Swallowing and Speech in Ataxia
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Transcript Swallowing and Speech in Ataxia
Laura Gregory, MA CCC-SLP
Rehab Without Walls - San Antonio, TX
SWALLOWING AND SPEECH IN ATAXIA:
A TEAM APPROACH
DISCLAIMER
The information provided by speakers in any
presentation made as part of the 2012 NAF Annual
Membership Meeting is for informational use only.
NAF encourages all attendees to consult with their
primary care provider, neurologist, or other health care
provider about any advice, exercise, therapies,
medication, treatment, nutritional supplement, or
regimen that may have been mentioned as part of any
presentation.
Products or services mentioned during these
presentations does not imply endorsement by NAF.
PRESENTER DISCLOSURES
Laura Gregory, MA CCC-SLP
The following personal financial relationships
with commercial interests relevant to this
presentation existed during the past 12
months:
No relationships to disclose or list
OUTLINE OF PRESENTATION
Overview of the swallowing process
Overview of speech
The team approach
Specific treatments and compensatory
strategies
SWALLOWING TERMINOLOGY
Dysphagia – the clinical term for a disorder of
swallowing
Speech Language Pathologist (SLP) aka speech
therapist – diagnoses and treats dysphagia
Dysphagia is typically diagnosed through a
videofluoroscopic or videoendoscopic swallow
examination.
VIDEO OF A NORMAL SWALLOW
EFFECTS OF ATAXIA ON THE SWALLOW
Decreased coordination and oral control
Delayed swallow initiation
Decreased pressure gradient to propel the
bolus
Impaired timing of reflexes for airway protection
Pure cerebellar ataxia does not cause
decreased strength or sensation
WHAT ARE THE SIGNS AND SYMPTOMS?
Coughing, especially with liquids and mixed or
crumbly textures
Penetration:
food/liquid enters the airway but does
not pass below the larynx
Aspiration: food/liquid enters the airway and
passes to the lungs – can lead to pneumonia
Food feeling stuck in throat
Liquids going into nasal cavity
EFFECTS OF ATAXIA ON SPEECH
Articulation of speech sounds is a complex
process of movements of oral structures
coordinated with respiration and voicing.
Ataxia affects speech in the areas of
Timing
Coordination
SPEECH DIFFICULTIES INCLUDE:
Slurring of sounds
“Scanning speech” with equal emphasis on each
syllable
Difficulty modulating volume of voice
Difficulty controlling force or direction of oral
movements (overshoot, undershoot)
Inadequate or poorly coordinated breath support
These are referred to as Ataxic Dysarthria
RESULT
Difficulty communicating with family and
friends
Fatigue
SO WHAT CAN I DO?
Educate
yourself and others
Be aware of early signs of difficulty with
swallowing and speech
Seek help before swallowing and speech
difficulties become a major issue
Recruit a support network
IT TAKES A TEAM
WHO ARE THE PLAYERS?
YOU!
Caregivers/family
Friends
Physicians
Speech pathologist
Occupational therapist
Physical therapist
Social worker/therapist
Dietitian
BECAUSE YOU ARE NOT JUST A MOUTH
VS
ROLES OF THE PLAYERS
YOU!
You know yourself best, so you are in the best
position to make decisions regarding your
healthcare in partnership with the team. The
team approach won’t work without YOUR
motivation and participation
CAREGIVERS, FAMILY, AND FRIENDS
Eating is a social
activity!
Communication goes two ways.
PHYSICIAN
Discusses signs and symptoms with you
Makes appropriate referrals
Communicates with the team along the way
THERAPISTS
Speech Pathologist
Physical Therapist
Evaluation and treatment of the oral/pharyngeal and
respiratory components of swallowing
Evaluation and treatment of postural and head control
as they relate to speech and swallowing. Can also
address respiration.
Occupational Therapist
Similar to physical therapist plus adaptive equipment
OTHER POTENTIAL TEAM MEMBERS
Social Worker/Therapist
Emotional
support for adjustment to disability.
Assistance in finding compensatory strategies to
decrease frustration when communicating with
friends and family.
Dietitian
If
changes to the diet are needed for swallowing
safety, a dietitian can assist in maintaining
adequate nutrition
SWALLOWING: COMPENSATORY STRATEGIES
Universal
Sit
upright at 90 degrees with good postural
support
Stay upright for 30 minutes after meals
Take small bites and sips
Reduce distractions, including talking
Eat several small meals if fatigue is a factor
Avoid problematic consistencies
SWALLOWING: COMPENSATORY STRATEGIES
An SLP may recommend other strategies based
on individual needs.
Chin
tuck
Swallowing maneuvers designed to protect the
airway
Diet modifications
Soft or pureed food
Solids chopped into smaller pieces
Thickened liquids
ADAPTIVE EQUIPMENT
Provale cup: delivers 1
tsp per sip
Bionix safe straw: 1 tsp
ADAPTIVE EQUIPMENT
Less measured but less
expensive ways to
control the flow of liquid
:
Squeeze the straw
Use a cup with a lid
ADAPTIVE EQUIPMENT
Scooper bowl
Weighted utensils
Dycem
SWALLOWING: POTENTIAL TREATMENTS
Oral-motor exercises may be of some benefit to
improve timing, coordination, and awareness.
Neuro-muscular electrical stimulation (NMES),
also referred to as Vitalstim, is not effective for
ataxia alone but may be beneficial when there
is accompanying weakness.
ALTERNATE METHOD OF NUTRITION
Naso-gastric tube- can be used for a short
period of time when eating by mouth is not
safe.
Gastric tube or less commonly a jejunal tube
can be surgically placed for long term
supplemental or alternate nutrition.
Choosing an alternate method of nutrition is a
difficult decision that should involve the entire
team and support network.
SPEECH: COMPENSATORY STRATEGIES
Speak face to face without distractions
Educate unfamiliar listeners
Break sentences into shorter phrases when you
are not understood
Introduce the topic using a single word
Take your time
SPEECH: POTENTIAL TREATMENTS
Overarticulation
Pacing/rhythmic training
Speech agility exercises
Lee Silverman Voice Therapy (LSVT) – Would be
beneficial for Ataxia when a patient has
difficulty speaking at a consistent volume or
coordinating respiration with speech. Evidence
base for multisystem atrophy.
ADDITIONAL ACTIVITIES
Yoga
Music therapy
AUGMENTATIVE/ALTERNATIVE COMMUNICATION
Low tech: Alphabet board, picture board, etc.
Voice output device (or ipad)
Picture
to speech
Text to speech
Access
Hand
Switch
Switch/scanning
Eye gaze
AUGMENTATIVE/ALTERNATIVE COMMUNICATION
Funding in Texas
Specialized
Telecommunications Assistance
Program (STAP) http://stap.puc.state.tx.us
Review of ipad apps
http://www.spectronicsinoz.com/article/iphoneipa
d-apps-for-aac
GO TEAM!!!