THE ROLE OF SPEECH-LANGUAGE PATHOLOGISTS
THE ROLE OF SPEECH-LANGUAGE PATHOLOGISTS
Progressive Supranuclear Palsy( PSP)
Changes in swallowing and speech often occur early in PSP, typically with more profound and rapid deterioration compared with Parkinson’ s disease( PD). Management of swallowing and speech disorders requires changing intervention strategies as the disease progresses.
Dysphagia is one of the most common causes of mortality, with recurrent respiratory infections and respiratory deaths more common in PSP than PD. Early swallowing evaluation and treatment and frequent monitoring of swallowing function allow for problem anticipation and use of supportive measures to minimize complications such as aspiration pneumonia and malnutrition.
No efficacious approach to speech therapy has been documented for this patient population, but speech evaluation and re-evaluation may help to classify motor speech impairment type and clarify the neurodegenerative process. Therapy programs should focus less on speech outcomes alone and be simple and enhance functional communication as quickly and efficiently as possible. Strategies to support communication should be implemented proactively as circumstances allow in advance of anticipated functional decline.
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Problems with Swallowing Patients often lack awareness of swallowing difficulties including:
• Difficulty looking down at the plate
• Mouth stuffing and rapid drinking
• Tremor or stiffness interfere with self-feeding
• Restricted head and neck posture or hyperextension
• Delayed pharyngeal swallow onset
• Poor cough
• Occasional difficulty opening the mouth
Swallowing Management: clinical evaluation should include mealtime observations and suggestions to promote easier and safer swallowing.
• Query the caregiver about swallowing symptoms, as patient may not recognize difficulties
• Family should maintain a journal of observations to help define and adjust management strategies
• VFSS, if conducted, needs to replicate the home eating environment and rule out non-neurogenic contributions
• Decompensation and aspiration may not be observed in a controlled VFSS environment, thus severity of dysphagia may not be truly appreciated
• Discussions regarding feeding tube options should take place sooner rather than later, and repeated frequently
• Patient and family should agree in advance with a doctor about what can be accomplished with or without placement of a feeding tube