by Linda L. Ganz, M.S. CCC-SLP
The goal of therapy in this population focuses on the management of the many symptoms associated with the condition. The role of exercise in the management of ALS is a topic of considerable interest and controversy. Because of the variable rates of progression of ALS, efficacy of exercise is difficult to document. Although clinical opinions vary, there appears to be some agreement that exercise to the point of fatigue is not beneficial. In speech therapy, we address tongue weakness causing slurred speech and more drastically swallowing problems (dysphagia). In our clinic, we use the ALS Severity Scale to rate a patient’s speech and swallowing function on a scale of 0-10. When the patient demonstrates a decline in function then we reassess our goals and home exercise program. During the initial to mid stages of ALS, speech therapy can assist with tongue exercises, modification of food and liquid consistency, and swallowing treatment with VitalStim (NMES). NMES, electrical stimulation, is performed by placing electrodes on the patient’s neck to stimulate recruitment of tongue and laryngeal muscle movement. We allow for adequate break times in order to not fatigue these muscles during treatment. The role of VitalStim may delay the PEG tube placement by increasing quality and safety of oral intake.
In our clinic, we have treated John, an ALS patient, who has been able to maintain the same level of swallowing function from February 2007 to the September 2007 with therapy. Therapy allowed this patient to continue to exercise his muscles with NO deterioration in his diet since that time. This is remarkable due to the nature of ALS! Read more about this exciting therapy on the About Us section under Vital Stim Therapy.