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Management of functional communication, swallowing, cough and related disorders: consensus recommendations for speech and language therapy
  1. Janet Baker1,2,
  2. Caroline Barnett3,
  3. Lesley Cavalli4,5,
  4. Maria Dietrich6,
  5. Lorna Dixon7,
  6. Joseph R Duffy8,
  7. Annie Elias9,
  8. Diane E Fraser10,
  9. Jennifer L Freeburn11,
  10. Catherine Gregory2,
  11. Kirsty McKenzie12,
  12. Nick Miller13,
  13. Jo Patterson14,
  14. Carole Roth15,
  15. Nelson Roy16,17,
  16. Jennifer Short18,
  17. Rene Utianski19,20,
  18. Miriam van Mersbergen21,
  19. Anne Vertigan22,23,
  20. Alan Carson24,
  21. Jon Stone24,
  22. Laura McWhirter24
  1. 1Speech Pathology, Flinders University, Adelaide, South Australia, Australia
  2. 2University of Technology Sydney, Sydney, New South Wales, Australia
  3. 3South Warwickshire NHS Foundation Trust, Warwick, Warwickshire, UK
  4. 4Department of Speech & Language Therapy, Great Ormond Street Hospital for Children NHS Foundation Trust, London, London, UK
  5. 5Division of Psychology and Language Sciences, University College London, London, London, UK
  6. 6Department of Psychiatry and Psychotherapy, University Hospital Bonn, Bonn, Nordrhein-Westfalen, Germany
  7. 7National Hospital for Neurology and Neurosurgery, London, London, UK
  8. 8Department of Neurology, Mayo Clinic, Rochester, Minnesota, USA
  9. 9Speech and Language Therapy, Kent Community Health NHS Foundation Trust, Ashford, Kent, UK
  10. 10Department of Clinical Neurosciences, Royal Infirmary of Edinburgh, Edinburgh, Edinburgh, UK
  11. 11Massachusetts General Hospital, Boston, Massachusetts, USA
  12. 12Lewisham and Greenwich NHS Trust, London, London, UK
  13. 13Speech Language Sciences, Newcastle University, Newcastle upon Tyne, Tyne and Wear, UK
  14. 14University of Liverpool, Liverpool, Merseyside, UK
  15. 15Speech Pathology Division, Naval Medical Center San Diego, San Diego, California, USA
  16. 16Department of Communication Sciences and Disorders, The University of Utah, Salt Lake City, Utah, USA
  17. 17Division of Otolaryngology - Head and Neck Surgery (Adjunct), The University of Utah, Salt Lake City, Utah, USA
  18. 18North Bristol NHS Trust, Westbury on Trym, Bristol, UK
  19. 19Neurology, Mayo Clinic, Rochester, Minnesota, USA
  20. 20Speech Pathology and Neurology, Mayo Clinic College of Medicine and Science, Rochester, Minnesota, USA
  21. 21School of Communication Sciences and Disorders, Institute for Intelligent Systems, The University of Memphis, Memphis, Tennessee, USA
  22. 22Speech Pathology, John Hunter Hospital, Newcastle, New South Wales, Australia
  23. 23Centre for Healthy Lungs, Hunter Medical Research Institute; School of Medicine and Public Health, The University of Newcastle, Newcastle, New South Wales, Australia
  24. 24Centre for Clinical Brain Sciences, The University of Edinburgh, Edinburgh, Edinburgh, UK
  1. Correspondence to Dr Laura McWhirter, Centre for Clinical Brain Sciences, The University of Edinburgh, Edinburgh, Edinburgh, UK; laura.mcwhirter{at}ed.ac.uk

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.

  • functional neurological disorder
  • speech therapy

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Footnotes

  • Twitter @CavalliLesley, @alancarson15, @jonstoneneuro, @lauramcw

  • Contributors LM, JS and AC developed the concept of the paper and together with JB defined the scope and assembled a group of expert coauthors. All authors contributed materially and substantially to a detailed online survey establishing the content of the manuscript, attended a zoom meeting for discussion of issues arising, and contributed to multiple subsequent rounds of comments and revision as per the methods described in the paper. LM coordinated this process. JB wrote the initial draft, which was sequentially revised by LM and JB as per this process. JS revised the long version to produce an abbreviated version to submit for print publication.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests LM is funded by a University of Edinburgh Clinical Research Fellowship funded philanthropically by Baillie Gifford. LM provides independent medical testimony in court cases regarding patients with functional disorders. AC is a director of a limited personal services company that provides independent medical testimony in Court Cases on a range of neuropsychiatric topics on a 50% pursuer 50% defender basis, is an associate editor of the Journal of Neurology Neurosurgery and Psychiatry, and is the treasurer of the International Functional Neurological Disorder Society. JS reports personal fees from UptoDate, outside the submitted work, runs a self help website for patients with functional neurological symptoms (www.neurosymptoms.org) which is free and has no advertising, provides independent medical testimony in personal injury and negligence cases regarding patients with functional disorders, and is secretary of the International Functional Neurological Disorder Society. JS is a Chief Scientists Office NHS Research Scotland Career Researcher.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.

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