Management of Speech and Swallowing in Degenerative Diseases

Book excerpt: 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.