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Management of functional communication, swallowing, cough & related disorders: consensus recommendations for speech & language therapy, 2021, Baker

Discussion in 'Other psychosomatic news and research' started by Andy, Jul 3, 2021.

  1. Andy

    Andy Committee Member

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    Authors also include Carson, Stone et al

    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.

    Paywall, https://jnnp.bmj.com/content/early/2021/06/30/jnnp-2021-326767
     
  2. rvallee

    rvallee Senior Member (Voting Rights)

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    Very common in Long Covid so very likely yet another "functional" crap that is actually an immune problem. Many are referred to speech therapists, obviously with little to show for it.

    These people are completely detached from reality and are either too malicious or incompetent to see that obviously this usually resolves naturally, and when it does they had nothing to do with it and when it doesn't they do, because they are responsible for occupying the space and blocking real work from happening.

    Bunch of quacks.
     
    Ash, Hutan, Art Vandelay and 3 others like this.
  3. Daisybell

    Daisybell Senior Member (Voting Rights)

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    As an SLT, I’m appalled to see this.
     
    Ash, Sly Saint, Hutan and 6 others like this.
  4. dave30th

    dave30th Senior Member (Voting Rights)

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    What's this?
     
    Peter Trewhitt likes this.
  5. Sid

    Sid Senior Member (Voting Rights)

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    There is no evidence that any treatment improves symptoms of FND.
     
    Snow Leopard, Michelle, Trish and 4 others like this.
  6. Andy

    Andy Committee Member

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    Speech and language therapist I would assume.
     
  7. Sean

    Sean Moderator Staff Member

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    Don't you just love the certainty.
    Maybe because there is no practical management approach to a made up condition?
     
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  8. rvallee

    rvallee Senior Member (Voting Rights)

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    And this comes from people claiming they effectively manage those made-up conditions with high success. Who readily admit they have no evidence for it. While also claiming they do. Because nobody cares about consistency, that's what happens when diseases are de-medicalized: it's no one's problem.
     
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  9. Peter Trewhitt

    Peter Trewhitt Senior Member (Voting Rights)

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    As an undergraduate in experimental psychology and as a research student in acquired language disorders, then in my SLT training and in nearly twenty years of being a practicing Speech & Language Therapist, largely working with acquired neurological conditions, I had not come across any suggestion of FND playing any role in speech or language or the mechanisms of eating and swallowing. Though it may be that this has become a ‘SLT thing’ in the last twenty years since I had to take ill health retirement.

    The authors of this paper seem to be a random selection of individuals from many settings across the English speaking academic and clinical world, which does not give a lot of clues about their clinical or research specialisms, so it is not clear how this ‘international panel’ was selected, presumably via clinical special interest groups some how.

    I must admit it does not help that the full article is behind a pay wall, but I find it hard to make sense of the abstract. It seems to be saying that every aspect of the entire communication process at every level and all aspects of the eating process that SLTs may be involved with have some potential FND involvement and that there are lots of unspecified BPS things that can be done, without clearly explaining any of it.

    I delayed commenting to this thread, because I wanted to consider what I would have done if someone diagnosed with an FND was referred to me when I was still practicing.

    The areas of SLT work that potentially fit most closely to a BSP model are voice work, fluency and elective mutism, which are the areas of our work I perhaps know least about, but my limited experience is that even here where there may be significant psychosocial components there is usually also some anatomical or neurological issue too. However the abstract is going far beyond this and including almost every aspect of what a SLT might possibly be involved with.

    I guess I would approach an FND referral by assessing their speech, language and/or swallowing symptoms, referring back to any brain scans, x rays or video fluoroscopy or requesting a medical referral for them to be done. Consider how the symptom patterns related to other diagnostic categories. Ensure that the patient understood their symptom patterns, and then discuss with the patient the idea of trial therapy as part of the diagnostic process. But without a significant literature of case studies, examples of good practice and formal research, I don’t understand how they can conclude “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”. This very much feels like prejudging the issue, putting the cart before the horse, and raises the question how they can be so definite about a wide range of normally unrelated symptoms. It just makes no sense suggesting that the same interventions are relevant to someone with word finding problems, someone displaying inappropriate pronoun selection, someone with problems executing the pharyngeal stage of swallowing or someone with slurred speech.

    I will pass the link on to friends still in practice to see if they have any comments.

    [added - corrected typos and indeed apparently FND has become something that SLTs are at least aware of]
     
    Last edited: Jul 4, 2021
    Ash, Snow Leopard, Sly Saint and 8 others like this.
  10. Peter Trewhitt

    Peter Trewhitt Senior Member (Voting Rights)

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    Note, I see that Dr David Perez has written an editorial comment for this article, see https://jnnp.bmj.com/content/early/2021/06/30/jnnp-2021-327213.full

    but the full text of this is also behind the paywall. As are the references for the ‘convergent’ consensus recommendations for physiotherapist and occupational therapy. @PhysiosforME are you aware of the physio FND recommendations?

    [added - by chance our thread on Dr Perez’s article on neuroimaging in FND is also under active discussion, see https://www.s4me.info/threads/neuro...edwards-hallet-stone-et-al.21323/#post-355253 . Is the current press of articles on FND a real world phenomenon or just a subjective consequence of current interests by those posting threads here? @Andy ?]
     
    Last edited: Jul 4, 2021
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  11. Andy

    Andy Committee Member

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    The authors I put in the thread title are ones that I see repeatedly on other FND papers (the others might be as well but they didn't ring any bells at time of posting). They seem to be working very hard to establish their version of FND, quoting their pals work to support their claims frequently.
     
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  12. dave30th

    dave30th Senior Member (Voting Rights)

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    Ah, right.
     
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  13. Daisybell

    Daisybell Senior Member (Voting Rights)

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    Sorry - i know the US uses Speech Language Pathologist (SLP) - a lot of the world uses Speech Language Therapist (SLT).
    @Peter Trewhitt Re the authors of this article - Lesley Cavalli is a voice specialist - I remember her name from my student days.
    I used to do some voice therapy when I was still working. I only had the very occasional patient where the cause for the voice problem appeared to be some kind of psychological issue. And I was never sure…. Mostly I found that those patients were very difficult to achieve improvements with. There wasn’t any psychology support anyway!
     
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  14. rvallee

    rvallee Senior Member (Voting Rights)

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    You got it right. It's not just their conclusion, it's their starting point, assumptions underlying everything. Still is their conclusion, because it's circular logic and the exact same idea behind Wessely's ideology of there being only one "functional disorder", aka the mythical conversion disorder. If it sounds insane it's because it clearly is, there is nothing to work with here.
     
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  15. Sean

    Sean Moderator Staff Member

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    Interesting how the BPS school dismiss any suggestion that there is any such thing as a purely biological condition (or it is vanishingly rare), and insist that all medical conditions involve a psychosocial component.

    While also insisting there is such thing as a purely psychosocial condition with no measurable biological component.
     
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  16. rvallee

    rvallee Senior Member (Voting Rights)

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    Heads they win. Tails they win. Sideways they win. Never flipped they win. Endlessly spinning they win.

    Problem is letting them pretend they won despite not playing. The blame is in a system that lets them do that, frankly expecting people to be better than this in any context is plain foolish, encourage cheaters and you will get nothing but cheating, it just makes it normal, even necessary, since those who don't cheat have to admit their assumptions are invalid.
     
    Ash, Sean, Wyva and 1 other person like this.
  17. Peter Trewhitt

    Peter Trewhitt Senior Member (Voting Rights)

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    I now have a pdf of the full article, but assume that sharing it here would be a breach of copyright.

    Hope to read it tomorrow, but anyone wanting to know more message me.
     
    Sean likes this.
  18. Peter Trewhitt

    Peter Trewhitt Senior Member (Voting Rights)

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    Here are the references for the Physiotherapy and Occupational Therapy FND consensus papers mentioned by Perez:

    Nielsen G, Stone J, Matthews A, et al. Physiotherapy for functional motor disorders: a
    consensus recommendation. J Neurol Neurosurg Psychiatry 2015;86:1113–9.

    (link https://jnnp.bmj.com/content/suppl/2014/11/28/jnnp-2014-309255.DC1/jnnp-2014-309255supp-new.pdf )

    Nicholson C, Edwards MJ, Carson AJ, et al. Occupational therapy consensus
    recommendations for functional neurological disorder. J Neurol Neurosurg Psychiatry
    2020;91:1037–45.

    (link https://jnnp.bmj.com/content/jnnp/91/10/1037.full.pdf )

    Do they warrant their own threads?

    Too brain fogged to make sense of any of the articles this morning, but surprised at how big a literature is developing in relation to FND and the various professions allied to medicine, and what I have read seems big on assertion but little on actual research.
     
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  19. PhysiosforME

    PhysiosforME Senior Member (Voting Rights)

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    Thanks for tagging - I will check with Karen as she has more knowledge of FND than me
     
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  20. PhysiosforME

    PhysiosforME Senior Member (Voting Rights)

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    Karen has apparently already flagged some issues with the recommendations relating to fatigue - most of the content apparently relates to movement disorders
     
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