American Speech-Language-Hearing Association

EBP Compendium: Summary of Clinical Practice Guideline

Royal College of Physicians; National Collaborating Centre for Chronic Conditions; National Institute for Health and Clinical Excellence (United Kingdom)
Parkinson's Disease: National Clinical Guideline for Diagnosis and Management in Primary and Secondary Care

National Collaborating Centre for Chronic Conditions (2006).
London (United Kingdom): Royal College of Physicians, 242 pages.

AGREE Rating: Highly Recommended

Description:

This guideline provides recommendations for the management of Parkinson's disease. The target audience of this guideline is healthcare professionals, individuals with Parkinson's disease and carers, support groups, and service providers, including speech-language pathologists. Recommendations are graded A, B, C, D, or "Good Practice Point" based on the strength of supporting evidence. Grade A recommendations are based on evidence from systematic reviews and meta-analyses of randomized controlled trials that are directly relevant to the population. Grade B recommendations include high quality case control or cohort studies or high quality systematic reviews of those studies that are directly applicable to the population, or recommendations extrapolated from Grade A evidence. Grade C recommendations include well conducted case control or cohort studies or recommendations extrapolated from Grade B evidence. Grade D recommendations are based on evidence from non-analytic studies or expert opinion or recommendations extrapolated from Grade C evidence. Good Practice Points are recommendations based on the clinical experience of the guideline development group. 

Recommendations:

  • Assessment/Diagnosis
    • Assessment Areas
      • Swallowing
        • The management of dysphagia may involve “an early referral to a speech and language therapist for assessment, swallowing advice, and where indicated further instrumental investigation (e.g. videofluoroscopy, [fiberoptic endoscopic evaluation of swallowing] FEES)” (Good Practice Point) (p. 130).
        • Referral to SLP should also be made for sialorrhoea (i.e., excessive saliva or drooling) (Good Practice Point).
    • Assessment Instruments
      • Swallowing
        • FEES/Videofluoroscopy - “[V]ideofluoroscopy/[fiberoptic endoscopic evaluation of swallowing] FEES should be considered to exclude silent aspiration" (Good Practice Point) (p. 130).
  • Treatment
    • Speech
      • General Findings
        • “Speech and language therapy should be available for people with Parkinson's disease" (p. 146).
        • Particular consideration should be given to the "improvement of vocal loudness and pitch range, including speech therapy programs such as [Lee Silverman Voice Treatment] LSVT" (Grade B Evidence) (p. 146).
        • Other considerations may include "teaching strategies to optimize speech intelligibility" and "ensuring an effective means of communication is maintained throughout the course of the disease, including use of assistive technologies“ (Level D Evidence, Good Practice Point) (p. 146).
      • AAC - Treatment considerations may include "teaching strategies to optimize speech intelligibility" and "ensuring an effective means of communication is maintained throughout the course of the disease, including use of assistive technologies" (Level D Evidence, Good Practice Point) (p. 146).
      • LSVT - Particular consideration should be given to the "improvement of vocal loudness and pitch range, including speech therapy programs such as [Lee Silverman Voice Treatment] LSVT" (Grade B Evidence) (p. 146).
    • Swallowing
      • General Findings
        • "Speech and language therapy should be available for people with Parkinson's disease" (p. 146).
        • Particular consideration should be given to "review and management to support the safety and efficiency of swallowing and to minimize the risk of aspiration" (Level D Evidence, Good Practice Point) (p. 146).
        • Treatment considerations may include "advice and trial of behavioral management techniques, use of portable metronomic brooch, and lip seal and swallow exercises" for the management of sialorrhoea (Level D Evidence, Good Practice Point) (p. 132). 
            

Keywords: Parkinson's Disease

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Added to Compendium: November 2010

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