American Speech-Language-Hearing Association

Neurodegenerative Disorders: Maximizing Patient Outcomes

Register Now!Session Descriptions

These pre-recorded lectures are on-demand and last only an hour, so you can listen to them whenever time permits!

Opening Plenary

Scope of the Series, Definition, and Classification

Jay Rosenbek, PhD, CCC-SLP, BC-NCD

Speech-language pathologists are increasingly involved in the management of the full range of neurologic disorders with potential to alter speaking and swallowing. Traditional training programs, even if faculty include discussions of such conditions as multiple system atrophy, one of the so-called Parkinson’s plus syndromes, lack time to discuss the specific impact of these conditions on evaluation and treatment. This lecture will fill in as many of these details as time permits. Participants will benefit from learning a method for organizing more than one hundred different disorders into a manageable few. Participants will also benefit from learning the major speech and swallow abnormalities associated with each disorder, with an emphasis on the importance to evaluation and treatment.

Learning Outcomes
You will be able to:

  • define and describe the major movement and neuromuscular disorders
  • identify likely patterns of speech and swallowing difficulty in each

Assessment of Dysphagia in Neurogenic Degenerative Diseases

Deanna Britton, PhD, CCC-SLP, BC-ANCDS

The effects of various neurogenic degenerative diseases on swallowing may differ substantially, depending on the nature of the condition. Assessment of the neuromuscular state and respiratory status is integral to swallowing assessment and critical for directing intervention. This session will provide a framework for assessment of swallowing in the context of neurogenic degenerative disease. Specific topics will include a brief review of the neurology of swallowing and levels of neuromuscular pathology, the clinical swallowing examination, and use of instrumental examinations.

Learning Outcomes
You will be able to:

  • describe the levels of neuromuscular pathology, along with potential effects on swallowing
  • describe use of the clinical swallowing exam to determine the neuromuscular state relative to swallowing, respiratory status and their combined effects on swallowing
  • discuss benefits and caveats of instrumental assessments for individuals with neuromuscular diseases

Dysphagia Intervention in Neurogenic Degenerative Diseases

Deanna Britton, PhD, CCC-SLP, BC-ANCDS

Consideration of the underlying neurogenic degenerative disease process and prognosis is critical to planning effective intervention for individuals with neurogenic degenerative diseases. This session will provide a discussion of principles of intervention for individuals with neurogenic degenerative diseases. Specific topics will include discussion of the influence of the medical diagnosis and prognosis on the treatment plan, staging intervention with disease progression, indications for various compensatory and rehabilitative techniques — based on the findings of the clinical and instrumental swallowing examinations and underlying neural state, coordination of efforts with the multi-disciplinary team, and current evidence available for selected interventions.

Learning Outcomes
You will be able to:

  • discuss general principles of intervention for degenerative neuromuscular disorders
  • describe the influence of the medical diagnosis and prognosis on the treatment plan
  • discuss current evidence available for selected interventions

Applying Principles of the ICF in the Management of PD and Other Motor Speech Disorders

Allyson Dykstra, PhD, SLP(C)

This course will provide an introduction to the ICF conceptual framework. It will also provide the audience with a framework in which to assess and manage individuals with PD and other motor speech disorders. The focus of this course will be on management of motor speech disorders from a perspective that emphasizes activity and participation.

Learning Outcomes
You will be able to:

  • describe the ICF conceptual framework
  • apply the conceptual framework of the ICF to the management of PD and other motor speech disorders

Medicare Coverage for Maintenance Therapy

Lisa Satterfield, MS, CCC-A

Coverage for maintenance therapy and the application of an “improvement standard” has been misunderstood by SLPs and patients, and not consistently implemented by Medicare and their contractors. The 2013 final settlement of Jimmo v. Sebelius clarified that coverage depends whether skilled care is required, not if restoration is possible. Medicare uses the SLP documentation to determine if skilled services were performed. This seminar will discuss the Medicare documentation rules, functional outcome reporting requirements, and appeals process related to patients with chronic and neurodegenerative conditions.

Learning Outcomes
You will be able to:

  • describe the Medicare documentation rules and ensure documentation compliance
  • apply the G-codes to the Medicare claim form accurately as they related to maintenance therapy
  • appeal a denied claim or service for maintenance therapy based on the application of the Jimmo settlement and clear documentation

Managing Motor Speech Disorders in Neurodegenerative Disease: Our Toolbox

Michelle S. Troche, PhD, CCC-SLP

Speech-language pathologists evaluate and treat a broad range of speech mechanism disorders caused by neurodegenerative disease. Each person being treated for a motor speech disorder presents with a different constellation of deviant speech characteristics which require individually tailored treatment plans. The goal of this course is to provide SLPs with basic tools to manage adults with varying motor speech disorders caused by neurodegenerative disease. This aim will be achieved through discussion of evidence-based treatment techniques within speech-language pathology and discussion of related areas of research which can be translated to our clinical practice.

Learning Outcomes
You will be able to:

  • discuss the importance of properly identifying deviant speech characteristics to develop a management plan for motor speech disorders
  • identify patient-specific factors which need to be considered in the development of the management plan for motor speech disorders
  • compare treatment approaches for patients with varying motor speech disorders

Orofacial and Prosodic Considerations in Treatment of Neurodegenerative Diseases

Jessica E. Huber, PhD, CCC-SLP

Orofacial impairments often occur with neurodegenerative disease and can contribute to articulation and intelligibility problems. Management of these issues at a functional level is critical to improve intelligibility and quality of life for patients. This session will discuss some common functional treatment paradigms for improving intelligibility in individuals with neurodegenerative disease. Secondly, these patients often present with prosodic changes of a variety of types. This session will review the most likely prosodic impairments and discuss functional treatment for prosodic impairments in people with neurodegenerative diseases.

Learning Outcomes
You will be able to:

  • describe the fundamental changes to prosody likely to be present in neurodegenerative diseases
  • list three therapy procedures which can be used to address prosodic impairments in people with neurodegenerative disease from a functional perspective
  • list two therapy procedures which can address orofacial and articulatory difficulties in people with neurodegenerative disease from a functional perspective

Building on Strengths: Practical Counseling Strategies

Rebecca Axline, LCSW, MSSW

Speech-language pathologists (SLPs) are trained to work with individuals who are experiencing speech or language disorders with the goals of improving abilities to communicate and function in life. This involvement frequently involves emotional reactions to changes taking place because of the disorder. In order to increase knowledge base and comfort level to address these emotional reactions, this course will provide an overview of psychosocial issues, a specific focus on theories of grief and loss, and practical strategies within the SLP’s scope of practice. The course will include evidence based counseling strategies as well as opportunities for audience participation and case studies.

Learning Outcomes
You will be able to:

  • discuss two to three psychosocial issues as they relate to developing counseling strategies for helping individuals with communication disorders
  • describe the process of adjustment and grief that individuals may encounter as they adjust and cope with communication changes
  • discuss two to three intervention strategies for use with individuals with communication changes in order to maximize treatment outcome potential

Evaluation and Management of Voice Disorders in Degenerative Neuromotor Speech Disorders

Julie Barkmeier-Kraemer, MA, PhD, CCC-SLP

Approximately 30 percent of the general population may experience a voice disorder during their lifetime. In those with neurodegenerative disorders, impaired voice production may affect up to 89 percent with Parkinson’s disease, 30 percent with Essential Tremor, and may be an early sign or symptom in other disorders such as bulbar amyotrophic lateral sclerosis. The purpose of this course lecture is to discuss recommended methods for evaluating and managing voice problems in individuals with neurodegenerative and other neuromotor disorders. Distinguishing voice evaluation characteristics will be highlighted for specific disorders as well as recommended approaches for management of each.

Learning Outcomes
You will be able to:

  • identify and describe the primary goals and methods for conducting a voice evaluation on an individual with a degenerative or other neuromotor speech disorder
  • identify and describe associated characteristics that distinguish and characterize degenerative and other neuromotor disorders such as Parkinson’s disease, Multiple System Atrophy, Spasmodic Dysphonia, Vocal Tremor, Myasthenia Gravis, vocal fold paralysis/paresis, and Amyotrophic Lateral Sclerosis
  • identify and describe general and specific recommended approaches for managing individuals with neurodegenerative and other neuromotor speech disorders

Nutrition and Dietary Considerations in Degenerative Neuromotor Disorders

Michelle McDonagh

This course is designed as an introduction to nutrition for patients with degenerative neuromotor disorders. There are more specific references to dietary considerations for Amyotropic Lateral Sclerosis, Multiple Sclerosis, and Parkinson's disease. The course includes guidelines for nutrition, assessments, and the identification of the barriers to optimal nutrition status. Appropriate nutrition interventions such as oral nutrition support, dietary modifications, and enteral nutrition support are reviewed. The aim is to demonstrate the importance of monitoring nutrition status and the use of nutrition interventions to maintain quality of life throughout disease progression.

Learning Outcomes
You will be able to:

  • identify at least three indicators that a patient is malnourished
  • identify at least three potential barriers to nutrition for patients with degenerative neuromotor disorders
  • list at least three potential nutrition interventions for a patient with swallowing difficulty

Transitioning from Natural Speech to AAC in Neurodegenerative Disease: Maximizing Functional Outcomes for Communication

Laura J Ball, MS, PhD, CCC-SLP

Because of their progressive nature, neurodegenerative disorders ultimately result in the demise of functional movements to varying degrees throughout the body. Natural speech is often significantly impaired and access to traditional AAC systems can be challenging. Although the preponderance of AAC research for people with neurodegenerative diseases targets ALS, AAC technologies and strategies also provide useful supports for people with other neurodegenerative impairments. This session examines transitions from natural speech to augmented communication, assessment of activity and participation needs, and treatment goals for technology implementation.

Learning Outcomes
You will be able to:

  • analyze three AAC techniques for optimal implementation with individuals with neurodegenerative disease
  • evaluate activity and participation needs to identify natural speech vs. AAC intervention options
  • develop treatment goals to facilitate functional communication with AAC technologies

Organizing for Evaluation and Treatment: Emphasis on Pathophysiology

Jay Rosenbek, PhD, CCC-SLP, BC-NCD

Treating neurologic disorders by name is doomed by vagueness and inefficiency. Because many movement and neuromuscular abnormalities share at least some pathophysiologic features, and the number of these features is small, using assumed pathophysiology as a focus for treatment can be efficient and effective. To be so, however, requires that the clinician has a reasonable idea about the active ingredients of potential treatments. Active ingredients will be discussed in the appropriate treatment sections. The first benefit of this lecture is in finding out the potential similarities in conditions such as one or more of the Parkinson’s plus syndromes and amyotrophic lateral sclerosis as but one example. The second is in learning to select treatments efficiently.

Learning Outcomes
You will be able to:

  • define pathophysiology
  • define the five forms of pathophysiology forming the basis for the speech and swallow abnormalities of the various movement and neuromuscular disorders that are the content of this series
  • identify the pathophysiology most likely causing speech and swallowing problems in the disorders that are the content of this series

Medical and Surgical Considerations in Neurodegenerative Disorders

Irene A. Malaty, MD

This session will introduce the clinical presentations of common neurodegenerative diseases with a focus on Parkinson’s disease and atypical Parkinsonism. Dystonia, a condition which may impact speech and swallow, will feature as well. Medical and surgical therapies will be reviewed, and impact of the diseases and their treatments on speech and swallowing function will be addressed. On an introductory level, we will also discuss Amyotrophic lateral sclerosis and multiple sclerosis and conditions of the nervous system that may impact speech and swallowing.

Learning Outcomes
You will be able to:

  • list the key diagnostic features of Parkinson’s disease and atypical parkinsonism
  • identify motor fluctuations in Parkinson's disease and describe the impact on symptoms and therapies
  • describe symptoms and treatments of other degenerative and episodic neurological conditions, specifically dystonia, ALS, and MS, that may impact speech and swallow

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