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An increasing number of speech-language pathologists have become involved in the evaluation and management of patients with swallowing disorders. Approximately sixty percent of practicing speech-language pathologists in health care settings throughout the United States are involved in dysphagia intervention according to the 1993 ASHA Omnibus survey (ASHA ,1995). It has been estimated that nearly 15 million Americans suffer from disorders of deglutition that potentially alter their quality of life, rehabilitation potential and survival (Simmons, 1986). In addition to increased patient demand impacting on the growing number of clinicians involved with dysphagic patients, consumers (e.g., patients, families, physicians, etc.) have also begun to recognize dysphagia management as a clinical science and the value added patient care service. The majority of dysphagic patients seen in hospitals and skilled nursing facilities have concomitant communication problems that may include disorders of voice, motor speech, language or cognition (Martin & Corlew, 1990). From a continuity of care arid cost perspective it follows that the speech pathologists! traditionally trained in the function of the neurologic system and vocal tract, also treat the functionally impaired upper aerodigestive tract comprised of structures common to the communication process (Martin & Corlew, 1990)1 However, speech-language pathologists have met with several challenges in their attempts toward dysphagia intervention with the often medically complex, multisystem involved patient. These challenges include the following:

Dysphagia evaluation and management: Clinical training, clinical competency and speciality recognition