American Speech-Language-Hearing Association

EBP Compendium: Summary of Clinical Practice Guideline

American Academy of Neurology; American Academy of Neuromuscular and Electrodiagnostic Medicine
Practice Parameter Update: The Care of the Patient with Amyotrophic Lateral Sclerosis: Multidisciplinary Care, Symptom Management, and Cognitive/Behavioral Impairment (An Evidence-Based Review). Report of the Quality Standards Subcommittee of the American Academy of Neurology

Miller, R. G., Jackson, C. E., et al. (2009).
Neurology, 73(15), 1227-1233.

AGREE Rating: Highly Recommended

Description:

This guideline and corresponding systematic review is an update of a 1999 Practice Parameter on the care and management of individuals with amyotrophic lateral sclerosis (ALS). The primary audience intended for this guideline is neurologists. The recommendations are classified A, B, C or U, based on the strength and consistency of evidence. Level A recommendations are "established as effective, ineffective or harmful" and based on evidence from consistent high quality randomized controlled trials (RCTs). Level B recommendations are "probably effective, ineffective or harmful" and based on evidence from a high quality RCT or consistent evidence from two or more lower quality RCTs. Level C recommendations are "possibly effective, ineffective or harmful" and based on evidence from at least one low quality RCT or consistent evidence from two or more controlled trials. Level U recommendations indicate that the data is "inadequate or conflicting" and therefore the treatment is unproven. 

Recommendations:

  • Assessment/Diagnosis
    • Assessment Areas
      • Cognition - “There is now considerable evidence for cognitive and behavioral manifestations in ALS” (p. 1230). However, the authors conclude that there is little consensus regarding assessment methods.
    • Assessment Instruments
      • Cognition - No consensus was found regarding best cognitive screening tools. The authors indicated that screening of executive function “may be considered to detect cognitive impairment prior to formal evaluation” (Level C Recommendation) (p. 1231).
  • Treatment
    • Cognition
      • General Findings - “There are insufficient data to support or refute the impact of cognitive and behavioral impairment on management in ALS” (Level U Recommendation) (p. 1231).
    • Speech
      • General Findings - No controlled trials investigating dysarthria treatments were found; therefore, there was insufficient evidence to support or refute specific treatments to improve communication. 

Keywords: Amyotrophic Lateral Sclerosis

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Added to Compendium: November 2011

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