Thesis: Does terminology create pathology? Making a speech therapy diagnosis

For a new classification, the Classification of Speech-Language Pathology Based on Clinical Practice (COFOP)

Constructed primarily during the 20th century, speech-language pathology (and/or speech therapy) is a paramedical discipline dedicated to the prevention, detection, diagnosis, and treatment of voice, speech, oral language, and written language disorders;assessment, diagnosis, and treatment of voice, speech, oral and written language disorders in expression and comprehension, oral and written communication, and swallowing disorders occurring in individuals throughout the life span.

Receiving patients referred by physicians from a variety of specialties, including neurologists, pediatric psychiatrists, ENT specialists, and others, the SLP performs anamnesis of the patient's speech and language abilities;The speech therapist performs an anamnesis and has multiple standardized evaluations to draw up assessments and propose educational programs. It is based on the standards set by the official care authorities where the consultation objects are standardized and labelled according to the needs of the patient;They are not only necessary for legal and conventional needs, but also for didactic purposes in order to identify and describe disorders and pathologies.

The speech-language pathologist is called upon to write initial and renewal assessment reports as well as letters of recommendation for (among others) schools and universities.

The speech-language pathology report is a written outcome, in a codified style and presentation. The speech therapy report, which is the result of an assessment and an interview, seems to be the concrete realization of the establishment of this link. This materialization, by means of a reactionary tape, makes it possible to consider the diagnostic phase and the use of diagnostic terms as an expert realisation of this speciality language.

Or, between a framed expertise of the profession and the proximate practice of the speech-language pathologist, there is a margin of diagnostic expression by où filtering the free will of the practitioner who can dictate differently and especially more accurately the patient's condition.

On the other hand the norm is somehow reductive or not perceived as such in certain situations. I know an artist who gays in everyday life and does not when he is on stage or singing… In Arabic, there are 2 different sounds the /r/ grasseyé of which we know the various modulations like those of Piaf or Brassens in French, and the [r] roulé which some people cannot manage to make. An actress and producer of Tunisian missions cultivates this particularity as a trademark as part of its charm and originality, which suits him beautifully.

In an attempt to show that classifications of language disorders do not correspond to the needs of speech-language pathologists, Frérique Brin-Henry, a speech-language pathologist and linguist, highlights in her thesis Does terminology create pathology? The case of clinical practice in speech-language pathology diagnosis.It is argued that the practitioner-researcher can be the source of a psychological questioning of speech-language pathology in the sense that he or she is not the only one who can make the diagnosis;It expresses nuances that are not yet codified, playful variations, and generates a lexicon and classifications that can be used in a variety of contexts;He also uses a lexicon and classifications that only he perceives in his practice with his patients, all of whom are particular individuals even though they are catalogued by a spirit of homogeneity, thanks to a jargon used by the different specialists who intervene on the same case.

The researcher proceeded, from 365 speech-language pathology assessment reports, to conduct a descriptive study that brought to light a specific terminology, generated by speech-language pathologists, and that will result in the proposal of a new classification, the Speech-Language Pathology Classification (SLPC);a new classification, the Classification Orthophonique FOndée sur la Pratique Clinique (COFOP), which through the lexicosyntactic treatment of diagnostic terms, illustrates speech therapy diagnostic practice.

Speech therapy is a unique discipline in which language, speech, and communication are both the object of consultation, the means of treatment for disorders affecting it, and the medium for describing those disorders; finally, language in its variations is also the object of speech therapy research.

Instead of the top-down approach that consists in applying to patients predefined nomenclatures that risk influencing and terminating the diagnosis, it is a matter of promoting in counterbalance a bottom-up approach that liberates the practice and the corresponding discourse of the practitioner researcher. It is known that there is a constant but perhaps unofficial evolution of certain terms through slippage, additional qualifications...

The pathologies are expressed under two possible headings:

a FORM that serves to spécify the pathology and the contours of the pathology, and thus rather what it is (formal, mécanicist aspects) : gaiety, dyslexia, language delay… And abilities and skills, in cognitive and linguistic motor functions (memory, language, phonological awareness…), including a quasi-anatomical substrate, objectively valuable.
a NATURE serving à to qualify a process in progress (what emerges from the’reach). The dynamic aspect of the pathology, the impact of the pathology, its persistence and durability, the importance (quantified) are the main criteria: difficulties, disorders, deficits; skills (structuring, organization, management, manipulation, programming) moving towards the linguistic and tacognitive (discourse skills, memory, memory, etc.);It is therefore important to analyze the individual skills of the patient in a specific context and interaction with his environment.

It is the nature of the pathologies that is made explicit by the practitioner and that prescribes the occurrences of the forms and can serve to renew their classification. Speech-language pathology terminology would thus benefit from integrating this Form/Nature dichotomy.

The researcher proposes her Classification Orthophonique FOndeacute;e sur la Pratique Clinique (COFOP), as a blueprint that will serve as a trigger for further study and reflection to avoid the risk of terminology being reeacute;ductrice et pour redonner la palce qui leur convient aux praticiens assistés certes par des nomenclatures mais créateurs et conceptualisateurs des rés des pathologies qu'ils côuit;au plus près.

Référence:

This is the case: Does terminology create pathology? The case of clinical practice in speech-language pathology diagnosis
. https://tel.archives-ouvertes.fr/tel-00655952/document