Speech therapists conduct assessments and therapy in the areas of communication and swallowing disorders. We also strive to make appropriate recommendations and suggest suitable therapy based on the assessment findings.

We provide assessment and interventions for the following:

Acquired cognitive communication impairment

Cognitive communication disorders refer to difficulties with carrying out communication tasks (e.g. reading, writing, speaking, and listening) due to problems with one’s ability to think (i.e. cognition). These disorders can arise from strokes (especially those affecting the right side of the brain), brain tumors, traumatic brain injuries, brain infections and other neurological conditions, such as dementia.

Assessment includes identifying which aspect of cognition (e.g. attention, perception, memory, organization, reasoning and problem solving) is affecting communication. Subsequently, relevant therapy techniques are recommended. Some types of cognitive communication disorders such as those arising from strokes and traumatic brain injuries may be more suitable for therapy.

Acquired language disorder

Aphasia, also known as acquired language disorder, may occur after a person suffers from a left-sided stroke/brain injury. There are two components of aphasia; Difficulties understanding and difficulties expressing. These two components can occur individually, but are commonly present in combination.

Assessment is used to identify the nature of language difficulties and strengths in current language function. Goals are set with patients and families after assessment. Some therapy sessions we offer include rehabilitation of language function through individual or group settings as well as introduction of compensatory strategies to patients and their communication partners.

Acquired speech disorder

There are two types of acquired speech disorders, namely dysarthria and apraxia of speech.

Dysarthria results from weakness, tension and/or slowed movement in muscles involved in speaking (e.g. muscles of face, mouth or breathing muscles), and is usually caused by stroke or other brain injuries.

Apraxia of speech is often a result of stroke/brain damage to the left side of the brain and often co-occurs with aphasia. Deficits in muscle programming and planning results saying the wrong word which are alike in sound (e.g. morning → mocking) or switching the position of sounds in a word (e.g. green glass → gleen grass).

Assessment includes identifying nature of speech difficulties while interventions we offer include learning strategies to improve speech clarity and practicing speech drills.

Swallowing disorder

Swallowing disorder is also known as dysphagia. Speech therapists specifically assess and treat oropharyngeal dysphagia.

To assess oropharyngeal dysphagia, speech therapists will first conduct a bedside swallow evaluation in the clinic. Activities done during the bedside swallow evaluation include physical examination of your mouth and throat, drinking fluids of various thicknesses and eating solids of various textures. Should a more objective assessment be needed, a video fluoroscopic swallow study or flexible endoscopic evaluation of swallow can be conducted.

Based on the bedside evaluation, changes to diet and fluid texture and consistency and/or feeding precautions will be recommended. Exercises to strengthen muscles involved in swallowing may also be taught.

Voice disorder

Patients with dysphonia (voice disorders) are encouraged to see an Ear, Nose & Throat (ENT) doctor [hyperlink to CGH ENT main site] for initial evaluation of the vocal cord structure. If suitable, patients will be referred to Speech Therapy for vocal rehabilitation.

Vocal rehabilitation aims at regaining optimal vocal function and preventing vocal abuse or misuse. This is done through voice therapy techniques and management of other factors such as vocal hygiene and laryngopharyngeal reflux.

An initial speech therapy session includes a detailed interview on the voice, perceptual voice assessment and/or acoustic analysis. Therapy techniques and/or vocal strategies will then be taught based on the assessment and evaluation of the voice.

Post cochlear implantation rehabilitation

Cochlear implants are hearing devices for hearing restoration in individuals who are severely to profoundly deaf and are unable to derive benefit from conventional hearing aids. Although cochlear implants allow one to have access to sounds, one might not be able to fully interpret the sounds and understand what is being said.

To be a good listener, one has to integrate a number of skills, of which hearing is only one out of many. Listening requires attention and intention to access and utilise acoustic information. Therefore, recipients need to spend time to re-learn the sounds and speech components reproduced by the cochlear implant.

Your speech therapist will be able to guide you in the right direction while you learn to adapt your listening skills to your new devices. In order to do so, your speech therapist will first conduct an assessment before formulating a therapy plan.

Assessment sessions can include:

• Understanding your functional listening skills
• Understanding your communication needs and expectations
• Pre-operative counselling

Intervention sessions can include:

• Auditory training
• Telephone training
• Training on communication repair strategies

Tracheostomy

A tracheostomy is a tube that is placed through a surgical opening through the front of the neck into the windpipe. This allows for breathing through the neck, bypassing the mouth and nose. The presence of a tracheostomy tube will affect your ability to speak and may also affect your swallowing ability.

Speech therapists can help manage communication and swallowing for patients with a tracheostomy. They also work alongside a multidisciplinary team in assessment and management towards the removal (weaning) of a tracheostomy tube

Laryngectomy

Total laryngectomy is a surgical procedure where the larynx (voice box) is removed completely and a permanent opening (stoma) is created at the neck for breathing.

Speech therapists work closely with ENT surgeons in helping patients with total laryngectomy by providing specialised services such as:

• Pre-operation counselling
• Post-operation care for the stoma
• Post-operation swallow rehabilitation and voice restoration

There is a close collaboration between doctors and therapists to help patients achieve better swallow and communication function after the surgery.

Hospital to Home Service

Our therapists are part of a multidisciplinary team, which assists in the successful transition from hospital to home by means of home visits and interventions where appropriate.