Question
What should be the main focus of speech and language therapy for patients with myasthenia gravis?
Answer
Individuals with myasthenia gravis have a disorder at the level of the neuromuscular junction, where the acetylcholine neurotransmitter is unable to sustain its activity on the receptors in the muscles. Consequently, patients are able to perform all movements for a while, but are unable to sustain the activity for an extended period of time. Essentially, muscles fatigue.
Individuals with myasthenia gravis have motor speech difficulties, specifically flaccid dysarthria, but no language disorders. With use, articulation becomes increasingly imprecise, hypernasality increases, etc. The assessment should include stress testing to show decrease of articulatory precision with use.
These patients are usually on anticholinesterase medications which help significantly. In most cases, speech pathologists focus on environmental modifications and AAC. The patient is asked to take multiple periods of rest and to avoid prolonged use of the articulatory musculature. Also, the SLP assesses and recommends an appropriate AAC device tailored to the patient's needs and preferences. This allows the patient to keep communicating during periods of rest or when speech becomes unintelligible. Because of intact language and cognition, a high tech AAC device is usually appropriate.
Patrick Coppens, Ph.D. is Professor and Chair of Communication Disorders and Sciences and Neurogenics Instructor at Plattsburgh State University of New York.