Management of functional communication, swallowing, cough and related disorders: consensus recommendations for speech and language therapy

Janet Baker; Caroline Barnett; Lesley Cavalli; Maria Dietrich; Lorna Dixon; Joseph R Duffy; Annie Elias; Diane E Fraser; Jennifer L Freeburn; Catherine Gregory; Kirsty McKenzie; Nick Miller; Jo Patterson; Carole Roth; Nelson Roy; Jennifer Short; Rene Utianski; Miriam van Mersbergen; Anne Vertigan; Alan Carson; Jon Stone; Laura McWhirter

doi:10.1136/jnnp-2021-326767

Management of functional communication, swallowing, cough and related disorders: consensus recommendations for speech and language therapy

J Neurol Neurosurg Psychiatry. 2021 Oct;92(10):1112-1125. doi: 10.1136/jnnp-2021-326767. Epub 2021 Jul 1.

Authors

Janet Baker^{1

2}, Caroline Barnett³, Lesley Cavalli^{4

5}, Maria Dietrich⁶, Lorna Dixon⁷, Joseph R Duffy⁸, Annie Elias⁹, Diane E Fraser¹⁰, Jennifer L Freeburn¹¹, Catherine Gregory², Kirsty McKenzie¹², Nick Miller¹³, Jo Patterson¹⁴, Carole Roth¹⁵, Nelson Roy^{16

17}, Jennifer Short¹⁸, Rene Utianski^{19

20}, Miriam van Mersbergen²¹, Anne Vertigan^{22

23}, Alan Carson²⁴, Jon Stone²⁴, Laura McWhirter²⁵

Affiliations

¹ Speech Pathology, Flinders University, Adelaide, South Australia, Australia.
² University of Technology Sydney, Sydney, New South Wales, Australia.
³ South Warwickshire NHS Foundation Trust, Warwick, Warwickshire, UK.
⁴ Department of Speech & Language Therapy, Great Ormond Street Hospital for Children NHS Foundation Trust, London, London, UK.
⁵ Division of Psychology and Language Sciences, University College London, London, London, UK.
⁶ Department of Psychiatry and Psychotherapy, University Hospital Bonn, Bonn, Nordrhein-Westfalen, Germany.
⁷ National Hospital for Neurology and Neurosurgery, London, London, UK.
⁸ Department of Neurology, Mayo Clinic, Rochester, Minnesota, USA.
⁹ Speech and Language Therapy, Kent Community Health NHS Foundation Trust, Ashford, Kent, UK.
¹⁰ Department of Clinical Neurosciences, Royal Infirmary of Edinburgh, Edinburgh, Edinburgh, UK.
¹¹ Massachusetts General Hospital, Boston, Massachusetts, USA.
¹² Lewisham and Greenwich NHS Trust, London, London, UK.
¹³ Speech Language Sciences, Newcastle University, Newcastle upon Tyne, Tyne and Wear, UK.
¹⁴ University of Liverpool, Liverpool, Merseyside, UK.
¹⁵ Speech Pathology Division, Naval Medical Center San Diego, San Diego, California, USA.
¹⁶ Department of Communication Sciences and Disorders, The University of Utah, Salt Lake City, Utah, USA.
¹⁷ Division of Otolaryngology - Head and Neck Surgery (Adjunct), The University of Utah, Salt Lake City, Utah, USA.
¹⁸ North Bristol NHS Trust, Westbury on Trym, Bristol, UK.
¹⁹ Neurology, Mayo Clinic, Rochester, Minnesota, USA.
²⁰ Speech Pathology and Neurology, Mayo Clinic College of Medicine and Science, Rochester, Minnesota, USA.
²¹ School of Communication Sciences and Disorders, Institute for Intelligent Systems, The University of Memphis, Memphis, Tennessee, USA.
²² Speech Pathology, John Hunter Hospital, Newcastle, New South Wales, Australia.
²³ Centre for Healthy Lungs, Hunter Medical Research Institute; School of Medicine and Public Health, The University of Newcastle, Newcastle, New South Wales, Australia.
²⁴ Centre for Clinical Brain Sciences, The University of Edinburgh, Edinburgh, Edinburgh, UK.
²⁵ Centre for Clinical Brain Sciences, The University of Edinburgh, Edinburgh, Edinburgh, UK [email protected].

PMID: 34210802
DOI: 10.1136/jnnp-2021-326767

Abstract

Communication problems (eg, dysphonia, dysfluency and language and articulation disorders), swallowing disorders (dysphagia and globus), cough and upper airway symptoms, resulting from functional neurological disorder (FND), are commonly encountered by speech and language professionals. However, there are few descriptions in the literature of the most effective practical management approaches. This consensus document aims to provide recommendations for assessment and intervention that are relevant to both adults and young people. An international panel of speech and language professionals with expertise in FND were approached to take part. Participants responded individually by email to a set of key questions regarding best practice for assessment and interventions. Next, a video conference was held in which participants discussed and debated the answers to these key questions, aiming to achieve consensus on each issue. Drafts of the collated consensus recommendations were circulated until consensus was achieved. FND should be diagnosed on the basis of positive clinical features. Speech and language therapy for FND should address illness beliefs, self-directed attention and abnormal movement patterns through a process of education, symptomatic treatment and cognitive behavioural therapy within a supportive therapeutic environment. We provide specific examples of these strategies for different symptoms. Speech and language professionals have a key role in the management of people with communication and related symptoms of FND. It is intended that these expert recommendations serve as both a practical toolkit and a starting point for further research into evidence-based treatments.

Keywords: functional neurological disorder; speech therapy.

Publication types

Review

MeSH terms

Consensus
Conversion Disorder / physiopathology
Conversion Disorder / therapy*
Cough / physiopathology
Cough / therapy*
Deglutition / physiology
Deglutition Disorders / physiopathology
Deglutition Disorders / therapy*
Humans
Language Therapy*
Speech / physiology
Speech Therapy*