Is There a Role for Exercise in the Management of Bulbar Dysfunction in Amyotrophic Lateral Sclerosis?

Journal of Speech, Language & Hearing Research

Plowman, E. K. (2015).

Journal of Speech, Language & Hearing Research, 58(4), 1151-1166.

This systematic review investigates the effects of limb, respiratory, or oral motor exercise interventions on disease progression, function, and survival in individuals with bulbar amyotrophic lateral sclerosis (ALS).

Not stated

Between 1960 and 2014

Controlled experimental studies, exploratory prospective or retrospective studies

18

<div>Findings regarding exercise-related treatments within the SLP scope of practice were limited. Regarding specific interventions, conclusions were as follows:</div> <div> <ul> <li>Expiratory muscle strength training was generally noted to be associated with improved outcomes. The authors suggest that mild to moderate intensity "might represent a useful program to maintain subglottic pressure generation abilities, cough, and airway protection in patients with early stage disease" (pp. 1161-1162).&nbsp;</li> <li>In one singular case study of an individual with bulbar ALS receiving lingual resistance training alongside speech and swallowing therapy, a significant worsening of dysarthria and dysphagia as well as a decline in lateral tongue strength and in alternating lingual motion rates was noted. Despite this, the authors of this review suggest that lingual resistance training of mild-moderate intensity may also be an appropriate intervention for reduced lingual strength early in the course of disease to "improve or maintain tongue strength, bolus propulsion, and minimize oral and pharyngeal residue and subsequent aspiration" (p. 1162).&nbsp;</li> <li>In one single case study of an individual with bulbar ALS with a "hoarse, strained, and pressed" voice quality, a reduction in voice quality and an increased number of voice breaks was noted following Lee Silverman Voice Treatment (p. 1162). Additional declines were noted following subsequent articulation and voice treatment.</li> </ul> Overall, there is insufficient evidence to support or refute the use of exercise for individuals with bulbar ALS. Due to limited research and small sample sizes, the above findings should be interpreted with caution. Further research is indicated.&nbsp;</div>