Use of palatal augmentation prostheses to maintain speech and swallowing function in patients with amyotrophic lateral sclerosis

Amyotrophic lateral sclerosis (ALS) is a progressive neurodegenerative disease caused by the degeneration of both upper and lower motor neurons. Moreover, dysphagia and respiratory failure almost invariably develop in ALS patients. Dysarthria and dysphagia sometimes occur early ALS patients, and the understanding and management of such patients are important. We report the case of an ALS patient with dysphagia/dysarthria in whom we used various types of palatal augmentation prostheses (PAPs) and serially observed the course of dysphagia/dysarthria. We fabricated 3 types of PAPs (2 for dysphagia/dysarthria and 1 obturator-type PAP) for the patient, and their effectiveness in improving dysphagia was evaluated by videofluoroscopic swallowing studies and fibreoptic endoscopic examination of swallowing, whereas their effectiveness in improving dysarthria was evaluated by the standard Japanese speech intelligibility test comprising 100 syllables.We believe that the obturator-type PAP was useful for improving dysphagia in the long term, while the other PAPs were useful for improving dysphagia/dysarthria only in the initial stages. PAPs are an adjunctive therapy for treating dysphagia/dysarthria and for maintaining patient function and improving quality of life in ALS patients.