Speech-Language Pathologists as Expert Witnesses

For most speech pathologists (speech-language pathologists, SLPs, speech therapists) court testifying as an expert witness is an undesirable professional task. There are relatively few speech pathologists who have had any experience in medical-legal work and even fewer who have been involved in more than one or two cases.  However, the education, training, and professional experience of speech pathologists makes them uniquely qualified to provide expert testimony in a variety of cases for either the plaintiff or the defense.

Speech pathologists are well educated in the areas of normal anatomy and physiology of the speech systems (respiratory, phonatory, resonatory, articulatory), as well as neuro-anatomy and neurophysiology.  In addition, they are educated in the areas of abnormal (pathological) anatomy and physiology of the speech systems and the central and peripheral nervous systems that affect communication, cognition, and swallowing. Knowing and understanding anatomy and physiology are the foundations of understanding communication, cognition, and swallowing disorders. Speech pathologists also are educated in the areas of normal and abnormal speech and language development. Knowledge of both normal and abnormal development allows for comparisons of children with delays and disorders with what is known and expected of similar aged children.

There are several general areas of communication disorders (impairments) that speech-language pathologists work with:

• Articulation and phonological disorders in children;
• Language (receptive and expressive) disorders in children – and their contributions to learning disabilities;
• Literacy disorders in children;
• Fluency (stuttering) disorders in children and adults;
• Voice disorders in children and adults;
• Cleft lip and palate (oral-facial anomalies); and
• Neurological disorders in adults (e.g., strokes and traumatic brain injuries) that cause speech (apraxia and dysarthria), language (receptive and expressive aphasia), cognitive (memory, orientation, reasoning, problem solving, and executive function) disorders, and swallowing disorders (dysphagia).

Speech pathologists also work with children and adults with developmental (intellectual) disabilities, autism spectrum disorders, attention deficit disorders (AD/HD), auditory processing disorders, traumatic brain injuries in children, cerebral palsy, children with syndromes, and individuals who need augmentative and alternative communication (AAC). In addition, speech pathologists work with children and adults who have hearing impairments to help them develop speech and language.

Most speech pathologists have a good working knowledge of the terminology of a variety of professions and are comfortable communicating with them, including regular education and special education teachers, psychologists, and medical specialists such as neurologists, otolaryngologists, and physiatrists (rehabilitation medicine). Speech pathologists commonly work with and sometimes do team treatments with rehabilitation specialists such as physical, occupational, and respiratory therapists. We also work with radiologists (for modified barium swallow studies – MBS) and dietitians for patients with swallowing disorders. 

Speech pathologists make distinctions in areas of speech, language, cognition, and swallowing that other professionals do not.  For example, speech pathologists make clear distinctions between apraxia and dysarthria of speech; receptive and expressive language disorders; levels of cognition and cognitive disorders; executive functions; and the stages (phases) of swallowing in reference to swallowing disorders. Speech pathologists can contribute significantly to cases of mild to severe traumatic brain injury beyond some professionals (e.g., neuropsychologists).  In most cases in which a neurological disorder or impairment occurs in either a child or adult, a speech pathologist can provide valuable testimony.
 
However, not all speech pathologists are necessarily well qualified to serve as expert witnesses.  Special qualifications, training, and experience that can help during medical-legal work include having:

• An earned doctoral degree (Ph.D.) in speech-language pathology;
• At least ten years of professional experience;
• A strong background in anatomy and physiology of the speech systems;
• A strong background in neurology and neuropathology;
• Taught at a university at least five years with experience answering uninhibited and challenging questions;
• On-going and recent experience providing direct therapy to clients and/or patients, not just clinical supervision in a university;
• Experience reviewing medical-legal records and writing medical-legal reports;
• Experience with depositions, court hearings, and court trials; and
• Some professional training by attorneys on being a proficient (actually, excellent) expert witness.

A distinction needs to be made between what a speech pathologist and an audiologist can contribute to medical-legal cases.  These are two different professions, although there is overlap in their training at the bachelor’s level. Audiologists evaluate hearing and pathological auditory systems. They also assess the benefits of amplification (hearing aids) and habilitation or rehabilitation to maximize a person’s hearing ability.  However, much of the habilitation and rehabilitation of hearing impaired children and adults are carried out by speech pathologists. If a child or adult has a hearing loss, an audiologist should definitely be involved when there is a medical-legal question. However, a speech pathologist also may need to be involved to get a complete understanding of the effects on speech and language a hearing loss may have on a person.

Dr. Paul T. Fogle, PhD, CCC-SLP, has over 45 years of experience as a Speech-Language Pathologist and Therapist. He was a university professor for 35 years (now Professor Emeritus), teaching primarily graduate courses in Neurology and Neuropathologies of Adults and Children, Swallowing Disorders / Dysphagia, Gerontology, Voice Disorders, Cleft Lip and Palate, and Counseling Skills for Speech-Language Pathologists. Working extensively in acute, subacute, and convalescent hospitals, he has maintained a private practice since 1980, specializing in children and adults with neurological disorders, stuttering, voice disorders, and cleft lip and palate. Dr. Fogle has worked as an expert witness for either plaintiff or defense on over 30 medical-legal cases and a few criminal cases.

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