A multidisciplinary approach to support management of nutrition, swallowing and quality of life in patients with Motor Neurone Disease

Kirsty Niven1, Timothea Lau1,2, Rachael Hammond1, Dr Hans Bogaardt1,2, Dr Parvathi Menon1,4, Professor Steve Vucic1,4, Professor Victoria Flood1,2,3

1Westmead Hospital, Western Sydney Local Health District, , , 2Faculty of Health Sciences, University of Sydney, , , 3Charles Perkins Centre, University of Sydney, , , 4Westmead Clinical School, University of Sydney, ,

Background: Motor Neurone Disease (MND) is a complex disease with heterogeneous symptoms, and physical disabilities such as dysphagia contributing to poor nutrition and quality of life (QoL). MND is best managed through multidisciplinary care including medical, nursing and allied health professionals, however further research is required to investigate novel approaches to health care of this progressive disease. This pilot study has undertaken a multidisciplinary approach to investigate the feasibility and impact of conducting an intensive swallowing exercise program and diet regime. This combined the disciplines of neurology, speech pathology and dietetics to build a collaborative research approach.

Methods: Participants with MND were randomised into three groups: 1. Exercise only (lingual and laryngeal exercises) (Ex); 2. Diet only (diet); 3. Exercise and diet combination (Ex+Diet). Intervention occurred over four weeks and included weekly support from a dietitian on a diet regime of 20% energy from extra virgin olive oil; and bi-weekly intensive exercises with a speech pathologist with home visits available.  Baseline and follow-up assessments of swallowing, diet and QoL were investigated (included Swallowing QoL (Swal-QoL), and EQ-5D QoL), including paired t-tests and chi-squared tests, where appropriate.

Results: Preliminary data from the pilot study (n=14, mean age 66 years, 64% male), indicated good compliance with the diet, and moderate with the exercises. Participants in the Ex+Diet group reported less burden and fatigue with swallowing (Swal-QoL) (54.0 vs 68.2, p=0.017), better communication and fewer symptoms of swallowing difficulty, compared to those in the Ex or Diet only groups.  Participants overall also reported a decrease in anxiety/depression (EQ-5D) (42% with moderate, severe or extreme at baseline vs 0% post-intervention).

Discussion: MND patients who received combined diet and exercise intervention had improved dysphagia, communication and QoL. The study suggests there is scope to include new models of multidisciplinary integrated care among people with MND.


Biography:

Ms Kirsty Niven is an experienced speech pathologist and an emerging researcher at Westmead Hospital, Sydney. She completed her undergraduate degree in Speech Pathology at The University of Sydney in 2014. Kirsty’s career focuses on providing high quality assessment and intervention within multidisciplinary teams to adults in an acute tertiary setting. Kirsty is highly experienced in dysphagia rehabilitation for patients with neurodegenerative and respiratory conditions including the application of surface electromyography (sEMG) in patients with swallowing impairments.

She is passionate about providing quality speech pathology services and integrating innovative research to optimise patient care.

NAHC Conferences

2007, Hobart (7th NAHC)

2009, Canberra (8th NAHC)

2012, Canberra (9th NAHC)

2013, Brisbane (10th NAHC)

2015, Melbourne (11th NAHC)

2017, Sydney (12th NAHC)

2019, Brisbane (13th NAHC)

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