Best practices protocol for the evaluation of bulbar dysfunction: summary recommendations from the NEALS bulbar subcommittee symposium

Gary L Pattee; Emily K Plowman; Benjamin R Brooks; James D Berry; Nazem Atassi; Jennifer L Chapin; Kendrea Garand; Yana Yunusova; Courtney E Mcilduff; Eufrosina Young; John M Costello; Eric A Macklin; Eduardo R Locatelli; Vincenzo Silani; Daragh Heitzman; James Wymer; Stephen A Goutman; Deborah F Gelinas; Richard Smith; Bridget Perry; Paige Nalipinski; Kaila Stipancic; Meghan O'Brien; Stacey L Sullivan; Jordan Green; CONTRIBUTING MEMBERS OF THE NEALS BULBAR SUBCOMMITTEE

doi:10.1080/21678421.2017.1404109

Best practices protocol for the evaluation of bulbar dysfunction: summary recommendations from the NEALS bulbar subcommittee symposium

Amyotroph Lateral Scler Frontotemporal Degener. 2018 May;19(3-4):311-312. doi: 10.1080/21678421.2017.1404109. Epub 2017 Dec 5.

Authors

Gary L Pattee¹, Emily K Plowman², Benjamin R Brooks³, James D Berry⁴, Nazem Atassi⁵, Jennifer L Chapin⁶, Kendrea Garand⁷, Yana Yunusova⁸, Courtney E Mcilduff^{9

10}, Eufrosina Young¹¹, John M Costello¹², Eric A Macklin¹³, Eduardo R Locatelli¹⁴, Vincenzo Silani¹⁵, Daragh Heitzman¹⁶, James Wymer¹⁷, Stephen A Goutman¹⁸, Deborah F Gelinas¹⁹, Richard Smith²⁰, Bridget Perry²¹, Paige Nalipinski²², Kaila Stipancic²³, Meghan O'Brien²⁴, Stacey L Sullivan²⁵, Jordan Green²⁶; CONTRIBUTING MEMBERS OF THE NEALS BULBAR SUBCOMMITTEE

Affiliations

¹ a Neurology Associates , Lincoln , NE , USA.
² b University of Florida, Rehabilitation Science , Gainesville , FL , USA.
³ c Department of Neurology, Neuroscience and Spine Institute , Carolinas Medical Center, Carolinas Neuromuscular/ALS-MDA Center , Charlotte , NC , USA.
⁴ d Massachusetts General Hospital, Department of Neurology , Boston , MA , USA.
⁵ e Neurology Clinical Trials Unit , Massachusetts Gerenal Hospital, Department of Neurology , Chalestown , SC , USA.
⁶ f Neuromotor Speech and Swallowing Restoration Lab , University of Florida Gainesville , Gainesville , FL , USA.
⁷ g Otolaryngology-Head and Neck Surgery , Medical University of South Carolina , Charleston , SC , USA.
⁸ h Department of Speech-Language Pathology , University of Toronto , Toronto , Ontario , Canada.
⁹ i Beth Israel Deaconess Medical Center, Department of Neurology , Boston , MA , USA.
¹⁰ j Dartmouth-Hitchcock Medical Center, Department of Neurology, One Medical Center Drive , Lebanon , PA , USA.
¹¹ k Department of Neurology , State University of New York Upstate Medical University , Syracuse , NY , USA.
¹² l Children's Hospital Boston at Waltham, ALS Augmentative Communication Program , Waltham , MA , USA.
¹³ m MGH Biostatistics Center , Boston , MA , USA.
¹⁴ n Department of Neurology , Holy Cross Hospital , Fort Lauderdale , FL , USA.
¹⁵ o Department Neurological Sciences , University of Milan , Milan , Italy.
¹⁶ p Texas Neurology , Dallas , PA , USA.
¹⁷ q University of Florida, Rehabilitation Science , Gainesville , FL , USA.
¹⁸ r Department of Neurology , University of Michigan , Ann Arbor , MI , USA.
¹⁹ s Grifols Inc, Medical Director Neuroimmunology , Research Triangle Park , NC , USA.
²⁰ t Center for Neurologic Study , San Diego , CA , USA.
²¹ u MGH Institute of Health Professions , Boston , MA , USA.
²² v Massachusetts General Hospital, Speech Language Pathology , Boston , MA , USA.
²³ w MGH Institute of Health Professions , Boston , MA , USA.
²⁴ x Children's Hospital Boston, Speech Language Pathology , Waltham , MA , USA.
²⁵ y Massachusetts General Hospital, Speech Language Pathology , Boston , MA , USA.
²⁶ z MGH-Institute of Health Professions, Rehab Sciences , Boston , MA , USA.

PMID: 29205054
DOI: 10.1080/21678421.2017.1404109

Abstract

Objective: The aim of this Symposium was to develop a consensus based, bulbar assessment protocol for implementation within NEALS clinics.

Methods: A one-day symposium, held in April 2017, was organized into Speech and Swallowing sections to establish summary recommendations for the assessment of bulbar dysfunction within each group.

Results: Summary recommendations included speech referrals and AAC evaluations at initial visit, CNS-BFS, maximum sustained phonation, and speaking rate. Dysarthria evaluation included the speech subsystem involvement of respiration, phonation, resonance, and articulation. Specific recommendations for swallowing were established for each of the following domains: dietary/oral intake, airway defense physiologic capacity, swallow safety screen, patient-reported swallow-related outcomes, oral sensorimotor exam, and pulmonary function. Practice parameters focused upon patient education and unresolved questions included the use of videofluoscopy, monitoring diet progression, and swallow safety screening.

Conclusions: The working goal is to establish a clinical bulbar protocol, designed to be incorporated within ALS clinics and ultimately to formulate a best practice set of bulbar ALS guidelines, available for implementation throughout the international ALS community.

Keywords: AAC; Bulbar; protocol; speech and swallowing.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Amyotrophic Lateral Sclerosis / complications*
Deglutition Disorders / diagnosis*
Deglutition Disorders / etiology*
Disease Progression
Dysarthria / diagnosis*
Dysarthria / etiology*
Female
Humans
Male
Retrospective Studies
Severity of Illness Index
Speech Disorders / diagnosis
Speech Disorders / etiology*