Speech and language therapy: A treatment case series of 20 patients with functional speech disorder

Issue title: Neuropsychiatric Aspects of Neurorehabilitation

Guest editors: Matthew E. Peters, Lindsey J. Gurin, Davin K. Quinn and Durga Roy

Article type: Case Report

Authors: Goldstein, Alexa N.^a | Paredes-Echeverri, Sara^a | Finkelstein, Sara A.^a | Guthrie, Andrew J.^a | Perez, David L.^{a; b; 1} | Freeburn, Jennifer L.^{a; c; 1; *}

Affiliations: [a] Functional Neurological Disorder Unit, Division of Behavioral Neurology and Integrated Brain Medicine, Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA | [b] Division of Neuropsychiatry, Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA | [c] Department of Speech, Language, and Swallowing Disorders, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA

Correspondence: [*] Address for correspondence: Jennifer L. Freeburn MS, CCC-SLP, Massachusetts General Hospital, 55 Fruit Street, Boston, MA, 02114, USA. E-mail: jfreeburn@mgb.org.

Note: [1] Indicates co-senior authors.

Abstract: BACKGROUND:While expert consensus recommendations support the use of speech and language therapy (SLT) for patients with functional speech disorder (FND-speech), there are limited published data on clinical outcomes. OBJECTIVE:To retrospectively report the treatment outcomes and clinical characteristics of patients with FND-speech that attended outpatient SLT as part of a multidisciplinary program for functional neurological disorder (FND). METHODS:In this case series, we included adult patients with FND-speech that consecutively participated in outpatient SLT at our institution between October 2014 and September 2021. Baseline demographic and neuropsychiatric characteristics were extracted from the medical records, along with data on FND-speech phenotypes, number of treatment sessions received, and clinician-determined outcomes. Only descriptive statistics were used to report findings. RESULTS:Twenty patients met inclusion criteria; ages ranged from 21–77, with a mean of 51.6±16.2 years. 85% of the cohort presented with mixed FND-speech symptoms. Patients attended a range of 2–37 visits, with an average of 9.2±8.0 visits over 4.4±3.5 months. At the last treatment session, 3 patients were asymptomatic, 15 had improved, and 2 had not improved; 8 individuals that improved received video telehealth interventions. CONCLUSION:This case series lends additional support for outpatient SLT in the assessment and management of individuals with FND-speech, and may help clarify patient and provider treatment expectations. Additional prospective research is needed to investigate baseline predictors of treatment response and further define the optimal frequency, intensity, duration, and clinical setting for SLT delivery in this population.

Keywords: Functional speech disorder, functional neurological disorder, speech and language therapy, speech and language pathology, treatment, communication, improvement, neurorehabilitation

DOI: 10.3233/NRE-220182

Journal: NeuroRehabilitation, vol. 53, no. 2, pp. 227-238, 2023