The Current State and Future Directions of Swallowing Care in Amyotrophic Lateral Sclerosis

Abstract

Purpose of Review Difficulty swallowing (dysphagia) is of great concern to patients with ALS as its complications can increase mortality and reduce the quality of life. This review aims to provide an overview of the recent developments and the current state of assessment, treatment, and management of dysphagia in ALS. Recent Findings The optimal timing of assessment, treatment, and management of dysphagia may be early in the ALS disease process, even before the dysphagia occurs. There is wide heterogeneity in SLP practice patterns for the management of dysphagia. Summary Dysphagia is common and debilitating; however, for various reasons, there is no clear consensus on how best to manage dysphagia in this population. Future work centered around predicting swallowing decline and improving interventions aimed at prolonging swallowing function in the early stages of the disease process may promote improved dysphagia care.

Hypotussic cough in persons with dysphagia: biobehavioral interventions and pathways to clinical implementation

“…The SLP recommends a repeat videofluoroscopic exam given values which indicate increased risk for unsafe swallowing (PEFR <397 L/min) and ineffective airway clearance (PEFR <297 L/min) ( 21 , 23 ). In a collaborative patient education session, the registered dietician and SLP provide care and support regarding her choice to decline PEG placement and remind her that they remain open to revisiting the conversation on PEG placement if her goals of care change over time (particularly in light of her FVC being above 50% to 60% predicted, a relevant factor for early PEG insertion and survival outcomes) in context of declining respiratory function ( 124 , 126 – 128 ). Given that her FVC is ≥70% predicted, a mild-intensity 12-week combined RST program at 30% load is presented as a treatment option ( 76 , 118 , 128 ), to which she is receptive.…”

“…In a collaborative patient education session, the registered dietician and SLP provide care and support regarding her choice to decline PEG placement and remind her that they remain open to revisiting the conversation on PEG placement if her goals of care change over time (particularly in light of her FVC being above 50% to 60% predicted, a relevant factor for early PEG insertion and survival outcomes) in context of declining respiratory function ( 124 , 126 – 128 ). Given that her FVC is ≥70% predicted, a mild-intensity 12-week combined RST program at 30% load is presented as a treatment option ( 76 , 118 , 128 ), to which she is receptive. Moreover, as her PEFR is greater than 270 L/min, the SLP recommends consultation with respiratory therapy for evaluation and consideration of proximal airway clearance techniques (i.e., manual assisted cough, lung volume recruitment, or “cough assist” mechanical insufflation-exsufflation techniques as clinically indicated) as proximal airway techniques may serve as a meaningful adjunct to augment airway protective behaviors and reduce risk of aspiration during meals ( 108 , 118 , 129 ).…”

Management and Treatment for Dysphagia in Neurodegenerative Disorders

“…Medical professionals may increase the bolus size to stimulate a swallow response or decrease it for patients who require multiple swallows per bolus. Larger bolus volumes have been associated with faster pharyngeal transit, while smaller volumes may be safer for swallowing in some populations [ 51 , 52 ].…”

Reliability and Validity of the Korean version of the Center for Neurologic Study Bulbar Function Scale (K-CNS-BFS): An observational study

“…Bulbar dysfunction causes significant weight loss and eventually reduces the survival and quality of life. [ 2 , 5 – 9 ]…”

“…Therefore, evaluation of bulbar dysfunction is clinically important for improving bulbar function, preventing long-term complications, and planning further treatment. [ 6 , 9 – 11 ] In order to evaluate bulbar dysfunction, clinical, radiological, and electrophysiological assessments are required. Multidisciplinary approaches are immediately needed in addition to a neurological approach, and rehabilitation or procedures the evaluation must be considered.…”