Management of Speech and Swallowing in Degenerative Diseases

by Yorkston, Kathryn M.; Miller, Robert M.; Strand, Edythe A.

• ISBN13: 9780127845746
• ISBN10: 0127845747
• Format: Paperback
• Copyright: 1999-01-01
• Publisher: Pro Ed

Summary

The ability to communicate is critical for people with life-threatening conditions. With loss of communication, they can no longer control their health care, make necessary financial and legal arrangements, or remain close to the family and friends whose support they desperately need. The ability to eat safely is no less critical. When eating becomes so difficult that it loses all enjoyment, patients usually eat too little and their health rapidly declines. These two vital aspects of managing a degenerative disease are typically the responsibility of the speech-language pathologist. Yorkston, Miller, and Strand, speech-language pathologists at a neuromuscular speech and swallowing disorders clinic, set forth the state-of-the-art in compassionate and effective speech and swallowing intervention for four degenerative diseases: amyotrophic lateral sclerosis (ALS), Parkinson's disease, Huntington's disease, and multiple sclerosis (MS). Because restoration of normal speech is an unrealistic goal, the authors emphasize ways to preserve functional communication. They present compensatory techniques for the typical features of each dysarthria and illustrate how to introduce augmentative communication gradually to supplement natural speech, ensuring a smooth transition to nonvocal communication. The authors stress the importance of maintaining adequate hydration and caloric intake in the face of progressive dysphagia. For each stage of involvement, they suggest compensatory strategies and dietary modifications you can implement to allow the patient to eat as safely and independently as possible. You'll read about the different feeding tube options and the transition to supplementary tubefeedings, then to complete alimentation by tube. You'll find scales for rating the deterioration of speech and swallowing in ALS, Parkinson's disease, Huntington's disease, and MS, plus reproducible clinical interview and evaluation forms. The patient and family education section provides handouts about normal speech and swallowing, information about each of the four diseases, and compensatory techniques for speech and swallowing that you can customize for each individual. With Management of Speech and Swallowing in Degenerative Diseases, Yorkston, Miller, and Strand have made an important contribution to improving the quality of care and the quality of life for people living with progressive neuromuscular disease.

Table of Contents

List of Figures	x	(1)
List of Tables	xi	(2)
Preface	xiii
Chapter 1: Amyotrophic Lateral Sclerosis	3	(94)
Nature of the Problem	3	(15)
What is amyotrophic lateral sclerosis (ALS)?	3	(1)
What changes in neural systems are associated with ALS?	3	(1)
What symptoms are associated with ALS?	4	(1)
What is known about the cause of ALS?	5	(2)
What is the typical course of ALS?	7	(2)
How is the diagnosis of ALS made?	9	(1)
What is the role of rehabilitation medicine in the management of ALS?	9	(3)
Are cognitive changes typical in individuals with ALS?	12	(3)
How frequent is emotional lability in ALS, and is it considered a cognitive dysfunction?	15	(1)
What respiratory problems are associated with ALS, and why are these problems so critical?	15	(3)
Speech Disorders	18	(38)
What speech characteristics are associated with ALS?	18	(4)
How rapidly do speech changes occur in ALS?	22	(1)
What information is obtained in a clinical examination of speech and swallowing disorders in adults with degenerative disease?	23	(16)
What approaches to speech treatment are available to individuals with ALS?	39	(17)
Swallowing Disorders	56	(21)
What is the rate of progression of swallowing problems in ALS?	56	(2)
How is swallowing function assessed in individuals with ALS?	58	(2)
What approaches to management are available for swallowing disorders in ALS?	60	(7)
What problems with saliva management are common for individuals with ALS?	67	(2)
How are problems with saliva managed in individuals with ALS?	69	(2)
How is aspiration in ALS managed?	71	(6)
Appendix: Reproducible Forms	77	(9)
Clinical Examination for ALS	77	(4)
ALS Severity Scale	81	(4)
Swallowing Disorders Interview Worksheet	85	(1)
References	86	(11)
Chapter 2: Parkinson's Disease	97	(52)
Nature of the Problem	97	(13)
What is Parkinson's disease?	97	(1)
What is progressive supranuclear palsy, and how is it related to Parkinson's disease?	97	(1)
What changes in neural systems are associated with Parkinson's disease	98	(1)
What symptoms are associated with Parkinson's disease?	98	(2)
How common is Parkinson's disease?	100	(1)
How is the diagnosis of Parkinson's disease made?	100	(1)
How is the overall progression of the disease measured?	100	(1)
How rapidly does parkinsonism progress?	101	(2)
What is the medical management of Parkinson's disease?	103	(1)
What drugs are typically prescribed for Parkinson's disease?	104	(2)
What rehabilitation approaches are available to individuals with Parkinson's disease?	106	(1)
What other problems are associated with Parkinson's disease?	106	(4)
Speech Disorders	110	(20)
What speech characteristics are associated with Parkinson's disease?	110	(2)
How are the components of the speech production mechanism altered in Parkinson's disease?	112	(2)
What is the typical progression of dysarthria in Parkinson's disease?	114	(1)
Has the effectiveness of speech treatment in Parkinson's disease been documented?	115	(5)
What issues are particularly important in assessment of parkinsonian dysarthria?	120	(1)
What approaches to speech treatment are available to individuals with Parkinson's disease?	121	(9)
Swallowing Disorders	130	(7)
Why do individuals with Parkinson's disease experience swallowing problems?	130	(1)
What swallowing characteristics are associated with Parkinson's disease?	131	(1)
How is swallowing evaluated in Parkinson's Disease?	132	(3)
What approaches to treatment are available for swallowing disorders in Parkinson's disease?	135	(2)
Appendix: Swallowing Disorders Interview for Parkinson's Disease	137	(1)
References	138	(11)
Chapter 3: Huntington's Disease	149	(30)
Nature of the Problem	149	(6)
What is Huntington's disease?	149	(1)
What changes in neural tissue and neural systems are associated with Huntington's disease?	149	(1)
What symptoms are associated with Huntington's disease?	150	(1)
What are the stages of functional progression in Huntington's disease?	150	(1)
How is the diagnosis of Huntington's disease made?	151	(1)
What is the medical management of Huntington's disease?	152	(1)
What cognitive and language problems are common in Huntington's disease?	153	(2)
Speech Disorders	155	(9)
What speech characteristics are associated with Huntington's disease?	155	(1)
What management approaches are available for speech difficulties in Huntington's disease?	156	(8)
Swallowing Disorders	164	(7)
What swallowing characteristics are associated with Huntington's disease?	164	(2)
How is swallowing function in Huntington's disease evaluated?	166	(1)
What are approaches to management for swallowing disorders in Huntington's disease?	167	(4)
Appendix: Reproducible Forms	171	(3)
Establishing a Yes/No System	171	(1)
Swallowing Function Interview for Huntington's Disease	172	(1)
Checklist of Swallowing Abnormalities in Huntington's Disease	173	(1)
References	174	(5)
Chapter 4: Multiple Sclerosis	179	(28)
Nature of the Problem	179	(12)
What is multiple sclerosis (MS)?	179	(1)
What changes in neural tissue or neural systems are associated with MS?	179	(1)
Who is at risk for MS?	180	(1)
What symptoms are commonly associated with MS?	180	(1)
How is the diagnosis of MS made?	180	(2)
What is the typical course of MS?	182	(1)
How is level of function in MS measured?	182	(1)
Can the course of Ms be modified?	183	(1)
How are the symptoms of Ms managed?	183	(2)
What types of devices are used to increase level of function?	185	(1)
What types of cognitive impairment are typical in MS?	185	(2)
What proportion of the MS population experiences cognitive problems?	187	(1)
Who is at risk for cognitive impairment in MS?	187	(1)
How are the cognitive problems in MS managed?	188	(1)
What is the relationship between cognitive function and affective disorders in MS?	188	(1)
Are the language skills of people with MS impaired?	189	(1)
How is employment affected by MS?	189	(2)
Speech Disorders	191	(9)
What are the typical speech characteristics of individuals with MS?	191	(1)
How common is dysarthria in MS?	191	(2)
What speech assessment issues are particularly important in MS?	193	(2)
How is dysarthria in MS managed?	195	(5)
Swallowing Disorders	200	(3)
How often do swallowing problems occur in MS?	200	(1)
What are the characteristics of swallowing disorders in MS?	200	(1)
What are the typical interventions for swallowing difficulty in MS?	201	(2)
References	203	(4)
Operational Definitions	207	(10)
Handouts for Patients and Families	217	(34)
Normal Speech Production	217	(1)
Dysarthria	218	(1)
Normal Swallowing and Disorders of Swallowing	219	(2)
Amyotrophic Lateral Sclerosis (ALS)	221	(1)
How ALS Affects Speech	222	(2)
How ALS Affects Swallowing	224	(1)
Parkinson's Disease	225	(1)
How Parkinson's Disease Affects Speech	226	(2)
How Parkinson's Disease Affects Swallowing	228	(1)
Huntington's Disease	229	(1)
How Huntington's Disease Affects Speech	230	(2)
How Huntington's Disease Affects Swallowing	232	(1)
Multiple Sclerosis (MS)	233	(1)
How MS Affects Speech	234	(2)
How MS Affects Swallowing	236	(1)
Tips for Understanding Severerly Dysarthric Speech	237	(1)
Ways You Can Compensate for Dysarthria	238	(3)
Augmentative Communication	241	(2)
Ways You Can Compensate for Swallowing Difficulties	243	(3)
Dietary Changes to Compensate for Swallowing Difficulties	246	(3)
Emergency Plan	249	(1)
Useful Addresses	250	(1)
Index	251