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Bulbar dysfunction in ALS: Psychological implications 

Bulbar dysfunction in ALS: Psychological implications
Chapter:
Bulbar dysfunction in ALS: Psychological implications
Author(s):

Jashelle Caga

and Matthew C. Kiernan

DOI:
10.1093/med/9780198757726.003.0015
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date: 26 February 2020

Bulbar dysfunction typically manifests as speech and swallowing impairment in amyotrophic lateral sclerosis (ALS). Timely assessment of changes in speech and swallowing is imperative, given its negative prognostic implication and impact on psychological well-being. The progressive loss of the ability to speak and swallow can also result in threats to the self-concept, which may compound issues with social interaction. The use of communication devices to accommodate loss of speech appears to be beneficial in reducing patient distress and caregiver burden. Implementation of interventions to manage problems eating secondary to swallowing impairment can also result in marked improvements in patients’ and caregivers’ quality of life. However, the success of these interventions depends on intact cognitive and behavioural functioning, which may be compromised in patients with bulbar dysfunction. Assessment of bulbar dysfunction should therefore be considered in the context of cognitive and behavioural change, to maximize patient and caregiver psychological well-being.

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