Progression #
ALS is a degenerative condition that is characterized by rapid progression of symptoms. There is a strong relationship between dysphagia and other bulbar functions (e.g. dysarthria).
It is therefore recommended to be prepared for future changes in function.
Assessment & Monitoring #
Regular assessment and monitoring of swallowing should be provided by a certified swallowing clinician (SLP).
Assessment should include a detailed case history, including specific attention to weight loss and respiratory status (see Tube Feeding below).
Instrumental assessments (e.g. VFSS, FEES) may be used to address specific concerns with swallowing (e.g. to rule out silent aspiration); however, it is important to be aware of lengthy wait lists and the potential that symptoms can progress rapidly – swallowing concerns therefore need to be addressed in a timely manner and instrumental findings may not be applicable over time.
Intervention #
Focus of intervention may include education, compensatory strategies, diet modifications, alternative nutrition (tube feeding), and NPO recommendations (unsafe to eat or drink by mouth).
As with speech intervention, the available research does not support the use of therapeutic exercise to improve swallowing function, and exercising weakened muscles may cause further deterioration.
The following handouts provide some general recommendations – these must be accompanied by SLP assessment and relevant education: Compensatory strategies for swallowing; Speech and swallowing – compensatory strategies; Food and Liquid Consistencies.
Handouts #
Tube Feeding #
If an individual cannot safely eat or drink by mouth, oral feeding is not efficient to meet nutrition/hydration needs, and/or respiratory function is compromised (FVC approaching 50%), a referral may be appropriate for alternative nutrition.
Education, assessment, and management of nutrition (regarding oral intake and tube feeding) should be provided by a registered dietitian (RD).
SLPs can provide education regarding the possibility of continued oral intake after feeding tube placement, as well as the importance of oral care (regardless of PO status).
Considerations #
When providing SLP services, consider the following:
- Detailed case history, including symptoms, level of severity, and rate of progression.
- Case history should include attention to weight loss/management and respiratory status.
- Early intervention – education about safety strategies, signs and symptoms to monitor for future changes.
- Client’s goals (e.g. interest in diet modification, alternative feeding, or palliative approach).
- Additional cognitive communication or language impairment – these may impact the individual’s awareness of dysphagia and/or ability to use compensatory strategies.
- Collaboration with RD, as appropriate.
Sources & Further Reading #
- Ng, L., Khan, F., Young, C. A., & Galea, M. (2017). Symptomatic treatments for amyotrophic lateral sclerosis/motor neuron disease. Cochrane Database of Systematic Reviews, (1).
- Shoesmith, C., Abrahao, A., Benstead, T., Chum, M., Dupre, N., Izenberg, A., Johnston, W., Kalra, S., Leddin, D., O’Connell, C., Schellenberg, K., Tandon, A., & Zinman, L. (2020). Canadian best practice recommendations for the management of amyotrophic lateral sclerosis. CMAJ, 192(46), E1453-E1468.
- Yorkston, K., Miller, R., Strand, E., & Britton, D. (2013). Management of Speech and Swallowing in Degenerative Diseases. 3rd edn (Austin, TX: PRO-ED).
