Perspectives on Swallowing and Swallowing Disorders (Dysphagia)

Editor's Corner

Edwards, D. — 2013-03-07T09:00:20-08:00

What is ALS and What is the Philosophy of Care?

Britton, D., Cleary, S., Miller, R. — 2013-03-07T09:00:20-08:00

Amyotrophic lateral sclerosis (ALS) is a rapidly degenerative disease involving upper motor neuron (UMN) and lower motor neuron (LMN) impairments, for which there is currently no cure. It is necessary for speech-language pathologists to understand the underlying neurological pathophysiology and philosophy of care for individuals with ALS in order to facilitate effective assessment and intervention in this population. The authors of this article review the characteristics of ALS, as well as the general philosophy of care for individuals with ALS. The article covers the topics of assessment and intervention within the context of a multidisciplinary ALS clinic; surgical and pharmacological interventions; and monitoring disease progression, including tracking respiratory status. Periodic multidisciplinary assessment aids in appropriate medical and therapeutic interventions, symptom management, and quality of life. Periodic assessment of respiratory function is especially important to aid in timely delivery of appropriate interventions.

Nutritional and Metabolic Support in Adults With Amyotrophic Lateral Sclerosis

McDonagh, M. — 2013-03-07T09:00:20-08:00

Amyotrophic lateral sclerosis (ALS) is an incurable, degenerative, neuromuscular condition. Nutritional and metabolic support is an integral component of care for patients with ALS because those capable of maintaining a normal nutrition status exhibit a slower rate of disease progression. Although there are multiple barriers to maintaining a normal nutrition status, the multidisciplinary team approach can facilitate early identification of symptoms, early intervention, and better outcomes for these patients. Barriers that patients often encounter include dysphagia, hypermetabolism, hypometabolism, upper extremity weakness, early satiety, constipation, depression, and loss of appetite. The role of the registered dietitian in the multidisciplinary ALS clinic is to intervene by providing a high standard of nutrition support. Further research into other facets of nutrition for ALS could lead to new interventions to slow weight loss and provide evidence-based guidelines for nutrition professionals. Areas for further research include the use of appetite stimulants, dietary supplements, delayed gastric motility, diet composition, metabolic rate, and the development of a standard equation for estimation of caloric needs in ALS.

An Overview of Respiratory Treatments for Individuals With Amyotrophic Lateral Sclerosis

Cleary, S., Richman-Eisenstat, J. — 2013-03-07T09:00:20-08:00

Given the limited life expectancy of individuals diagnosed with amyotrophic lateral sclerosis (ALS) and the high likelihood that patients will suffer from a breathing difficulty and an encumbered airway, promoting the highest level in the ability to maintain an open and clear airway is of the utmost importance to patients and their families. In this article, authors describe the basic mechanisms of neuromuscular-induced respiratory failure and explain the underlying physiological rationale for four commonly used respiratory treatments in cases of advanced ALS. The article also includes research on the use of manual breath stacking to improve coughing and airway clearance while swallowing.

Management of Dysphagia in Individuals With Amyotrophic Lateral Sclerosis

Bedore, B. — 2013-03-07T09:00:20-08:00

This article presents a comprehensive approach to the evaluation and treatment of dysphagia in individuals with amyotrophic lateral sclerosis (ALS). The author considers the role of therapeutic exercise in ALS in the context of dysphagia rehabilitation.

Food for Thought: A Journey to Food in a Can Requiring No Thought at All

Sterling, L., Axline, R., Ragland, P. — 2013-03-07T09:00:20-08:00

Speech-language pathologists have little, if any, formal training in counseling during graduate school. Working with neurodegenerative diseases such as amyotrophic lateral sclerosis (ALS) requires more listening than talking and direct therapy. Knowing what to say and how to address patient emotions about loss of speech and swallowing function can be difficult. We share an patient with ALS's perspective of her experiences in life as she lost her ability to go out to lunch with her coworkers and fought to maintain her weight. We introduce the SPIKES protocol (Baile et al., 2000) for delivering "bad news" as a format for speech-language pathology sessions when broaching difficult topics such as percutaneous endoscopic gastrostomy (PEG) tube placement.