EBP Compendium: Summary of Clinical Practice Guideline

National Institute for Clinical Excellence
Multiple Sclerosis: National Clinical Guidelines for Diagnosis and Management in Primary and Secondary Care
National Collaborating Centre for Chronic Conditions (2004).
London (United Kingdom): Royal College of Physicians, 213 pages.

AGREE Rating: Highly Recommended

Description:

This evidence-based guideline provides recommendations for the diagnosis and management of multiple sclerosis (MS). The audience for the guideline is health care professionals. Specific recommendations pertaining to the field of speech-language pathology involve cognitive losses, swallowing difficulties, and speech difficulties.

Recommendations:

• Swallowing Screening/Assessment
  • Swallowing should be screened if:
    • There are signs of bulbar symptoms
    • The individual has a chest infection
    • The individual reports difficulty chewing or swallowing
    • The individual has an altered diet
  • Individuals demonstrating difficulty should be further assessed by a speech language pathologist
  • The individual should receive further diagnostic assessment (e.g. videofluoroscopy) if initial therapy is ineffective or if a specific objective of the assessment is identified.
• Swallowing Treatment
  • The speech language pathologist should offer advice on swallowing techniques and adaptation of food consistencies.
  • An individual experiencing difficulty swallowing for more than a few days should be assessed by a neurological rehabilitation team to determine if seating adjustments are necessary, provide chest physiotherapy, or provide short-term use of a nasogastric tube as necessary.
  • If swallowing difficulties persist for more than one month, dietary intake should be reviewed and weight monitored.
  • A PEG (percutaneous endoscopic gastrostomy) tube should be considered if:
    • The individual demonstrates recurrent chest infections
    • The individuals food or fluid intake is inadequate
    • Feeding is prolonged or distressing
    • A nasogastric tube has been in place for longer than one month
• Speech Screening/Assessment
  An individual with MS should be assessed by a speech-language pathologist if he/she presents with dysarthria which impacts communication or is a concern of the individual.
• Speech Treatment
  • Intervention for dysarthria in individuals with MS should include techniques to improve and maintain speech production and clarity.
  • If communication difficulties persist, the individual should be considered for training in the use of alternative, non-verbal means of communication.
  • The family members, carers, and others of the individual with MS should be informed by the speech-language pathologist regarding the most effective means of assisting with communication.
• Cognitive Screening/Assessment
  "Any person with MS whose level of dependence or whose social behavior cannot be easily understood in terms of other known impairments or factors should be offered a formal neuropsychological assessment by a specialist clinical psychologist (and speech and language therapist if appropriate); it should be investigated whether cognitive or communicative losses are a contributing factor and, if so, appropriate management should be recommended" (p. 116).

Keywords: Multiple Sclerosis

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Added to Compendium: November 2010