THE ROLE OF SPEECH-LANGUAGE PATHOLOGISTS
THE ROLE OF SPEECH-LANGUAGE PATHOLOGISTS
Research Articles Josephs KA, Duffy JR. Apraxia of speech and nonfluent aphasia: a new clinical marker for corticobasal degeneration and progressive supranuclear palsy. Current Opinion in Neurology. 2008. 21:688-692.
Reich SG, Grill SE. Corticobasal degeneration. Current Treatment Options in Neurology. 2009. 11:179-185.
Multiple System Atrophy( MSA)
The management of swallowing and speech disorders in MSA requires changing intervention strategies as the disease progresses. Mixed dysarthria is common and tends to emerge earlier in MSA than in PD, is more severe and progresses more rapidly. No efficacious approach to speech therapy has been documented for this patient population. Up to one-third of individuals with MSA may have laryngeal stridor possibly caused by vocal fold abductor paresis or laryngeal dystonia. Therefore, a therapy program should be simple and enhance functional communication as quickly and efficiently as possible and strategies to support communication should be implemented proactively as circumstances allow in advance of anticipated functional decline. Speech evaluation and re-evaluation may help to classify motor speech impairment and clarify the neurodegenerative process.
Evaluate and monitor swallowing early and frequently to anticipate problems and maximize supportive measures.
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Problems with Swallowing
• Difficulty sitting upright at mealtimes
• Tendency towards bolus holding in oral cavity, and discoordinated oral bolus formation and propulsion
• Pharyngeal weakness and disruption of the cricopharyngeal segment
• Excessive accumulation of pharyngeal secretions
• Vocal fold motion impairment may compromise airway protection as the disease progresses
• May have tracheotomy
• Cough may also be compromised
Swallowing Management
• Clinical evaluation should include mealtime observations and suggestions for 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 revisited often
• Patients and their families should agree in advance with a doctor about what can be accomplished with or without placement of a feeding tube
Swallowing Treatment Strategies
• Optimize oral hygiene
• Positioning / support to sit upright against the chair back
• Maintain head in a chin-tucked position
• Alternate food and liquid swallows