The Interface between Linguistics and Speech Pathology

with Special Focus on the Philippine Context

An invited paper presented at the 11th Philippine Linguistics Congress
9 Dec 2011, UP-NISMED, Quezon City

Jocelyn Marzan
Associate Professor
Dept. of Speech Pathology, College of Allied Medical Professions, UP Manila
jcbmarzan@post.upm.edu.ph

What is Speech Pathology?

Speech Pathology is a discipline dedicated to enhancing the communication-related quality of
life of persons whose development and functioning are impaired by physical, physiological,
neurological, environmental and/or other challenges to speech and language that are generally
greater than those experienced by the average person. Our goal is to enhance their ability to
participate actively in their social context, to contribute to their empowerment to make a positive
contribution to human development.

This includes speech, spoken language and auditory comprehension, but also to some extent
reading or pre-reading skills (particularly phonogical development) and written communication,
as well as the use of what are called augmentative or alternative communication systems such the
Makaton Sign Language developed for children with Downs Syndrome, the Picture Exchange
system for children with autism, or assistive technology such as computer communication using
head mounted controls for persons with Amyotrophic Lateral Sclerosis (ALS) and other
conditions that hinder the control of voluntary muscle movement.1

Conditions Addressed
Speech pathologists work with children and adults. Among children, this includes children with
developmental conditions such as autism and Downs syndrome (as mentioned), as well as those
with cerebral palsy, hearing loss, clefts of the lip and palate, and children with speech-sound
production disorders, specific language impairments and learning disabilities. Our work
with these children can extend over more than a decade, as they will often need support to meet
the speech-languages challenges of school, expanding social interactions and in some cases work
settings.

Among adolescents and adults, we typically work with persons with voice disorders (among
them call center agents, teachers, professional singers), fluency problems (such as Colin Firths
Bertie in The Kings Speech), aphasia (or loss of language functioning due to brain damage,
such as a stroke, head injury, brain tumor or Alzheimers) and cognitive disorders (often due to
the same conditions that lead to aphasia). It is also possible for a speech pathologist to work on
accent change, although this is not a common area of practice in the Philippines.

History in the Philippines

Speech pathology came to the Philippines in 1978, when UP opened the BS Speech Pathology
program in what was then the School of Allied Medical Professions of the College of Medicine.
1
The speech pathologist also works to enhance swallowing and feeding functions in persons post-CVA or with
other conditions that affect safety of the swallow. Dysphagias (or swallowing disorders) are not discussed in this
paper as they are less relevant to linguistics than the other conditions the speech pathologist addresses.

Tables and graphics that illustrate points made in this paper

can be found the in accompanying PowerPoint handout. jm
 Marzan (2011) Linguistics and Speech Pathology_page 2

For 30 years, this was the sole program providing professional training for speech pathology. In
2009, UST opened a similar program. As of 2008, UP had graduated 377 speech pathologists (or
an estimated 470 as of 2011), with 51% actively practicing the profession, 35% having left the
country and 14% having changed careers. Thus at present less than 500 speech pathologists are
providing services in the country, primarily in Metro Manila.

This is grossly inadequate in contrast to service delivery needs. For example, there are an
estimated 634 Filipino children are born with clefts every year (Padilla et al, 2008) , a prevalence
rate of 1 out of every 150 Filipino children (or 10,000 live births each year) affected by autism
(Reyes, 2008; Padilla, 2008) an estimated 376,040 Filipinos with aphasia (National Aphasia
Association, 2011; NSO 2011). There are 4,034 special education classes in Philippine public
schools serving 79,118 children with disabilities (Dept of Education, 2011), none of which
systematically receive the speech pathology support available in other countries. In view of this
the Commission on Higher Education recently approved the policies, standards and guidelines
needed to offer tertiary level speech pathology programs at other universities nationwide with the
goal of developing competent speech pathologists who can respond to the needs of Filipinos with
speech-language conditions through-out the country.

The Interdisciplinary Nature of Speech Pathology

Disciplines
Speech pathology is essentially an interdisciplinary science. Various disciplines may look at the
work we do and feel this work is within their territory. And rightly so. The individualized
instruction programs and student assessments we prepare will be very familiar to the special
educator. The knowledge we need to have of motor control, muscle strengthening and
coordination belong to the world of physical therapy. The management of the emotional
response to disability are likewise addressed by clinical psychologists and counselors. The
developmental psychologist will be as interested in the progression of language skills through-
out the lifespan as we are. The occupational therapist and perhaps the sociologist and social
psychologist and others will be as fascinated with the use of language for interpersonal purposes
and daily interactions as we are. The cognitive psychologist looks as closely at cognitive-
linguistic processing as we do. And the linguist will no doubt be as interested in more than one
of the above aspects.

What perhaps differentiates the speech pathologist from each of these disciplines is the
integration of this array of knowledge with a view to how it is developed and used by a person
with some condition that impairs typical functioning and development.

Linguists/Linguistics
My own knowledge of linguistics is sadly limited and as prepared for todays presentation, I
became more acutely aware of how sad that limitation is. Linguistics is intimately related with
speech pathology. Wolfram (1978) called for a greater appreciation of linguistics among speech
pathologists 30 years ago. David Crystal (1987) repeated that call a decade later. In the
international community of speech pathology, that call has been heeded.
 Marzan (2011) Linguistics and Speech Pathology_page 3

Crystal, who is perhaps well known among linguists, is honorary vice-president of both the
Royal College of Speech and Language Therapists and the Institute of Linguists. He was a
lecturer of linguistics with research interests in the development of a range of linguistic profiling
techniques for diagnostic and therapeutic purposes (among others). The academic background of
Dr. Hanna Ulatowska, professor of Communication Disorders at the University of Texas at
Dallas was not in Speech Pathology but Linguistics at the University of Edinburgh.
The Speech and Language Pathology Program at MacQuarie University in Australia is housed
within the Dept. of Linguistics. Johanne Paradis, professor of linguistics of the University of
Alberta, is an associate editor of the Journal of Speech, Hearing and Language Research whose
principal audience is speech pathologists.

At our program in UP Manila, the incorporation of linguistics into our program is limited to the
inclusion of a single course in our curriculum:

Linguistics 112: Descriptive Linguistics. Descriptive analysis of phonological,

morphological and syntactic structures. Intensive practice in solving problems from a
variety of languages. (3 units; UP Manila Catalogue of Information, 2005-2010)

Sadly, neither does the CHEd curriculum incorporate linguistics coursework. Perhaps in the
future this can be remedied. The inclusion of instructors or professors whose primary academic
background is linguistics into the faculty complement of the department might also be a
possibility. In the meantime, there is a great deal of collaborative research that speech pathology
and linguistics (and psychology) and engage in.

Models of Speech-Language Processing

Linguists would be more concerned with the conditions that affect language functioning, rather
than speech. It is, in reality, hard to draw the line between the two. Even in cases where the
difficulty appears to be due to a clearly peripheral phenomenon, such as a cleft palate with no
accompanying cognitive deficits, the capacity for speaking affects the capacity for language. For
example, stuttering is disruptions in the production of speech sounds (ASHA 2011), but the
avoidance of these disruptions often leads the speaker to develop a wide vocabulary so as to be
able to choose words other than those he usually has difficulty with.

The Speech-Language Processing Model developed by Nation and Aram (1977) is perhaps
parallel to models used by linguists among linguists and illustrates the interrelations between
speech sound production, language and the environment. Elements of the model include
pragmatic, phonetic, phonological, semantic, syntactic and prosodic input, internal language
comprehension and formulation processes, and language output. A speech-language disorder
arises from disruption at any point in the model. Linguistic phenomena are clearly a components
at all levels. The model of put forth by Kay, Lesser and Coltheart (1992) for the analysis of
aphasia illustrates linguistic phenomena that the speech pathologist works with even more
explicitly. This model was actually developed by cognitive scientists and is used by both
psychologists and speech pathologists and includes elements such as phonological and
orthographic output buffers, in addition to the elements in the Nation and Aram Model.
 Marzan (2011) Linguistics and Speech Pathology_page 4

Research in Linguistics and Speech Pathology

The linguist is perhaps as interested in the language itself as in the user of that language, the
sound systems, the syntactic systems, and the impact of language contact. The speech pathologist
is interested in how individual persons learn and use language within their specific contexts,
including contexts of disability. A connoisseur delights in the flavors of a dish, in discovering the
ingredients that comprise it, in exploring the fusion of Chinese and Italian cuisine. A skills
teacher is interested in how the cook learned to select, store, slice and combine those ingredients,
and how it might be possible to cook the same recipe with a paralyzed hand.

Yet Crystal (1987) points out that without clear descriptors of the language itself, it is not
possible to define what goes into learning it.

Developmentally and Functionally Appropriate Targets

When faced with an 11-year-old whose score on language tests is similar to a 3-year-old, how
does one decide what language skills to help this child develop? Using a developmental
framework (NAEYC, 2009; Lahey, 1988; Paul, 2001) the skills we target for this child should
follow the same sequence as that for typically developing children. This is based on the
understanding that this sequence indicates the zones of proximal development (Vygotsky, 1962)
for a child who demonstrates a set of skills at a given developmental level.

Pinker (1995) summarizes language acquisition research as showing that the general course of
language acquisition is similar across cultures. Milestones include a receptive vocabulary of
about 200 words and an expressive vocabulary of about 50 words by the age of 18 months, and a
mean length of 3.1 morphemes per utterance by the age of 36 months (Sax & Weston, 2007).
Crystal (1987) points out that we teach neither vocabulary nor MLU in general but the
meaning and use of specific lexical items and specific syntactic structures. In order to set
appropriate learning goals for our children, it is thus imperative to document systematically the
sequence of language development in Filipino children. Both cross-sectional and longitudinal
studies are needed to determine the sequence of acquisition of phonemes, of receptive and
expressive vocabulary, of the one grammatical morpheme after another, of focus or voice, of
discourse patterns, etc Each of these could form an entire research agenda for a speech
pathologist, a linguist, a psychologist, and early childhood specialist.

A survey of online catalogues accessible through the Library Link and internet searches in 2008
indicated a total of less than 150 studies (published or unpublished but catalogued) relevant to
Filipino child language development (Marzan, 2008). Of these, about a third covered topics of
general child development rather than being focused on language skills. Some 20% focused on
the development of specific constructs among children, leaving only half of the studies to focus
on more specific aspects. The database has grown, perhaps not least due to the contributions
from the Philippine Linguistics Congresses held since 2008, but the research is meager in
contrast to the need. In addition, roughy 80 of the papers found had been published prior to 1990.
 Marzan (2011) Linguistics and Speech Pathology_page 5

Targets Appropriate to the Cultural, Linguistic and Educational Context

The larger environment impacts on a childs development through and beyong his home and
school community (Bronfenbrenner, 1979). In view of the impact of internet access, changes in
music and television programming, and the general international exposure received by the
Filipino child today, it is likely that studies done more than a decade ago are somewhat limited in
their applicability to todays children. The question is not only what lexicon and what syntax to
target, but what pragmatic skills to target. These must be those typical of the childs context,
including intonation patterns, politeness markers, in-group registers for adolescents, and
culturally appropriate modes of emotional expression. Again, each of these potentially forms an
entire research agenda.

Many school-age children need support to develop proficiency in academic cognitive-language

demands. These demands are distinct from the basic interpersonal communicative skills used at
home (Cummins, 2007) and require special attention. In order to determine what those demands
are in the local setting, it is not enough to access the educational objectives set by the
Department of Education or the specific school the child goes to. It is necessary to analyze the
language content of actual teaching-learning materials used. It is also necessary to systematically
describe the characteristics of communication in the classroom setting, such as the language used
by the teacher, the language accepted for recitation in class, for groupwork among students, and
for informal interactions among students outside of class.

Assessment Tools
It is also necessary to develop psychometrically sound assessment tools to measure levels of
language developed. Tests are widely available in English. The context of use and the dialect of
English spoken by Filipinos reduces the usefulness of tests designed and standardized for
speakers of English in the United States or the United Kingdom.

Test development can initially be done by the adaptation of existing measures, making sure to
develop items representative of the construct to be tested, rather than simply translating test
items into local languages. Ideally, however, we will in time define what parameters of language
are most relevant in the Philippine context and to develop tests that measure those parameters
directly in and for each of the major Philippine languages. Participation of Filipino linguists in
this task will be important.

For example, language tests for aphasia typically measure word recognition across phonological,
semantic and in some cases syntactic neighborhoods. They test for differential access or
recognition of high and low frequency words. The principle basis for frequency of occurrence of
Filipino words appears to be McFarlands (1989) frequency count of Filipino. This count was
made based on written works. Technology today perhaps now allows us to determine the extent
to which frequencies of words in written media actually tallies with frequencies in conversational
speech.
 Marzan (2011) Linguistics and Speech Pathology_page 6

Materials for and Methods of Intervention

The preparation of speech and language worksheets, language games, computer programs, and
other instructional or augmentative material in Filipino are also necessary. Linguists are also
possible contributors to the production of these materials, so as to ensure the aptness of the
material for the targeted language tasks.

Evidence Based Practice

Evidence based practice is currently a catch-word in the health sciences. Hopefully it will
become a stable tradition. It is the habituation of clinical decision-making on a process that
includes searching for research data in support of clinical options, and examining the validity and
reliability of that data so as to ensure that there is a basis for the treatment options we select more
substantial than the anecdotes traded among clinicians. Treatment outcomes in speech pathology
are sometimes documented using standardized tests. But this is perhaps most appropriate when
one seeks to measure change of large blocks of time, such as one to two years. Most
standardized tests are gross indicators of performance, not sensitive to smaller changes in skill.
Treatment outcomes for language intervention instead need to be measured behaviorally in terms
of changes in specific parameters of language performance. This is best done when we have clear
labels for the behavior we are measuring. This behavior is likely to be described using linguistic
parameters such as frequency of the use of transitive voice, coding of aspect using specific
morphemes, etc again a domain where the expertise of the linguist would be valuable.

Bi- or Multi-lingualism
The National Statistics Office (2009) lists seven major Philippine languages or ethnic groups
based on data from the year 2000: Tagalog, Cebuano, Ilocano, Bisaya/Binisaya,
Hiligaynon/Ilongo, Bikol/Bicol and Waray. The linguistics community may or may not agree
with this listing, but the fact remains that several major Philippine languages are spoken by a
majority of the population, and well over a hundred Philippine languages are spoken nationwide.
This magnifies each of the concerns mentioned above, as norms, test materials and intervention
materials and strategies must needs be developed for at least each of the major lingua franca.

The Philippines is essentially a bi and multi-lingual country. Multi-lingualism in the Philippines

is complex. There are various types of Philippine bilingualism, indeed often Filipinos are
bilingual, trilingual, or even quadrilingual. There is no small set of consistent typologies of
bilingualism nationwide. The learning of more than one language will sometimes be sequential
and additive. In other cases, learning of more than one language will be simultaneous within a
code-mixing environment. In this context, it can be hard to determine a childs (or a persons)
first language (Marzan, 2007). Multi-lingual early language acquisition, multi-lingual
functioning and the code-mixing that is typical of Filipinos in urban or in rural settings adds to
the layers of language functioning that need to be documented and described.

There is an added interest in cognitive science: the description of lexical storage, lexical
identification and word recognition in bi-linguals, the implications this has in neural networking
and architecture (Grosjean, 1998; Dijkstra &Van Heuven, 2002), and the further impact this has
on intervention for aphasia and other language conditions (Santos et al, 2011).
 Marzan (2011) Linguistics and Speech Pathology_page 7

Audiology
The Audiologist is a hearing specialist, who works closely with the speech pathologist and the
otorhinolaryngologist to prevent hearing loss and to maximize the use of residual hearing in
persons whose hearing is impaired. In relation to linguistics, this includes measuring not only
the ability to hear sounds, but the ability to recognize and process speech. Some specialize in
what are known as Central Auditory Processing Disorders, which is thought to be modality-
specific perceptual dysfunction that is not due to peripheral hearing loss (Cacace & McFarland,
2005) that leads to difficulty with language comprehension. The simplest forms of speech
perception testing in English involve the use of spondaic words and monosyllables for testing
speech awareness, speech recognition and supra-threshold word recognition. Tests that meet the
same goals must be consistent with Filipino syllable structures and the frequency distribution of
Filipino phonemes in conversation. Again, the input of the linguist in developing these and other
measures will be needed.

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