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Neurology and Speech-language Pathology: The clinical connection

Current practice literature supports speech and language support in a very wide range of neurological disorders in children1 and adults.2

Both amyotrophic lateral sclerosis (ALS) and Parkinson's disease (PD) exhibit a variety of patterns of dysphagia, so evaluation and treatment of swallowing function is vital. When the oral or pharyngeal stage of swallowing are affected early in dysphagia, adjusting swallowing volume and varying consistency can be beneficial in ALS. When all stages of swallowing are impaired in ALS, complications such as pneumonia, dehydration and malnutrition can arise. In PD, dysphagia can appear at any time during the course of the disease, and can manifest at any stage of swallowing. Aspiration is an important risk factor for pneumonia in PD. On this, rehabilitation has been shown to be of some effect.3,4

In lobar ALS there are also changes in facial kinematics, vowel formant frequencies, and speech intelligibility,5 and motor deficits like reduction in tongue strength may also coexist with cognitive deficits compatible with frontotemporal lobar degeneration (FTLD). A key intervention in this patient population is speech-language therapy, which evaluates communication skills and designs a personalized intervention plan to improve communication abilities. It has been used in patients with aphasia of different etiologies and has been shown to be effective. There is research on SLT interventions in patients on the FTLD-ALS spectrum, and the initial findings do indicate some success, where the goal is to delay language decline.6

Huntington’s disease can give rise to dysarthria to generalized language impairment.7 There is some evidence to support the use of speech pathology for the management of eating and swallowing disorders in this disease.8 There is evidence as well that intervention is effective in HD-related dysphagia, in both the hyperkinetic and rigid-bradykinetic patient subgroups, in abnormalities of deglutition. These abnormalities include rapid lingual chorea, swallow incoordination, repetitive swallows, prolonged laryngeal elevation, inability to stop respiration, and frequent eructations.9

Dysarthria occurs in approximately 40% of all patients with multiple sclerosis. This usually presents as a spastic-ataxic dysarthria with disorders of voice intensity, voice quality, articulation, and intonation. Easily as common are swallowing disorders.10 Treating both dysarthria and dysphagia is effective for reestablishing functional daily activities.11 Dysarthria is also a core feature of polymicrogyria, often accompanied by receptive and expressive language impairments.12 The same is true, with sleep abnormalities as well, in progressive supranuclear palsy.13

Dysphagia and dysarthria are common problems in stroke recovery, too.14 Focussed interdisciplinary care can often restore much functionality in these two areas.15 As well, people with dementia generally, and with mild cognitive impairment, are major consumers of services provided by speech-language pathologists. These services include not only direct assessment and treatment of communication and swallowing (communication disorders have proven to be among the strongest predictors for discriminating among dementia subtypes16) but also counseling, collaboration, prevention, and wellness. The demand for SLP services for patients with dementia and mild cognitive impairment is expected to grow significantly over the next few decades.17

There is a complicated relationship between disorder-related language activities and epileptic seizures.18 This can raise thorny issues for diagnosticians. Research continues on the pathophysiological and psychogenic background of seizures, even to the apparent role of stuttering as a contributing factor to their appearance.19

Individuals with Down syndrome often receive speech-language therapy services starting in infancy or toddlerhood, in part to consider the impact of other developmental and comorbid disorders that can affect language development, such as the presence of a dual diagnosis of DS and autism spectrum disorder, which is ~20% higher than in the general population.20

Finally, research in the area of autism interventions delivered, at least in part, by SLPs has markedly increased over the past 10 years. This research captures the versatility of the SLP's role in the preschool purview in particular.21

1 Nyman A, Strömbergsson S, Lindström K, Lohmander A, Miniscalco C. Speech and Language in 5-year-olds with Different Neurological Disabilities and the Association between Early and Later Consonant Production. Dev Neurorehabil. 2021 Aug;24(6):408-417. doi: 10.1080/17518423.2021.1899327.

2 Fried-Oken M, Mooney A, Peters B. Supporting communication for patients with neurodegenerative disease. NeuroRehabilitation. 2015;37(1):69-87. doi: 10.3233/NRE-151241.

3 Yamamoto T. [Evaluation and treatment of dysphagia in amyotrophic lateral sclerosis and Parkinson's disease]. Rinsho Shinkeigaku. 2011 Nov;51(11):1072-4

4 Suttrup I, Warnecke T. Dysphagia in Parkinson's Disease. Dysphagia. 2016 Feb;31(1):24-32. doi: 10.1007/s00455-015-9671-9.

5 Yunusova Y, Green JR, Lindstrom MJ, Pattee GL, Zinman L. Speech in ALS: Longitudinal Changes in Lips and Jaw Movements and Vowel Acoustics. J Med Speech Lang Pathol. 2013 Mar;21(1):1-13.

6 Kiousi V, Arnaoutoglou M, Printza A. Speech and language intervention for language impairment in patients in the FTD-ALS spectrum. Hell J Nucl Med. 2019 Jan-Apr;22 Suppl:133-146.

7 Gagnon M, Barrette J, Macoir J. Language Disorders in Huntington Disease: A Systematic Literature Review. Cogn Behav Neurol. 2018 Dec;31(4):179-192. doi: 10.1097/WNN.0000000000000171.

8 Bilney B, Morris ME, Perry A. Effectiveness of physiotherapy, occupational therapy, and speech pathology for people with Huntington's disease: a systematic review. Neurorehabil Neural Repair. 2003 Mar;17(1):12-24. doi: 10.1177/0888439002250448.

9 Kagel MC, Leopold NA. Dysphagia in Huntington's disease: a 16-year retrospective. Dysphagia. 1992;7(2):106-14. doi: 10.1007/BF02493441.

10 Alali D, Ballard K, Bogaardt H. The frequency of dysphagia and its impact on adults with multiple sclerosis based on patient-reported questionnaires. Mult Scler Relat Disord. 2018 Oct;25:227-231. doi: 10.1016/j.msard.2018.08.003.

11 Merson RM, Rolnick MI. Speech-language pathology and dysphagia in multiple sclerosis. Phys Med Rehabil Clin N Am. 1998 Aug;9(3):631-41.

12 Braden RO, Boyce JO, Stutterd CA, Pope K, Goel H, Leventer RJ, Scheffer IE, Morgan AT. Speech, Language, and Oromotor Skills in Patients With Polymicrogyria. Neurology. 2021 Apr 6;96(14):e1898-e1912. doi: 10.1212/WNL.0000000000011698.

13 Hokelekli FO, Ali F, Carlos AF, Martin PR, Clark HM, Duffy JR, Utianski RL, Botha H, St Louis EK, Whitwell JL, Josephs KA. Sleep disturbances in the speech-language variant of progressive supranuclear palsy. Parkinsonism Relat Disord. 2021 Oct;91:9-12. doi: 10.1016/j.parkreldis.2021.08.009.

14 Cohen DL, Roffe C, Beavan J, Blackett B, Fairfield CA, Hamdy S, Havard D, McFarlane M, McLauglin C, Randall M, Robson K, Scutt P, Smith C, Smithard D, Sprigg N, Warusevitane A, Watkins C, Woodhouse L, Bath PM. Post-stroke dysphagia: A review and design considerations for future trials. Int J Stroke. 2016 Jun;11(4):399-411. doi: 10.1177/1747493016639057.

15 Gerstenecker A, Lazar RM. Language recovery following stroke. Clin Neuropsychol. 2019 Jul;33(5):928-947. doi: 10.1080/13854046.2018.1562093.

16 Reilly J, Rodriguez AD, Lamy M, Neils-Strunjas J. Cognition, language, and clinical pathological features of non-Alzheimer's dementias: an overview. J Commun Disord. 2010 Sep-Oct;43(5):438-52. doi: 10.1016/j.jcomdis.2010.04.011.

17 Lanzi AM, Ellison JM, Cohen ML. The "Counseling+" Roles of the Speech-Language Pathologist Serving Older Adults With Mild Cognitive Impairment and Dementia From Alzheimer's Disease. Perspect ASHA Spec Interest Groups. 2021 Oct;6(5):987-1002. doi: 10.1044/2021_persp-20-00295.

18 Melo PD, Melo AN, Maia EM. Oral language disorders in preschool children with epilepsy: a speech-language screening. Pro Fono. 2010 Jan-Mar;22(1):55-60.

19 Papadopoulou S, Pavlidou E, Argyris G, Flouda T, Koukoutsidi P, Krikonis K, Shah S, Chirosca-Vasileiou D, Boussios S. Epilepsy and Diagnostic Dilemmas: The Role of Language and Speech-Related Seizures. J Pers Med. 2022 Apr 18;12(4):647. doi: 10.3390/jpm12040647.

20 Versaci TM, Mattie LJ, Imming LJ. Down Syndrome and Autism Spectrum Disorder Dual Diagnosis: Important Considerations for Speech-Language Pathologists. Am J Speech Lang Pathol. 2021 Jan 27;30(1):34-46. doi: 10.1044/2020_AJSLP-20-00050.

21 Binns AV, Smyth R, Andres A, Lam J, Oram Cardy J. Looking back and moving forward: A scoping review of research on preschool autism interventions in the field of speech-language pathology. Autism Dev Lang Impair. 2021 Oct 20;6:23969415211033171. doi: 10.1177/23969415211033171.

News from Eugene Speech Therapy/BreatheWorksTM is a report on trends and developments in oromyofunctional disorders and therapy. These updates are not intended as diagnosis, treatment, cure or prevention of any disease or syndrome.

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