Speech therapy
Functional speech disorders are prevalent, but some speech and language therapists may feel unsure when dealing with patients with functional neurological speech issues. Apart from assisting in distinguishing between diagnoses, therapists also need to manage a broader spectrum of functional communication disorders, including swallowing and coughing difficulties. They must also assess the overall effects of comorbid symptoms (Baker et al., 2021; Barnett et al., 2021; Duffy, 2016).
Speech and language therapists will therefore face the following functional impairments in their work (Baker et al., 2021):
Functional communication disorders (e.g. dysphonia, dysfluency, articulation disorders)
Functional cough disorders
Functional swallowing disorders such as dysphagia and globus,
Upper respiratory tract symptoms due to FND
Some basic tips for treating patients with functional speech disorder (Duffy et al., 2016)
1.
They should imitate some very simple sounds or words that are produced differently than normal (e.g. slowly lengthening a word instead of repeating a sound or word quickly), with initial praise for anything that represents a change.
2.
Identify patients' primary speech abnormalities (e.g. tense voice, repetition of sounds, facial grimaces) and determine if they are a barrier to normal speech and how they need to be changed.
3.
Gradually get them to correct their mistakes without your help, and express optimism for every attempt to correct your own. Praise them for their initial recognition of their mistake and tell them that this is a crucial step towards recovery.
4.
When appropriate, use physical contact to give feedback (e.g. touch the face if there are abnormal facial expressions during attempts to speak).
5.
Gradually work on their efforts to speak longer without irregularities.
6.
When the speech starts to improve consistently, stop the touching, maintain and increase the enthusiasm, and ask them to consistently self-correct.
7.
Gradually move to longer and more natural reading or speaking.
9.
When there is improvement, ask them to rate the degree of improvement and ask them how they feel about their ability to manage their speech and the effort it takes.
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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.