Best practices protocol for the evaluation of bulbar dysfunction: summary recommendations from the NEALS bulbar subcommittee symposium.

AbstractObjective: The aim of this Symposium was to develop a consensus based, bulbar assessment protocol for implementation within NEALS clinics. Methods: A one-day symposium, held in April 2017, was organized into Speech and Swallowingsections to establish summary recommendations for the assessment of bulbar dysfunction within each group. Results: Summary recommendations included speech referrals and AAC evaluations at initial visit, CNS-BFS, maximum sustained phonation, and speaking rate. Dysarthriaevaluation included the speech subsystem involvement of respiration, phonation, resonance, and articulation. Specific recommendations for swallowingwere established for each of the following domains: dietary/oral intake, airway defense physiologiccapacity, swallowsafety screen, patient-reported swallow-related outcomes, oral sensorimotor exam, and pulmonary function. Practice parameters focused upon patient educationand unresolved questions included the use of videofluoscopy, monitoring diet progressio...