Tag: Clinicians

The answer is NO.

Most patients have the perception that when they see or being referred to a speech therapist, they must receive some form of active treatment that involves active exercises. This may not be true all the time.

Why?

From speech therapy perspective, a medical diagnosis that explains the presentation of speech/ language/ voice / swallowing difficulties is required before any active therapy can be initiated.

That is because these difficulties are usually symptoms presented as a result of certain medical condition(s). For example, a new onset of swallowing difficulty is actually a symptom of neurological disorder(s) or brain related problem(s) that require further diagnosis by a neurologist. The causes may include stroke, neurodegenerative diseases, myasthenia gravis and etc.

Some active treatment may contraindicate the presenting medical diagnosis. For example, for myasthenia gravis (MG), the muscles will weaken further as one gets more tired/fatigue. As such strengthening exercises would not be appropriate for this condition. In fact, compensatory methods such as eating small amount but frequent meals if patient gets fatigue easily and unable to finish up full meal safely may be a better choice of management. In fact treatment for MG that has been shown to be more effective in improving functions include medical intervention and/or surgical intervention. Speech therapist plays the role in assessing suitability for oral feeding, teaching compensatory strategies and providing information counseling.

So for any presenting symptoms that do not associate with any preexisting medical diagnoses, perhaps the next best management is to refer the patient to see a medical specialist who can assess and potentially provide a diagnosis that may explain the presenting symptoms.

In summary, active speech therapy that involves exercises need not be the choice of management all the time especially if there is no confirmed medical diagnoses. Finding out the cause(s) of the symptom(s) / presentation(s) will allow us to make better clinical diagnosis which will lead to better management / treatment that is usually more cost effective. This is especially so with the rising cost of healthcare in Singapore and Worldwide.