Swallowing and Speech in Ataxia

Report
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!!!

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