• Restrict bolus volumes
• Moist, soft, tender foods with lubrication; blend multiple consistency items
• Use mealtime adaptive devices including cups, plates and utensils to assist with self-feeding
• Consider smaller, more frequent meals to shorten duration of mealtimes
• Ask the neurologist about the role of anticholinergic drugs or botulinum toxin for management of secretions
• There is the potential for lowered blood pressure following meal times( postprandial hypotension)
Speech Problems MSA-P: hypokinetic dysarthria is expected, sometimes mixed with spastic or hyperkinetic dysarthria, and hypophonia( parkinsonian) MSA-A: often ataxic or hypokinetic dysarthria, but may be mixed with spastic dysarthria( autonomic) MSA-C: ataxic dysarthria is most often expected, or in combination with spastic dysarthria( cerebellar)
• Typically, more changes in speech than voice
• Cognitive impairment if present is typically mild
Speaking Strategies
• Speech must become a conscious effort
• Emphasize taking a breath before speaking
• Reduce rate of speech to improve coordination and accuracy
• Intelligibility drills with exaggeration of articulation movements
• Investigate assistive forms of communication such as a communication board or speech-generating device to supplement natural speech, considering motor and cognitive limitations
• Simple augmentative communication will be required in later stages
• Consider personal portable amplifier
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Listener Strategies
• Eliminate distractions to reduce background noise
• Face the speaker with MSA
• Keep comments and questions brief
• Stick with familiar topics, and one topic at a time
• Use“ yes / no” question format
• Ask for clarification,“ Did you say...?”
• Provide choices to ease decision making
Research Articles Tada M, Onodera O, Tada M, Ozawa T, Piao YS, Kakita A, et al. Early development of autonomic dysfunction may predict poor prognosis in patients with multiple system atrophy. Archives of Neurology. 2007. 64:256 – 60.
Wenning GK, Tison F, Seppi K, et al. Development and validation of the Unified Multiple System Atrophy Rating Scale. Movement Disorders. 2004. 19( 12): 1391-1402.