The Power of Speech Therapy
Not being able to speak, communicate effectively, or swallow without difficulty can severely impair your quality of life. The right treatment can make a huge difference.
Last year, Madam Agnes Fong’s 87-year-old father was referred to a speech therapist after he had recurrent bouts of pneumonia. Initially, Mdm Fong was puzzled by the referral, wondering how a speech therapist could help with her father’s chest infection.
To her surprise, it was revealed that the pneumonia episodes stemmed from her father’s deteriorating ability to swallow properly, causing food particles to enter his airways and lungs. After a thorough evaluation, the speech therapist worked with Mdm Fong and her father’s caregiver to modify the elderly man’s diet. The speech therapist also taught them safer feeding techniques.
“Consulting with the speech therapist proved invaluable as we were unsure how to prevent choking incidents at home,” Mdm Fong explains. “We learnt to blend food to a consistency suitable for my father, and even discovered techniques to thicken water to prevent it from entering his airways.”
Similar to physical therapy and occupational therapy, speech therapy plays a pivotal role in supporting individuals with medical conditions or injuries that limit their physical capabilities during the recovery process.
Speech therapists assist patients of all ages with various communication, voice, and speech disorders or impairments. They enable individuals to improve their verbal abilities so that they can understand others and effectively express and communicate their thoughts.
Ms Chai Cai Ling, a speech therapist from the Rehabilitation ervices Department at Khoo Teck Puat Hospital (KTPH), highlights a common misconception — that speech therapy solely addresses speech disorders. In reality, these healthcare professionals also work with patients and their caregivers in managing swallowing difficulties, as seen in Mdm Fong’s case.
At KTPH, speech therapists work collaboratively within a multidisciplinary rehabilitation team that includes other medical and allied health professionals. Most of their patients are middle-aged to elderly individuals. Conditions they often encounter range from congenital (present from birth) disorders or those that develop during childhood, to acquired disorders arising from medical conditions or injuries such as stroke, brain injury, and dementia.
Speech and Communication Disorders
One common communication disorder encountered by Ms Chai and her colleagues is aphasia — a condition caused by damage to the brain region responsible for language expression and
comprehension, often as a result of stroke. Patients with aphasia have trouble speaking or understanding spoken language.
Dysarthria and apraxia are other frequently observed speech and communication disorders. Dysarthria causes slurred or slow speech due to weak muscles involved in speech. This is often caused by brain or nerve damage or medication side effects.
Apraxia refers to difficulties in coordinating tongue and mouth movements for speech. It can develop in childhood or as an acquired condition from head trauma, stroke, or a brain tumour.
Speech therapists also help patients with cognitive communication disorders resulting from conditions like stroke, brain injury, tumours, degenerative brain disorders, or neurological damage. These disorders impact memory, organisation, and problem-solving, and hinder abilities in speaking, listening, reading, writing, and social interaction.
During rehabilitation, speech therapists use behavioural techniques, strategies rooted in neuroplasticity, and devices to enhance or restore specific skills. Neuroplasticity is the brain’s ability to reorganise and establish new connections in response to new experiences, aiding the relearning of skills in individuals with brain injuries.
Patients’ loved ones are also roped in to undergo education to learn how to better support them.
“In addition, we set collaborative and functional goals to ensure that therapy is meaningful to patients. For example, in language therapy, we may target items for daily activities at home, such as fruits or household items. The patient is taught to figure out the attributes of the item, including its location, use, and category. This process can be repeated several times daily for a range of target items before moving on to other targets,” Ms Chai shares.
Speech therapy sessions may involve activities such as tongue and mouth exercises to improve
coordination, and playing word games and crossword puzzles to enhance cognitive skills. For
individuals with speech disorders that hinder proper mouth and tongue movements, they may practise reading aloud.
When Eating and Swallowing Become a Challenge
The ability to eat and drink is essential for our nourishment. However, for those experiencing swallowing difficulties, even drinking water can become a health hazard. “If left untreated, this may lead to chest infections, increased phlegm production, fever, and malnutrition,” says Ms Chai.
Patients with dementia, degenerative disorders like Parkinson’s disease, or long-term respiratory issues such as chronic obstructive pulmonary disease (COPD), face a higher risk of developing swallowing problems. COPD is a condition characterised by damaged lungs and airways, resulting in breathing-related difficulties.
Speech therapists employ a range of tests to assess and diagnose swallowing issues. Bedside
examinations are commonly conducted, during which the therapist physically evaluates the patient’s swallowing function by having them ingest substances of various consistencies, such as thickened fluids, soft foods, biscuits, or oats. If necessary, the speech therapist may request additional tests like a swallowing test with X-ray or endoscopy.
To manage swallowing issues, patients and caregivers are taught techniques to modify food types, textures, and consistencies. For instance, thickeners can be added to fluids like water or soup to give individuals more time to swallow.
In some cases, novel devices are used to assess and manage swallowing difficulties. For example, surface electromyography (sEMG) is a biofeedback tool that records muscle activity during treatment for dysphagia. It involves placing electrical pads on swallowing muscles in the throat to visualise muscle activity. This biofeedback can help patients increase effort and duration during swallowing attempts.
The Recovery Journey
The extent of recovery from speech, language, communication, or swallowing disorders depends on various factors. “If the cause of the disorder is neurological, complete recovery may not be attainable. However, individuals can still reach an adequate level of function and adapt to their new lives. For patients with other reversible conditions, full recovery from speech and cognitive difficulties is possible,” says Ms Chai.
"We set collaborative and functional goals to ensure that therapy is meaningful to patients."
Ms Chai Cai Ling, Speech Therapist, Rehabilitation Services, Khoo Teck Puat Hospital
For those who have trouble coordinating their swallowing process, identifying the underlying cause is crucial. “A swallowing disorder typically stems from an underlying medical condition. If the condition is reversible, the swallowing problem can improve,” says Ms Chai.
While not everyone may achieve a full recovery, early and timely intervention will undoubtedly enhance outcomes and prevent the condition from worsening, empowering individuals to lead more fulfilling lives. LW
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