THE ROLE OF SPEECH-LANGUAGE PATHOLOGISTS
THE ROLE OF SPEECH-LANGUAGE PATHOLOGISTS
Research Articles Goetz CG, Leurgans S, Lang AE, Litvan I. Progression of gait, speech and swallowing in progressive supranuclear palsy. Neurology. 2003. 60( 6): 917-22.
Wenning GK, Litvan I, Tolosa E. Milestones in atypical and secondary Parkinsonisms. Movement Disorders. 2011. 26( 6): 1083-1095.
Corticobasal Degeneration( CBD)
Changes in swallowing and speech often occur early in CBD and are typically more severe and deteriorate more rapidly than Parkinson’ s disease( PD). Management requires changing intervention strategies as the disease progresses.
No efficacious approach to speech therapy has been documented for this patient population. It may help, however, to evaluate and re-evaluate motor speech impairment type and clarify the neurodegenerative process. Therapy should be simple and enhance functional communication as quickly and efficiently as possible instead of focusing on speech outcomes alone and strategies to support communication should be implemented proactively as circumstances allow in advance of anticipated functional decline.
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Swallowing function should be evaluated early and monitored frequently to anticipate problems and provide appropriate supportive measures. Dysphagia is one of the most common causes of mortality, with recurrent respiratory infections and respiratory deaths more common in CBD than PD. The goal of swallowing therapy is to minimize complications such as aspiration pneumonia and malnutrition through early symptomatic treatment.
Problems with Swallowing
• Impaired self-feeding
• Slow or incomplete chewing
• Oral and swallowing apraxia
• Slowed swallowing movements
• Patients may be aware of swallowing difficulties
Swallowing Management
• Clinical swallowing evaluation should include mealtime observations and suggestions to promote easier and safer swallowing
• 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 truly be 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 is possible with or without placement of a feeding tube