speech and swallowing difficulties in MND

Question 1

speech and language therapy can

Answer 1

assess speech and swallowing,

educate patient and family about motor speech and swallowing,

educate about dysarthria and dysphagia,

manage motor and speech swallowing difficulties,

assist in maintaining functional communication,

assist in achieving adequate nutrition.

Question 2

motor speech and swallowing rely on the function of which cranial nerves?

Answer 2

V trigeminal, 
VII facial,
IX glossopharygeal, 
X vagus,
XI accessory, 
XII hypoglossal

Question 3

what motor speech difficulties exist in MND

Answer 3

dysarthria: ALS (spastic and flaccid due to both upper and lower motor neuron),

PBP, PLS (only spastic dysarthria, as upper motor neuron involvement)

apraxia of speech reported in some (duffy et al 2007)

Question 4

what voice quality changes generally occur in MND

Answer 4

harsh voice, 
hypernasality,
breathy voice,
voice tremor,
strain, 
slowed rate,
prolonged phonemes, high pitch

Question 5

how can FTD impact on communication abilities further?

Answer 5

emotionally detached, apathy,
selfishness,
decreased facial expression,

difficulty planning and keeping up with topics,

socially innappropriate

Question 6

SALT focuses on what in MND

Answer 6

educating patient and family and maintaining functional communication,

stategies to maximise ability for verbal communication,

alternative augmentive communication (AAC)
introduced as early as possible-with ranging complexity from hanheld. Apps, dedicated computers

Question 7

what are the four phases of a normal swallow

Answer 7

oral preparation,

oral,

pharyngeal,

oesophageal

Question 8

what areas control swallowing

Answer 8

frontal swallowing area: primary motor cortex,

Cental pattern generator (medullary swallowing centre)

brainstem nuclei

Question 9

what is dysphagia?

Answer 9

eating and drinking disorders which may occur in the oral, pharygeal and oesphageal stages of degultition.

Problems posititoning food in the mouth and in oral movements (ie sucking, mastication)

Question 10

what are the signs and symptoms of dysphasia in MND?

Answer 10

coughing when eating/drinking,

more frequent swallowing,

unable to clear mouth or throat,

drooling,

difficulty swallowing medication,

gagging or choking on food, liquids or saliva

Question 11

what are some problems associated with dysphagia?

Answer 11

embarassment and loss of enjoyment eating,

dehydration (sticky saliva/uncomfortable dry swallow)

malnutrition,

weight loss

Question 12

what are two common dysphagia problems in MND

Answer 12

excess saliva,

aspiration

Question 13

what assessments can be performed for dysphagia?

Answer 13

subjective: palpation, and cervical auscultation
objective: videofluroscopy (VFSS),

Fibre endoscopic evaluation of swallow (FEES)

Question 14

what is normally reccomended when oral intake of food is no longer safe?

Answer 14

PEG