Evidence-Based Intervention for Dysarthria in a Patient with Amyotrophic Lateral Sclerosis
Nearly all individuals diagnosed with amyotrophic lateral sclerosis (ALS) will experience a decline in speech communication at some point during their illness. Management of dysarthria to maximize communicative competence is a key target for speech-language pathologists and must employ evidence-based practices to optimize efficacy.
DS was a 71-year-old, community-dwelling Caucasian man who was seen for speech pathology evaluation approximately 6 months after being diagnosed with ALS, following a long career as a civil engineer. His medical history included high blood pressure that was well controlled with diuretics, gastroesophageal reflux disease (GERD), including frequent heartburn symptoms (poorly managed with chewable antacids), and mild, untreated depression and anxiety. During the evaluation, DS reported increased difficulty speaking and swallowing. He also reported difficulty typing, which was particularly problematic as he was in the process of completing a book and also interfered with simple email communications. In addition, he reported difficulty ambulating and with self-care. He described his speech as “softer and quieter,” as well as requiring increased effort to “get the words out.” These issues were particularly noticeable later in the day, on the telephone, and in group settings. He also regularly coughed and occasionally drooled while speaking. DS’s wife confirmed that his speech intelligibility was progressively worsening, and she occasionally had to ask him to repeat himself several times to increase intelligibility. They agreed that these speech changes had worsened over the past 9 to 12 months prior to receiving the ALS diagnosis (See Appendix).