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Logotherapy

Speech therapy techniques in the treatment of FND patients

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  • Functional impairment of communication, swallowing, coughing and the upper airway is due to loss of voluntary control over the initiation, inhibition and maintenance of functions involved in the processes of speech, voice, language, swallowing, breathing or coughing.

  • Don't forget to ask patients the following:

    • How and when did the symptoms start? Could you give a possible reason for the onset of symptoms?

    • What is the nature of the symptoms? Are the symptoms constant or do they come and go? Are there periods when they disappear completely? Can you identify factors that make your symptoms worse or better?

    • What is your experience with health professionals? What was the outcome of any previous treatment?

    • What is the impact of symptoms on daily life, work and relationships?

  • It is important to diagnose the patient on the basis of positive signs and not on the basis of excluding other speech disorders or structural changes in the brain. Explain the mechanism to the patient and let him know that you believe in his symptoms and that his disorder is not a mystery disease. Provide relevant information and links to useful websites.

  • Many patients achieve rapid and almost dramatic improvement, or even elimination of all symptoms, during the initial consultation. This sometimes does not mean that the disorder is completely cured, but early symptomatic improvement is extremely encouraging. On the other hand, some patients need several symptomatic/behavioural therapies together with counselling to make progress.

    Some will need several weeks or months of regular, intensive therapy to see a visible improvement. If progress is slower than you would like, it is a good idea to keep checking the impact of persistent factors on the maintenance of symptoms and consequently the disorder.

    • Poor acceptance of the diagnosis

    • Psychiatric comorbidity

    • Patient's lack of confidence in the therapist's ability to help them

    • Social functionality of the disorder for the patient

  • Understanding FND

    Functional impairment of communication, swallowing, coughing and the upper airway is due to loss of voluntary control over the initiation, inhibition and maintenance of functions involved in the processes of speech, voice, language, swallowing, breathing or coughing.

  • Identify symptomatic behaviour and explain to the patient the underlying mechanism

    Explain how its symptoms differ from those associated with normal speech, voice, swallowing or coughing, and then point out unintentional strains in specific muscle groups, e.g. in the neck, head, face or upper torso.

  • Present strategies to stimulate automatic speech patterns

  • Try to evoke voluntary control over the conscious initiation of speech, phonation, swallowing, etc.

  • Gradually extend automatic activities into functional and meaningful activities

    E.g. during a verbal task, find a way to stop the patient from listening to your speech. Redirecting attention can trigger a reflexive automatic speech response.

  • Positive/negative training (old operation/new operation)

    Remind the patient to pay attention to positive changes in other senses; to make comparisons between old and new speech patterns, which will give them a sense of control and mastery.

  • Consolidate and normalise behaviour in a wider social context

    Graduate meaningful and task-oriented activities that culminate in conversation, normal swallowing during a social meal or managing cough symptoms in different social situations.

  • Address psychosocial factors and help the patient to identify the factors that maintain their disorder

  • Prepare strategies to cope with failures or recurrences of symptoms

    • Baker, J., Barnett, C., Cavalli, L., Dietrich, M., Dixon, L., Duffy, J. R., ...and McWhirter, L. (2021). Management of functional communication, swallowing, cough and related disorders: consensus recommendations for speech and language therapy. Journal of Neurology, Neurosurgery & Psychiatry, 92(10), 1112-1125.

    • Barnett, C., Armes, J., and Smith, C. (2019). Speech, language and swallowing impairments in functional neurological disorder: a scoping review. International journal of language & communication disorders, 54(3), 309-320.

    • Duffy, J. R. (2016). Functional speech disorders: clinical manifestations, diagnosis, and management. Handbook of clinical neurology, 139, 379-388.