Who treats speech and swallowing after a stroke?
A speech-language therapist. The same professional helps with speech and with swallowing, because the muscles and nerves involved overlap. Physiotherapists do not treat either.
The World Health Organization (WHO) says stroke rehabilitation is multidisciplinary, meaning a team including physiotherapy works together [1]. In practice that team includes the doctor, nurses, speech-language therapists, occupational therapists and physiotherapists. Each looks after a different part of recovery.
What changes can happen?
There are two separate problems, and a person can have either or both.
- Aphasia is trouble finding or understanding words. The person may speak fluently but make little sense, or understand but struggle to answer.
- Dysarthria is slurred, weak or slow speech because the muscles are weak, though the person knows what to say.
- Dysphagia is trouble swallowing, which can let food or drink go into the lungs. See our glossary on dysphagia referral.
What should you watch at meals?
Swallowing problems can be silent, so watch closely in the first weeks.
- Coughing or throat clearing during or after eating.
- A wet, gurgly voice after a mouthful.
- Food collecting in the cheek, or leaking from the lips.
- Fever or a chest infection after meals.
- Eating very slowly or avoiding meals.
- Weight loss.
Tell the doctor the same day if you see these. Do not thicken fluids or change the diet yourself unless the therapist has shown you how.
How do you ask for a referral in Ipoh?
Speak to the ward team before discharge, or ask the doctor at the follow-up clinic, at Hospital Raja Permaisuri Bainun or another hospital. Say, “My father has trouble speaking and swallowing since his stroke. Can he see a speech-language therapist?” Ask when the first appointment is and who to call if swallowing worsens.
Private hospitals such as Fatimah and Pantai may also offer speech therapy; ask them about waiting time and charges. Bring the discharge letter. If you are in KL, you can phone the ward on your parent’s behalf.
How should you talk with someone who has aphasia?
Ipoh families mix languages at home: Cantonese, Hokkien, Mandarin, Malay, Tamil and English. After a stroke, a person may recover one language faster than another. Tell the speech-language therapist every language your parent uses.
Keep sentences short, ask yes-or-no questions, and give time to answer. Use pictures, gestures or writing as well. Turn off the television when talking, and never talk about your parent as if they are not there.
Where does physiotherapy fit?
Movement affects both speech and swallowing, and that is where physiotherapy helps. A person who slumps in the chair swallows less safely. We work on sitting balance, neck and trunk control and posture at the dining table, and follow the speech-language therapist’s instructions on food and seating.
Read about stroke rehabilitation at home and our stroke family guide for the wider plan. Our Canning Garden centre, near Fatimah Hospital, is opening soon. Home and centre prices differ and are quoted on WhatsApp.
When is it an emergency?
Choking that does not clear, a blue colour around the lips, severe breathlessness or a sudden loss of speech needs emergency care. Call 999 or go to the nearest emergency department.