing disabilities;
(e) Selects, fits and establishes effective use of appropriate prosthetic/adaptive devices for speaking and swallowing, such as tracheoesophageal valves, electrolarynges, or speaking valves;
(f) Uses instrumental technology to diagnose and treat disorders of communication and swallowing, such as videofluoroscopy, nasendoscopy, ultrasonography and stroboscopy.
Nevada
NRS 637B.060 "Practice of speech-language pathology” means the application of principles, methods and procedures relating to the development and effectiveness of human communication and disorders of human communication, and includes, without limitation:
....
5.The use of oral and nasal endoscopy for the purpose of vocal tract imaging and visualization;
New Jersey
13:44C-7.2 SCOPE OF PRACTICE—SPEECH-LANGUAGE PATHOLOGY
a) The practice of speech-language pathology includes, but is not restricted to, the following functions:
1) Providing screening, identification, assessment, diagnosis, treatment, intervention (that is, prevention, restoration, amelioration, compensation), consultation, counseling, and follow-up services for disorders of:
iii) Oropharyngeal and related functions (that is, dysphagia, orofacial myofunctional disorders);
2) Training and supporting family members and other communication partners of individuals with speech, voice, language, other communication, and swallowing disabilities;
4) Selecting, fitting, and establishing effective use of appropriate prosthetic/adaptive devices for speaking and swallowing (that is, tracheoesophageal valves, electrolarynges, speaking valves.)
13:44C-7.2A SCOPE OF PRACTICE: FIBER OPTIC ENDOSCOPIC EXAMINATION OF SWALLOWING (FEES)
a) The purpose of this section is to set forth standards for the performance of Fiber Optic Endoscopic Examination of Swallowing (FEES) by a licensed speech-language pathologist. FEES is within the scope of practice of a speech-language pathologist who meets the requirements of this section.
b) The following words and terms, when used in this section, shall have the following meaning, unless the context clearly indicates otherwise:
"FEES" means a fiber optic endoscopic examination of swallowing.
c) FEES shall only be performed by a licensed speech-language pathologist who is certified in Basic Life Support (BLS) and who has:
1) Completed a 12-hour seminar or workshop in fiber optic endoscopy as a technique for investigating swallowing which qualifies for American Speech-Language-Hearing Association (ASHA) continuing education credit and which includes instruction in:
i) Medical contraindications and possible adverse reactions to FEES, including the use of topical anesthesia to the nares; and
ii) Recognizing patient distress and appropriate actions to take if complications are encountered;
2) Observed 10 FEES procedures performed by either a speech pathologist who has met the requirements of this section or a physician, at a licensed healthcare facility that requires that healthcare professionals have privileges to perform the FEES procedure; and
3) Successfully performed 25 FEES procedures under the supervision of a speech pathologist who has met the requirements of this section or a physician, at a licensed healthcare facility that requires that a healthcare professional have privileges to perform the FEES procedure.
d) A licensed speech-language pathologist shall only perform FEES in a healthcare facility licensed by the Department of Health and Senior Services or in the office of a physician who received training during residency or post-residency in endoscopic examination.
e) FEES shall only be performed when a physician who received training during residency or post-residency in endoscopic examination is present.
f) FEES shall only be performed upon the written request of a physician.
New Jersey Rules and Regulations [PDF]
New York
In 1997 the scope of practice of the New York State Licensure Law in Speech-Language Pathology and Audiology was amended to include the diagnosis and remediation of swallowing disorders. This expansion in the scope of practice allows the licensed Speech-Language Pathologist to treat swallowing disorders. With the inclusion of swallowing in the scope, the New York State Licensure Board has been asked its position concerning a speech-language pathologist performing the flexible fiberoptic endoscopic examination of swallowing (FEES). See the complete New York Practice Guidelines.
North Carolina
§ 90-293. Definitions.
(7) "The practice of speech and language pathology" means the application of principles, methods, and procedures for the measurement, testing, evaluation, prediction, counseling, treating, instruction, habilitation, or rehabilitation related to the development and disorders of speech, voice, language and swallowing for the purpose of identifying, preventing, ameliorating, or modifying such disorders.
North Caroline Practice Act [PDF]
Fiberoptic Endoscopic Evaluation of Swallowing (FEES)
Whether any licensed speech-language pathologist may participate in FEES is a question of the level of the training of the individual speech-language pathologist, the quality of the facility in which the procedure is performed, and the risk management policy of the hospital. Accordingly, the Board is unable to say categorically that either all speech-language pathologists may perform the FEES procedure or that none are able to perform the procedure, as this is a matter of individual ethical consideration.
The question is not so much one of scope of practice as one of individual ethics. G.S. 90-301(A)(8) states that it is unethical for a person licensed to provide services for which the licensee is not properly prepared to perform. Licensed speech and language pathologists who perform fiberoptic endoscopic evaluation of swallowing (FEES) should be prepared to produce evidence of special preparation in this field to the Board or to others who may question the specific qualifications of a particular licensee. Authority – G.S. 90-301A(8). See the complete North Carolina Scope of Practice Position Statements [PDF].
Pennsylvania
Practice of speech-language pathology—The application of principles, methods and procedures of prevention, screening, consultation, identification, assessment and evaluation, determination of disorders and service delivery model, nonmedical treatment and intervention, counseling, collaboration and referral services for persons with known or suspected language, cognitive and linguistic, social, speech (resonance and voice, fluency and sound production), feeding and swallowing, orofacial myofunctional disorders or communication disorders, including all of the following:
...
(iii) Using instrumentation to observe, collect data and measure parameters of communication and swallowing or other upper aerodigestive functions.
...
(vi) Selecting, fitting and establishing effective use of devices for communication and swallowing other than hearing amplification.
...
(vii) Providing nonmedical treatment and instruction on modification or enhancement of communication performance.
...
(x) Teaching and implementing techniques to assure safety and efficiency in swallowing.
South Dakota
36-37-1. Definitions
(3) "Endoscopy," an imaging procedure included within the scope of practice for speech-language pathologists in which a speech-language pathologist uses a flexible/nasal endoscopy, rigid/oral endoscopy, or stroboscopy for the purpose of evaluating and treating disorders of speech, voice, resonance, and swallowing function;
36-37-2. Practice of speech-language pathology defined. For the purposes of this chapter, t he practice of speech-language pathology is the application of principles, methods, and procedures related to the development, disorders, and effectiveness of human communication and related functions including providing prevention, screening, consultation, assessment/evaluation, diagnosis, treatment/intervention/ management, counseling, collaboration, and referral services for disorders of speech, language, feeding, and swallowing, and for cognitive aspects of communication. The practice of speech-language pathology also includes establishing augmentative and alternative communication techniques and strategies, including developing, selecting, and prescribing of such systems and devices, excluding the dispensing and fitting of hearing aids pursuant to chapter 36-24, providing services to individuals with hearing loss and their families, screening persons for hearing loss or middle ear pathology using conventional pure-tone air conduction methods, otoacoustic emissions screening, or screening typanometry, using instrumentation to observe, collect data, and measure parameters of communication and swallowing, selecting, fitting, and establishing effective use of prosthetic or adaptive devices for communication, swallowing, or other upper aerodigestive functions, and providing services to modify or enhance communication performance.
36-37-6. Nonmedical endoscopy. Any person who is licensed as a speech-language pathologist in South Dakota may perform assessment, treatment, and procedures related to speech, voice, resonance, and swallowing function using nonmedical endoscopy as long as the person has received training and is competent to perform these procedures. A licensed speech-language pathologist shall have protocols in place for emergency medical backup when performing procedures using an endoscope.
Tennessee
5) (A) "Practice of speech language pathology" means the non-medical application of principles, methods, and procedures for the measurement, testing, assessment, prediction, counseling or instruction related to the development and disorders of speech, voice, language or oral, pharyngeal, and laryngeal sensorimotor competencies for the purpose of assessing, preventing, treating, ameliorating or modifying such disorders and conditions in individuals and groups of individuals;
(B) The practice of speech language pathology shall include the use of rigid and flexible endoscopes to observe the pharyngeal and laryngeal areas of the throat in order to observe, collect data, and measure the parameters of communication and swallowing for the purpose of functional assessment and rehabilitation planning. A speech language pathologist who uses an endoscope shall meet all of the following conditions:
(i) Obtain written verification from a board certified otolaryngologist that the speech language pathologist is competent in the proper and safe use of an endoscope. The otolaryngologist's determination of competency shall be based on the speech language pathologist's training in the proper use of endoscopes, the successful completion of a university course or other educational program of at least fifteen (15) hours on endoscopy, and the successful performance of at least twenty-five (25) endoscopic procedures under the supervision of an otolaryngologist or another speech language pathologist who has successfully performed at least fifty (50) endoscopic procedures and has been approved in writing by a board-certified otolaryngologist to provide that supervision. The speech language pathologist shall maintain this written verification on file at all times at the primary practice location of the speech language pathologist;
(ii) Not perform a procedure utilizing an endoscope unless the patient has been referred to the speech language pathologist by an otolaryngologist or other qualified physician for the performance of the procedure;
(iii) Perform only non-operative procedures with an endoscope;
(iv) Have protocols in place for emergency medical backup for every setting in which the speech language pathologist performs a procedure using an endoscope:
(a) If the procedure is performed in a community setting such as a physician's office, a physician shall be on the premises and provide on-site supervision; and
(b) If the procedure is performed in an institutional setting such as a hospital or nursing home, a physician shall provide general supervision and be readily available in the event of an emergency, including, but not limited to, physical presence at the institution or availability by telephone; and
(v) Send to the referring physician in a timely manner a report and visual recording of each endoscopic procedure performed upon referral of that physician. If the referring physician is not an otolaryngologist, the speech language pathologist shall also provide a visual recording of the endoscopic procedure to an otolaryngologist, if directed to do so by the referring physician.
Virginia
§ 54.1-2600. Definitions.
"Speech-language disorders" means disorders in fluency, speech articulation, voice, receptive and expressive language (syntax, morphology, semantics, pragmatics), swallowing disorders, and cognitive communication functioning.
It is the opinion of the Board of Audiology and Speech-Language Pathology that a speech-language pathologist (SLP), who is specially trained, may perform FEES pursuant to a physician order and under the general supervision of a physician provided there are protocols in place for emergency response. A SLP is not authorized to possess or administer prescription drugs except as provided in § 54.1-3408 B.
Policy on Fiberoptic Endoscopic Evaluation of Swallowing (FEES)
