Comunicación Verbal Prejudicada: revisión del diagnóstico en pacientes con Esclerosis Lateral Amiotrófica

Severo, Amanda Holanda; Carvalho, Zuila Maria de Figueiredo; Lopes, Marcos Venícios de Oliveira; Brasileiro, Renata Sá Ferreira; Braga, Deyse Cardoso de Oliveira

doi:10.1590/0034-7167-2017-0763

Amanda Holanda Severo CORRESPONDING AUTHOR: Amanda Holanda Severo. E-mail: amandah_severo@hotmail.com

Universidade Federal do Ceará. Fortaleza, Ceará, Brazil.

Zuila Maria de Figueiredo Carvalho

Universidade Federal do Ceará. Fortaleza, Ceará, Brazil.

Marcos Venícios de Oliveira Lopes

Universidade Federal do Ceará. Fortaleza, Ceará, Brazil.

Renata Sá Ferreira Brasileiro

Universidade Federal do Ceará. Fortaleza, Ceará, Brazil.

Deyse Cardoso de Oliveira Braga

Universidade Federal do Ceará. Fortaleza, Ceará, Brazil.

CORRESPONDING AUTHOR: Amanda Holanda Severo. E-mail: amandah_severo@hotmail.com

CRITICAL ATTRIBUTES OF “COMMUNICATION DISORDERS”
Comunicação voluntária diminuída; fala prejudicada ⁽⁷⁾7 Kühnlein P, Gdynia H-J, Sperfeld A-D, Lindner-Pfleghar B, Ludolph AC, Prosiegel M, Riecker A. Diagnosis and treatment of bulbar symptoms in amyotrophic lateral sclerosis. Nat Clin Pract Neurol[Internet]. 2008[cited 2015 Dec 02];4(7):366-74. Available from: https://www.rku.de/files/Diagnosis_and_treatment_of_bulbar_symptoms_in_amyotrophic_lateral_sclerosis_Khnlein_et_al__2009.pdf https://www.rku.de/files/Diagnosis_and_t... .
Produção da fala torna-se incompreensível até para o ouvinte mais familiar nas interações ricas em informação contextual; falhas na comunicação ⁽⁸⁾8 Ball LJ, Beukelman DR, Pattee GL. Communication effectiveness of individuals with amyotrophic lateral sclerosis. J Commun Disord[Internet]. 2004[cited 2015 Dec 18];37(3):197-215. Available from: https://linkinghub.elsevier.com/retrieve/pii/S0021992403000789 https://linkinghub.elsevier.com/retrieve... .
Déficit na comunicação; alterações na fala; lentos na fluência da fala e escrita; alteração na fluência da escrita ⁽¹⁶⁾16 Roberts-South A, Findlater K, Strong MJ, Orange JB. Longitudinal changes in discourse production in amyotrophic lateral sclerosis. Semin Speech Lang[Internet]. 2012[cited 2015 Nov 15];33(1):79-94. Available from: http://www.thieme-connect.com/DOI/DOI?10.1055/s-0031-1301165 http://www.thieme-connect.com/DOI/DOI?10... .
Deterioração da fala; falta de habilidades de fala para satisfazer as necessidades diárias; Diminuição da compreensão das modalidades verbais: escrita e fala ⁽¹⁸⁾18 Bloch S, Clarke M. Handwriting-in-interaction between people with ALS/MND and their conversation partners. Augment Altern Commun[Internet]. 2013[cited 2015 Dec 23];29(1):54-67. Available from: http://www.tandfonline.com/doi/full/10.3109/07434618.2013.767497 http://www.tandfonline.com/doi/full/10.3... .
Problemas de comunicação oral devido à fraqueza, incoordenação, ou paralisia da musculatura da fala; alterações na fala; dificuldades de comunicação; perda de comunicação ⁽⁹⁾9 Brownlee A, Palovcak M. The role of augmentative communication devices in the medical management of ALS. NeuroRehabilitation[Internet]. 2007[cited 2016 Jan 03];22(6):445-450. Available from: https://www.ncbi.nlm.nih.gov/pubmed/18198430 https://www.ncbi.nlm.nih.gov/pubmed/1819... .
Déficit no discurso narrativo; padrão de discurso narrativo prejudicada; problemas na fala; desempenho da linguagem prejudicada; dificuldade de execução da fala ⁽¹⁰⁾10 Ash S, Menaged A, Olm C, Mcmillan CT, Boller A, Irwin DJ, et al. Narrative discourse deficits in amyotrophic lateral sclerosis. Neurol[Internet]. 2014[cited 2016 Jan 17];83(6):520-28. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4142005/ https://www.ncbi.nlm.nih.gov/pmc/article... .
Perda da comunicação falada; diminuição da capacidade de utilizar a voz; perda da capacidade de atender às necessidades diárias de comunicação com seu discurso natural; incapacidade de falar por longos períodos de tempo antes da morte; rápida perda da fala; perda rápida de expressão; perda do discurso ⁽¹¹⁾11 Mckelvey M, Evans DL, Kawai N, Beukelman D. Communication styles of persons with ALS as recounted by surviving partners. Augment Altern Commun[Internet]. 2012[cited 2016 Jan 22];28(4):232-42. Available from:https://www.ncbi.nlm.nih.gov/pubmed/23256855 from:https://www.ncbi.nlm.nih.gov/pubmed... .
Perda da comunicação; perda da utilização da fala; Alteração da linguagem falada e escrita ⁽¹⁹⁾19 Tomik B, Guiloff RJ. Dysarthria in amyotrophic lateral sclerosis: a review. Amyotroph Lateral Scler[Internet]. 2010[cited 2016 Feb 12];11(1-2):4-15. Available from: http://www.tandfonline.com/doi/full/10.3109/17482960802379004 http://www.tandfonline.com/doi/full/10.3... .
Perda da fala; deterioração gradual da capacidade da fala; perturbações da fala; dificuldades de comunicação; problema em transmitir e/ou compreender a mensagem; dificuldades com a fala ⁽¹²⁾12 Murphy J. Communication strategies of people with ALS and their partners. Amyotroph Lateral Scler Other Motor Neuron Disord[Internet]. 2004[cited 2016 Feb 28];5(2):121-6. Available from: https://www.ncbi.nlm.nih.gov/pubmed/15204014 https://www.ncbi.nlm.nih.gov/pubmed/1520... .
Distúrbios de comunicação; deterioração da fala; dificuldades funcionais de comunicação por serem incapazes de satisfazer todas as suas necessidades de comunicação através do discurso oral; perda de expressão verbal; problemas de fala; perda da capacidade de usar o discurso natural; deterioração do discurso; impossibilidade de fala ⁽¹³⁾13 Ray J. Real-life challenges in using augmentative and alternative communication by persons with amyotrophic lateral sclerosis. Commun Disord Q[Internet]. 2015[cited 2016 Mar 12];36(3):187-92. Available from: http://journals.sagepub.com/doi/abs/10.1177/1525740114545359 http://journals.sagepub.com/doi/abs/10.1... .
Fala e linguagem prejudicada; conversa prejudicada; deficiências de comunicação; deficiências na fala ⁽¹⁴⁾14 Bloch S, Beeke S. Co-constructed talk in the conversations of people with dysarthria and aphasia. Clin Linguist Phon[Internet]. 2008[cited 2016 Mar 21];22(12):974-90. Available from: https://www.ncbi.nlm.nih.gov/pubmed/19031194 https://www.ncbi.nlm.nih.gov/pubmed/1903... .
Disfunção da fala; problemas de fala; incapacidade para se comunicar ⁽¹⁵⁾15 Ball LJ, Willis A, Beukelman DR, Pattee GL. A protocol for identification of early bulbar signs in amyotrophic lateral sclerosis. J Neurol Sci[Internet]. 2001[cited 2016 Apr 04];191(1-2):43-53. Available from: https://linkinghub.elsevier.com/retrieve/pii/S0022510X01006232 https://linkinghub.elsevier.com/retrieve... .
Comprometimento progressivo da linguagem escrita; comprometimento da fala; escrita desordenada; escrita anormal ⁽¹⁷⁾17 Ferguson JH, Boller F. A different form of "pure agraphia": syntactic writing errors in patients with motor speech and movement disorders. Neurol Neurocir Psiquiatr[Internet]. 1977[cited 2015 Nov 22];4(3):382-89. Available from: https://www.ncbi.nlm.nih.gov/pubmed/616562 https://www.ncbi.nlm.nih.gov/pubmed/6165... .
Perda da capacidade para falar e escrever; perda progressiva da capacidade de se comunicar com discurso natural; perda de discurso inteligível; perda do discurso natural; perda do discurso funcional; perda do discurso ⁽²⁰⁾7 Kühnlein P, Gdynia H-J, Sperfeld A-D, Lindner-Pfleghar B, Ludolph AC, Prosiegel M, Riecker A. Diagnosis and treatment of bulbar symptoms in amyotrophic lateral sclerosis. Nat Clin Pract Neurol[Internet]. 2008[cited 2015 Dec 02];4(7):366-74. Available from: https://www.rku.de/files/Diagnosis_and_treatment_of_bulbar_symptoms_in_amyotrophic_lateral_sclerosis_Khnlein_et_al__2009.pdf https://www.rku.de/files/Diagnosis_and_t... .

RF – Concept analysis	RF – Concept analysis
Degeneration of motor neurons( ⁷7 Kühnlein P, Gdynia H-J, Sperfeld A-D, Lindner-Pfleghar B, Ludolph AC, Prosiegel M, Riecker A. Diagnosis and treatment of bulbar symptoms in amyotrophic lateral sclerosis. Nat Clin Pract Neurol[Internet]. 2008[cited 2015 Dec 02];4(7):366-74. Available from: https://www.rku.de/files/Diagnosis_and_treatment_of_bulbar_symptoms_in_amyotrophic_lateral_sclerosis_Khnlein_et_al__2009.pdf https://www.rku.de/files/Diagnosis_and_t... - ⁸8 Ball LJ, Beukelman DR, Pattee GL. Communication effectiveness of individuals with amyotrophic lateral sclerosis. J Commun Disord[Internet]. 2004[cited 2015 Dec 18];37(3):197-215. Available from: https://linkinghub.elsevier.com/retrieve/pii/S0021992403000789 https://linkinghub.elsevier.com/retrieve... , ¹³13 Ray J. Real-life challenges in using augmentative and alternative communication by persons with amyotrophic lateral sclerosis. Commun Disord Q[Internet]. 2015[cited 2016 Mar 12];36(3):187-92. Available from: http://journals.sagepub.com/doi/abs/10.1177/1525740114545359 http://journals.sagepub.com/doi/abs/10.1... , ¹⁵15 Ball LJ, Willis A, Beukelman DR, Pattee GL. A protocol for identification of early bulbar signs in amyotrophic lateral sclerosis. J Neurol Sci[Internet]. 2001[cited 2016 Apr 04];191(1-2):43-53. Available from: https://linkinghub.elsevier.com/retrieve/pii/S0022510X01006232 https://linkinghub.elsevier.com/retrieve... , ¹⁸18 Bloch S, Clarke M. Handwriting-in-interaction between people with ALS/MND and their conversation partners. Augment Altern Commun[Internet]. 2013[cited 2015 Dec 23];29(1):54-67. Available from: http://www.tandfonline.com/doi/full/10.3109/07434618.2013.767497 http://www.tandfonline.com/doi/full/10.3... )	Vocal fold hyperadduction( ⁷7 Kühnlein P, Gdynia H-J, Sperfeld A-D, Lindner-Pfleghar B, Ludolph AC, Prosiegel M, Riecker A. Diagnosis and treatment of bulbar symptoms in amyotrophic lateral sclerosis. Nat Clin Pract Neurol[Internet]. 2008[cited 2015 Dec 02];4(7):366-74. Available from: https://www.rku.de/files/Diagnosis_and_treatment_of_bulbar_symptoms_in_amyotrophic_lateral_sclerosis_Khnlein_et_al__2009.pdf https://www.rku.de/files/Diagnosis_and_t... , ¹⁹19 Tomik B, Guiloff RJ. Dysarthria in amyotrophic lateral sclerosis: a review. Amyotroph Lateral Scler[Internet]. 2010[cited 2016 Feb 12];11(1-2):4-15. Available from: http://www.tandfonline.com/doi/full/10.3109/17482960802379004 http://www.tandfonline.com/doi/full/10.3... )
Tongue paralysis( ⁷7 Kühnlein P, Gdynia H-J, Sperfeld A-D, Lindner-Pfleghar B, Ludolph AC, Prosiegel M, Riecker A. Diagnosis and treatment of bulbar symptoms in amyotrophic lateral sclerosis. Nat Clin Pract Neurol[Internet]. 2008[cited 2015 Dec 02];4(7):366-74. Available from: https://www.rku.de/files/Diagnosis_and_treatment_of_bulbar_symptoms_in_amyotrophic_lateral_sclerosis_Khnlein_et_al__2009.pdf https://www.rku.de/files/Diagnosis_and_t... - ⁸8 Ball LJ, Beukelman DR, Pattee GL. Communication effectiveness of individuals with amyotrophic lateral sclerosis. J Commun Disord[Internet]. 2004[cited 2015 Dec 18];37(3):197-215. Available from: https://linkinghub.elsevier.com/retrieve/pii/S0021992403000789 https://linkinghub.elsevier.com/retrieve... , ¹⁵15 Ball LJ, Willis A, Beukelman DR, Pattee GL. A protocol for identification of early bulbar signs in amyotrophic lateral sclerosis. J Neurol Sci[Internet]. 2001[cited 2016 Apr 04];191(1-2):43-53. Available from: https://linkinghub.elsevier.com/retrieve/pii/S0022510X01006232 https://linkinghub.elsevier.com/retrieve... , ¹⁸18 Bloch S, Clarke M. Handwriting-in-interaction between people with ALS/MND and their conversation partners. Augment Altern Commun[Internet]. 2013[cited 2015 Dec 23];29(1):54-67. Available from: http://www.tandfonline.com/doi/full/10.3109/07434618.2013.767497 http://www.tandfonline.com/doi/full/10.3... 19 Tomik B, Guiloff RJ. Dysarthria in amyotrophic lateral sclerosis: a review. Amyotroph Lateral Scler[Internet]. 2010[cited 2016 Feb 12];11(1-2):4-15. Available from: http://www.tandfonline.com/doi/full/10.3109/17482960802379004 http://www.tandfonline.com/doi/full/10.3... - ²⁰20 Hanson EK, Yorkston KM, Britton D. Dysarthria in amyotrophic lateral sclerosis: a systematic review of characteristics, speech treatment, and augmentative and alternative communication options. J Med Speech Lang Pathol[Internet]. 2011[cited 2016 Apr 13];19(3):12-30. Available from: https://www.asha.org/articlesummary.aspx?id=8589955557 https://www.asha.org/articlesummary.aspx... )	Vocal fold hypoadduction( ⁷7 Kühnlein P, Gdynia H-J, Sperfeld A-D, Lindner-Pfleghar B, Ludolph AC, Prosiegel M, Riecker A. Diagnosis and treatment of bulbar symptoms in amyotrophic lateral sclerosis. Nat Clin Pract Neurol[Internet]. 2008[cited 2015 Dec 02];4(7):366-74. Available from: https://www.rku.de/files/Diagnosis_and_treatment_of_bulbar_symptoms_in_amyotrophic_lateral_sclerosis_Khnlein_et_al__2009.pdf https://www.rku.de/files/Diagnosis_and_t... , ¹⁹19 Tomik B, Guiloff RJ. Dysarthria in amyotrophic lateral sclerosis: a review. Amyotroph Lateral Scler[Internet]. 2010[cited 2016 Feb 12];11(1-2):4-15. Available from: http://www.tandfonline.com/doi/full/10.3109/17482960802379004 http://www.tandfonline.com/doi/full/10.3... )
Reduced tongue speed( ⁷7 Kühnlein P, Gdynia H-J, Sperfeld A-D, Lindner-Pfleghar B, Ludolph AC, Prosiegel M, Riecker A. Diagnosis and treatment of bulbar symptoms in amyotrophic lateral sclerosis. Nat Clin Pract Neurol[Internet]. 2008[cited 2015 Dec 02];4(7):366-74. Available from: https://www.rku.de/files/Diagnosis_and_treatment_of_bulbar_symptoms_in_amyotrophic_lateral_sclerosis_Khnlein_et_al__2009.pdf https://www.rku.de/files/Diagnosis_and_t... - ⁸8 Ball LJ, Beukelman DR, Pattee GL. Communication effectiveness of individuals with amyotrophic lateral sclerosis. J Commun Disord[Internet]. 2004[cited 2015 Dec 18];37(3):197-215. Available from: https://linkinghub.elsevier.com/retrieve/pii/S0021992403000789 https://linkinghub.elsevier.com/retrieve... , ¹⁵15 Ball LJ, Willis A, Beukelman DR, Pattee GL. A protocol for identification of early bulbar signs in amyotrophic lateral sclerosis. J Neurol Sci[Internet]. 2001[cited 2016 Apr 04];191(1-2):43-53. Available from: https://linkinghub.elsevier.com/retrieve/pii/S0022510X01006232 https://linkinghub.elsevier.com/retrieve... , ¹⁸18 Bloch S, Clarke M. Handwriting-in-interaction between people with ALS/MND and their conversation partners. Augment Altern Commun[Internet]. 2013[cited 2015 Dec 23];29(1):54-67. Available from: http://www.tandfonline.com/doi/full/10.3109/07434618.2013.767497 http://www.tandfonline.com/doi/full/10.3... 19 Tomik B, Guiloff RJ. Dysarthria in amyotrophic lateral sclerosis: a review. Amyotroph Lateral Scler[Internet]. 2010[cited 2016 Feb 12];11(1-2):4-15. Available from: http://www.tandfonline.com/doi/full/10.3109/17482960802379004 http://www.tandfonline.com/doi/full/10.3... - ²⁰20 Hanson EK, Yorkston KM, Britton D. Dysarthria in amyotrophic lateral sclerosis: a systematic review of characteristics, speech treatment, and augmentative and alternative communication options. J Med Speech Lang Pathol[Internet]. 2011[cited 2016 Apr 13];19(3):12-30. Available from: https://www.asha.org/articlesummary.aspx?id=8589955557 https://www.asha.org/articlesummary.aspx... )	Respiratory muscle weakness( ⁸8 Ball LJ, Beukelman DR, Pattee GL. Communication effectiveness of individuals with amyotrophic lateral sclerosis. J Commun Disord[Internet]. 2004[cited 2015 Dec 18];37(3):197-215. Available from: https://linkinghub.elsevier.com/retrieve/pii/S0021992403000789 https://linkinghub.elsevier.com/retrieve... , ¹⁹19 Tomik B, Guiloff RJ. Dysarthria in amyotrophic lateral sclerosis: a review. Amyotroph Lateral Scler[Internet]. 2010[cited 2016 Feb 12];11(1-2):4-15. Available from: http://www.tandfonline.com/doi/full/10.3109/17482960802379004 http://www.tandfonline.com/doi/full/10.3... )
Tongue atrophy( ⁷7 Kühnlein P, Gdynia H-J, Sperfeld A-D, Lindner-Pfleghar B, Ludolph AC, Prosiegel M, Riecker A. Diagnosis and treatment of bulbar symptoms in amyotrophic lateral sclerosis. Nat Clin Pract Neurol[Internet]. 2008[cited 2015 Dec 02];4(7):366-74. Available from: https://www.rku.de/files/Diagnosis_and_treatment_of_bulbar_symptoms_in_amyotrophic_lateral_sclerosis_Khnlein_et_al__2009.pdf https://www.rku.de/files/Diagnosis_and_t... , ¹⁹19 Tomik B, Guiloff RJ. Dysarthria in amyotrophic lateral sclerosis: a review. Amyotroph Lateral Scler[Internet]. 2010[cited 2016 Feb 12];11(1-2):4-15. Available from: http://www.tandfonline.com/doi/full/10.3109/17482960802379004 http://www.tandfonline.com/doi/full/10.3... )	Dyspnea( ⁷7 Kühnlein P, Gdynia H-J, Sperfeld A-D, Lindner-Pfleghar B, Ludolph AC, Prosiegel M, Riecker A. Diagnosis and treatment of bulbar symptoms in amyotrophic lateral sclerosis. Nat Clin Pract Neurol[Internet]. 2008[cited 2015 Dec 02];4(7):366-74. Available from: https://www.rku.de/files/Diagnosis_and_treatment_of_bulbar_symptoms_in_amyotrophic_lateral_sclerosis_Khnlein_et_al__2009.pdf https://www.rku.de/files/Diagnosis_and_t... , ¹⁷17 Ferguson JH, Boller F. A different form of "pure agraphia": syntactic writing errors in patients with motor speech and movement disorders. Neurol Neurocir Psiquiatr[Internet]. 1977[cited 2015 Nov 22];4(3):382-89. Available from: https://www.ncbi.nlm.nih.gov/pubmed/616562 https://www.ncbi.nlm.nih.gov/pubmed/6165... )
Tongue fasciculations( ⁷7 Kühnlein P, Gdynia H-J, Sperfeld A-D, Lindner-Pfleghar B, Ludolph AC, Prosiegel M, Riecker A. Diagnosis and treatment of bulbar symptoms in amyotrophic lateral sclerosis. Nat Clin Pract Neurol[Internet]. 2008[cited 2015 Dec 02];4(7):366-74. Available from: https://www.rku.de/files/Diagnosis_and_treatment_of_bulbar_symptoms_in_amyotrophic_lateral_sclerosis_Khnlein_et_al__2009.pdf https://www.rku.de/files/Diagnosis_and_t... , ¹⁷17 Ferguson JH, Boller F. A different form of "pure agraphia": syntactic writing errors in patients with motor speech and movement disorders. Neurol Neurocir Psiquiatr[Internet]. 1977[cited 2015 Nov 22];4(3):382-89. Available from: https://www.ncbi.nlm.nih.gov/pubmed/616562 https://www.ncbi.nlm.nih.gov/pubmed/6165... , ²⁰20 Hanson EK, Yorkston KM, Britton D. Dysarthria in amyotrophic lateral sclerosis: a systematic review of characteristics, speech treatment, and augmentative and alternative communication options. J Med Speech Lang Pathol[Internet]. 2011[cited 2016 Apr 13];19(3):12-30. Available from: https://www.asha.org/articlesummary.aspx?id=8589955557 https://www.asha.org/articlesummary.aspx... )	Tracheostomy( ¹⁹19 Tomik B, Guiloff RJ. Dysarthria in amyotrophic lateral sclerosis: a review. Amyotroph Lateral Scler[Internet]. 2010[cited 2016 Feb 12];11(1-2):4-15. Available from: http://www.tandfonline.com/doi/full/10.3109/17482960802379004 http://www.tandfonline.com/doi/full/10.3... )
Hemifacial spasm( ⁷7 Kühnlein P, Gdynia H-J, Sperfeld A-D, Lindner-Pfleghar B, Ludolph AC, Prosiegel M, Riecker A. Diagnosis and treatment of bulbar symptoms in amyotrophic lateral sclerosis. Nat Clin Pract Neurol[Internet]. 2008[cited 2015 Dec 02];4(7):366-74. Available from: https://www.rku.de/files/Diagnosis_and_treatment_of_bulbar_symptoms_in_amyotrophic_lateral_sclerosis_Khnlein_et_al__2009.pdf https://www.rku.de/files/Diagnosis_and_t... , ¹⁹19 Tomik B, Guiloff RJ. Dysarthria in amyotrophic lateral sclerosis: a review. Amyotroph Lateral Scler[Internet]. 2010[cited 2016 Feb 12];11(1-2):4-15. Available from: http://www.tandfonline.com/doi/full/10.3109/17482960802379004 http://www.tandfonline.com/doi/full/10.3... )	Sialorrhea( ⁷7 Kühnlein P, Gdynia H-J, Sperfeld A-D, Lindner-Pfleghar B, Ludolph AC, Prosiegel M, Riecker A. Diagnosis and treatment of bulbar symptoms in amyotrophic lateral sclerosis. Nat Clin Pract Neurol[Internet]. 2008[cited 2015 Dec 02];4(7):366-74. Available from: https://www.rku.de/files/Diagnosis_and_treatment_of_bulbar_symptoms_in_amyotrophic_lateral_sclerosis_Khnlein_et_al__2009.pdf https://www.rku.de/files/Diagnosis_and_t... , ²⁰20 Hanson EK, Yorkston KM, Britton D. Dysarthria in amyotrophic lateral sclerosis: a systematic review of characteristics, speech treatment, and augmentative and alternative communication options. J Med Speech Lang Pathol[Internet]. 2011[cited 2016 Apr 13];19(3):12-30. Available from: https://www.asha.org/articlesummary.aspx?id=8589955557 https://www.asha.org/articlesummary.aspx... )
Flaccid facial paralysis( ⁷7 Kühnlein P, Gdynia H-J, Sperfeld A-D, Lindner-Pfleghar B, Ludolph AC, Prosiegel M, Riecker A. Diagnosis and treatment of bulbar symptoms in amyotrophic lateral sclerosis. Nat Clin Pract Neurol[Internet]. 2008[cited 2015 Dec 02];4(7):366-74. Available from: https://www.rku.de/files/Diagnosis_and_treatment_of_bulbar_symptoms_in_amyotrophic_lateral_sclerosis_Khnlein_et_al__2009.pdf https://www.rku.de/files/Diagnosis_and_t... , ¹⁹19 Tomik B, Guiloff RJ. Dysarthria in amyotrophic lateral sclerosis: a review. Amyotroph Lateral Scler[Internet]. 2010[cited 2016 Feb 12];11(1-2):4-15. Available from: http://www.tandfonline.com/doi/full/10.3109/17482960802379004 http://www.tandfonline.com/doi/full/10.3... )	Emotional lability( ¹²12 Murphy J. Communication strategies of people with ALS and their partners. Amyotroph Lateral Scler Other Motor Neuron Disord[Internet]. 2004[cited 2016 Feb 28];5(2):121-6. Available from: https://www.ncbi.nlm.nih.gov/pubmed/15204014 https://www.ncbi.nlm.nih.gov/pubmed/1520... , ²⁰20 Hanson EK, Yorkston KM, Britton D. Dysarthria in amyotrophic lateral sclerosis: a systematic review of characteristics, speech treatment, and augmentative and alternative communication options. J Med Speech Lang Pathol[Internet]. 2011[cited 2016 Apr 13];19(3):12-30. Available from: https://www.asha.org/articlesummary.aspx?id=8589955557 https://www.asha.org/articlesummary.aspx... )
Velopharyngeal insufficiency( ⁷7 Kühnlein P, Gdynia H-J, Sperfeld A-D, Lindner-Pfleghar B, Ludolph AC, Prosiegel M, Riecker A. Diagnosis and treatment of bulbar symptoms in amyotrophic lateral sclerosis. Nat Clin Pract Neurol[Internet]. 2008[cited 2015 Dec 02];4(7):366-74. Available from: https://www.rku.de/files/Diagnosis_and_treatment_of_bulbar_symptoms_in_amyotrophic_lateral_sclerosis_Khnlein_et_al__2009.pdf https://www.rku.de/files/Diagnosis_and_t... - ⁸8 Ball LJ, Beukelman DR, Pattee GL. Communication effectiveness of individuals with amyotrophic lateral sclerosis. J Commun Disord[Internet]. 2004[cited 2015 Dec 18];37(3):197-215. Available from: https://linkinghub.elsevier.com/retrieve/pii/S0021992403000789 https://linkinghub.elsevier.com/retrieve... , ¹⁵15 Ball LJ, Willis A, Beukelman DR, Pattee GL. A protocol for identification of early bulbar signs in amyotrophic lateral sclerosis. J Neurol Sci[Internet]. 2001[cited 2016 Apr 04];191(1-2):43-53. Available from: https://linkinghub.elsevier.com/retrieve/pii/S0022510X01006232 https://linkinghub.elsevier.com/retrieve... , ¹⁹19 Tomik B, Guiloff RJ. Dysarthria in amyotrophic lateral sclerosis: a review. Amyotroph Lateral Scler[Internet]. 2010[cited 2016 Feb 12];11(1-2):4-15. Available from: http://www.tandfonline.com/doi/full/10.3109/17482960802379004 http://www.tandfonline.com/doi/full/10.3... - ²⁰20 Hanson EK, Yorkston KM, Britton D. Dysarthria in amyotrophic lateral sclerosis: a systematic review of characteristics, speech treatment, and augmentative and alternative communication options. J Med Speech Lang Pathol[Internet]. 2011[cited 2016 Apr 13];19(3):12-30. Available from: https://www.asha.org/articlesummary.aspx?id=8589955557 https://www.asha.org/articlesummary.aspx... )	Cognitive deficits( ¹²12 Murphy J. Communication strategies of people with ALS and their partners. Amyotroph Lateral Scler Other Motor Neuron Disord[Internet]. 2004[cited 2016 Feb 28];5(2):121-6. Available from: https://www.ncbi.nlm.nih.gov/pubmed/15204014 https://www.ncbi.nlm.nih.gov/pubmed/1520... - ¹³13 Ray J. Real-life challenges in using augmentative and alternative communication by persons with amyotrophic lateral sclerosis. Commun Disord Q[Internet]. 2015[cited 2016 Mar 12];36(3):187-92. Available from: http://journals.sagepub.com/doi/abs/10.1177/1525740114545359 http://journals.sagepub.com/doi/abs/10.1... , ¹⁶16 Roberts-South A, Findlater K, Strong MJ, Orange JB. Longitudinal changes in discourse production in amyotrophic lateral sclerosis. Semin Speech Lang[Internet]. 2012[cited 2015 Nov 15];33(1):79-94. Available from: http://www.thieme-connect.com/DOI/DOI?10.1055/s-0031-1301165 http://www.thieme-connect.com/DOI/DOI?10... , ²⁰20 Hanson EK, Yorkston KM, Britton D. Dysarthria in amyotrophic lateral sclerosis: a systematic review of characteristics, speech treatment, and augmentative and alternative communication options. J Med Speech Lang Pathol[Internet]. 2011[cited 2016 Apr 13];19(3):12-30. Available from: https://www.asha.org/articlesummary.aspx?id=8589955557 https://www.asha.org/articlesummary.aspx... )

DC – Concept analysis	DC – Concept analysis
Dysgraphia( ¹⁶16 Roberts-South A, Findlater K, Strong MJ, Orange JB. Longitudinal changes in discourse production in amyotrophic lateral sclerosis. Semin Speech Lang[Internet]. 2012[cited 2015 Nov 15];33(1):79-94. Available from: http://www.thieme-connect.com/DOI/DOI?10.1055/s-0031-1301165 http://www.thieme-connect.com/DOI/DOI?10... - ¹⁷17 Ferguson JH, Boller F. A different form of "pure agraphia": syntactic writing errors in patients with motor speech and movement disorders. Neurol Neurocir Psiquiatr[Internet]. 1977[cited 2015 Nov 22];4(3):382-89. Available from: https://www.ncbi.nlm.nih.gov/pubmed/616562 https://www.ncbi.nlm.nih.gov/pubmed/6165... , ¹⁹19 Tomik B, Guiloff RJ. Dysarthria in amyotrophic lateral sclerosis: a review. Amyotroph Lateral Scler[Internet]. 2010[cited 2016 Feb 12];11(1-2):4-15. Available from: http://www.tandfonline.com/doi/full/10.3109/17482960802379004 http://www.tandfonline.com/doi/full/10.3... )	Intelligibility of impaired speech( ⁷7 Kühnlein P, Gdynia H-J, Sperfeld A-D, Lindner-Pfleghar B, Ludolph AC, Prosiegel M, Riecker A. Diagnosis and treatment of bulbar symptoms in amyotrophic lateral sclerosis. Nat Clin Pract Neurol[Internet]. 2008[cited 2015 Dec 02];4(7):366-74. Available from: https://www.rku.de/files/Diagnosis_and_treatment_of_bulbar_symptoms_in_amyotrophic_lateral_sclerosis_Khnlein_et_al__2009.pdf https://www.rku.de/files/Diagnosis_and_t... , ⁹9 Brownlee A, Palovcak M. The role of augmentative communication devices in the medical management of ALS. NeuroRehabilitation[Internet]. 2007[cited 2016 Jan 03];22(6):445-450. Available from: https://www.ncbi.nlm.nih.gov/pubmed/18198430 https://www.ncbi.nlm.nih.gov/pubmed/1819... , ¹¹11 Mckelvey M, Evans DL, Kawai N, Beukelman D. Communication styles of persons with ALS as recounted by surviving partners. Augment Altern Commun[Internet]. 2012[cited 2016 Jan 22];28(4):232-42. Available from:https://www.ncbi.nlm.nih.gov/pubmed/23256855 from:https://www.ncbi.nlm.nih.gov/pubmed... 12 Murphy J. Communication strategies of people with ALS and their partners. Amyotroph Lateral Scler Other Motor Neuron Disord[Internet]. 2004[cited 2016 Feb 28];5(2):121-6. Available from: https://www.ncbi.nlm.nih.gov/pubmed/15204014 https://www.ncbi.nlm.nih.gov/pubmed/1520... - ¹³13 Ray J. Real-life challenges in using augmentative and alternative communication by persons with amyotrophic lateral sclerosis. Commun Disord Q[Internet]. 2015[cited 2016 Mar 12];36(3):187-92. Available from: http://journals.sagepub.com/doi/abs/10.1177/1525740114545359 http://journals.sagepub.com/doi/abs/10.1... , ¹⁵15 Ball LJ, Willis A, Beukelman DR, Pattee GL. A protocol for identification of early bulbar signs in amyotrophic lateral sclerosis. J Neurol Sci[Internet]. 2001[cited 2016 Apr 04];191(1-2):43-53. Available from: https://linkinghub.elsevier.com/retrieve/pii/S0022510X01006232 https://linkinghub.elsevier.com/retrieve... , ¹⁹19 Tomik B, Guiloff RJ. Dysarthria in amyotrophic lateral sclerosis: a review. Amyotroph Lateral Scler[Internet]. 2010[cited 2016 Feb 12];11(1-2):4-15. Available from: http://www.tandfonline.com/doi/full/10.3109/17482960802379004 http://www.tandfonline.com/doi/full/10.3... - ²⁰20 Hanson EK, Yorkston KM, Britton D. Dysarthria in amyotrophic lateral sclerosis: a systematic review of characteristics, speech treatment, and augmentative and alternative communication options. J Med Speech Lang Pathol[Internet]. 2011[cited 2016 Apr 13];19(3):12-30. Available from: https://www.asha.org/articlesummary.aspx?id=8589955557 https://www.asha.org/articlesummary.aspx... )
Agraphia( ¹⁷17 Ferguson JH, Boller F. A different form of "pure agraphia": syntactic writing errors in patients with motor speech and movement disorders. Neurol Neurocir Psiquiatr[Internet]. 1977[cited 2015 Nov 22];4(3):382-89. Available from: https://www.ncbi.nlm.nih.gov/pubmed/616562 https://www.ncbi.nlm.nih.gov/pubmed/6165... , ²⁰20 Hanson EK, Yorkston KM, Britton D. Dysarthria in amyotrophic lateral sclerosis: a systematic review of characteristics, speech treatment, and augmentative and alternative communication options. J Med Speech Lang Pathol[Internet]. 2011[cited 2016 Apr 13];19(3):12-30. Available from: https://www.asha.org/articlesummary.aspx?id=8589955557 https://www.asha.org/articlesummary.aspx... )	Decline of speech rate( ¹¹11 Mckelvey M, Evans DL, Kawai N, Beukelman D. Communication styles of persons with ALS as recounted by surviving partners. Augment Altern Commun[Internet]. 2012[cited 2016 Jan 22];28(4):232-42. Available from:https://www.ncbi.nlm.nih.gov/pubmed/23256855 from:https://www.ncbi.nlm.nih.gov/pubmed... , ¹³13 Ray J. Real-life challenges in using augmentative and alternative communication by persons with amyotrophic lateral sclerosis. Commun Disord Q[Internet]. 2015[cited 2016 Mar 12];36(3):187-92. Available from: http://journals.sagepub.com/doi/abs/10.1177/1525740114545359 http://journals.sagepub.com/doi/abs/10.1... , ¹⁵15 Ball LJ, Willis A, Beukelman DR, Pattee GL. A protocol for identification of early bulbar signs in amyotrophic lateral sclerosis. J Neurol Sci[Internet]. 2001[cited 2016 Apr 04];191(1-2):43-53. Available from: https://linkinghub.elsevier.com/retrieve/pii/S0022510X01006232 https://linkinghub.elsevier.com/retrieve... , ²⁰20 Hanson EK, Yorkston KM, Britton D. Dysarthria in amyotrophic lateral sclerosis: a systematic review of characteristics, speech treatment, and augmentative and alternative communication options. J Med Speech Lang Pathol[Internet]. 2011[cited 2016 Apr 13];19(3):12-30. Available from: https://www.asha.org/articlesummary.aspx?id=8589955557 https://www.asha.org/articlesummary.aspx... )
Dysarthria( ⁷7 Kühnlein P, Gdynia H-J, Sperfeld A-D, Lindner-Pfleghar B, Ludolph AC, Prosiegel M, Riecker A. Diagnosis and treatment of bulbar symptoms in amyotrophic lateral sclerosis. Nat Clin Pract Neurol[Internet]. 2008[cited 2015 Dec 02];4(7):366-74. Available from: https://www.rku.de/files/Diagnosis_and_treatment_of_bulbar_symptoms_in_amyotrophic_lateral_sclerosis_Khnlein_et_al__2009.pdf https://www.rku.de/files/Diagnosis_and_t... 8 Ball LJ, Beukelman DR, Pattee GL. Communication effectiveness of individuals with amyotrophic lateral sclerosis. J Commun Disord[Internet]. 2004[cited 2015 Dec 18];37(3):197-215. Available from: https://linkinghub.elsevier.com/retrieve/pii/S0021992403000789 https://linkinghub.elsevier.com/retrieve... - ⁹9 Brownlee A, Palovcak M. The role of augmentative communication devices in the medical management of ALS. NeuroRehabilitation[Internet]. 2007[cited 2016 Jan 03];22(6):445-450. Available from: https://www.ncbi.nlm.nih.gov/pubmed/18198430 https://www.ncbi.nlm.nih.gov/pubmed/1819... , ¹²12 Murphy J. Communication strategies of people with ALS and their partners. Amyotroph Lateral Scler Other Motor Neuron Disord[Internet]. 2004[cited 2016 Feb 28];5(2):121-6. Available from: https://www.ncbi.nlm.nih.gov/pubmed/15204014 https://www.ncbi.nlm.nih.gov/pubmed/1520... 13 Ray J. Real-life challenges in using augmentative and alternative communication by persons with amyotrophic lateral sclerosis. Commun Disord Q[Internet]. 2015[cited 2016 Mar 12];36(3):187-92. Available from: http://journals.sagepub.com/doi/abs/10.1177/1525740114545359 http://journals.sagepub.com/doi/abs/10.1... 14 Bloch S, Beeke S. Co-constructed talk in the conversations of people with dysarthria and aphasia. Clin Linguist Phon[Internet]. 2008[cited 2016 Mar 21];22(12):974-90. Available from: https://www.ncbi.nlm.nih.gov/pubmed/19031194 https://www.ncbi.nlm.nih.gov/pubmed/1903... 15 Ball LJ, Willis A, Beukelman DR, Pattee GL. A protocol for identification of early bulbar signs in amyotrophic lateral sclerosis. J Neurol Sci[Internet]. 2001[cited 2016 Apr 04];191(1-2):43-53. Available from: https://linkinghub.elsevier.com/retrieve/pii/S0022510X01006232 https://linkinghub.elsevier.com/retrieve... - ¹⁶16 Roberts-South A, Findlater K, Strong MJ, Orange JB. Longitudinal changes in discourse production in amyotrophic lateral sclerosis. Semin Speech Lang[Internet]. 2012[cited 2015 Nov 15];33(1):79-94. Available from: http://www.thieme-connect.com/DOI/DOI?10.1055/s-0031-1301165 http://www.thieme-connect.com/DOI/DOI?10... , ¹⁸18 Bloch S, Clarke M. Handwriting-in-interaction between people with ALS/MND and their conversation partners. Augment Altern Commun[Internet]. 2013[cited 2015 Dec 23];29(1):54-67. Available from: http://www.tandfonline.com/doi/full/10.3109/07434618.2013.767497 http://www.tandfonline.com/doi/full/10.3... 19 Tomik B, Guiloff RJ. Dysarthria in amyotrophic lateral sclerosis: a review. Amyotroph Lateral Scler[Internet]. 2010[cited 2016 Feb 12];11(1-2):4-15. Available from: http://www.tandfonline.com/doi/full/10.3109/17482960802379004 http://www.tandfonline.com/doi/full/10.3... - ²⁰20 Hanson EK, Yorkston KM, Britton D. Dysarthria in amyotrophic lateral sclerosis: a systematic review of characteristics, speech treatment, and augmentative and alternative communication options. J Med Speech Lang Pathol[Internet]. 2011[cited 2016 Apr 13];19(3):12-30. Available from: https://www.asha.org/articlesummary.aspx?id=8589955557 https://www.asha.org/articlesummary.aspx... )	Reduction of speech productivity( ¹⁰10 Ash S, Menaged A, Olm C, Mcmillan CT, Boller A, Irwin DJ, et al. Narrative discourse deficits in amyotrophic lateral sclerosis. Neurol[Internet]. 2014[cited 2016 Jan 17];83(6):520-28. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4142005/ https://www.ncbi.nlm.nih.gov/pmc/article... , ¹³13 Ray J. Real-life challenges in using augmentative and alternative communication by persons with amyotrophic lateral sclerosis. Commun Disord Q[Internet]. 2015[cited 2016 Mar 12];36(3):187-92. Available from: http://journals.sagepub.com/doi/abs/10.1177/1525740114545359 http://journals.sagepub.com/doi/abs/10.1... - ¹⁴14 Bloch S, Beeke S. Co-constructed talk in the conversations of people with dysarthria and aphasia. Clin Linguist Phon[Internet]. 2008[cited 2016 Mar 21];22(12):974-90. Available from: https://www.ncbi.nlm.nih.gov/pubmed/19031194 https://www.ncbi.nlm.nih.gov/pubmed/1903... , ¹⁶16 Roberts-South A, Findlater K, Strong MJ, Orange JB. Longitudinal changes in discourse production in amyotrophic lateral sclerosis. Semin Speech Lang[Internet]. 2012[cited 2015 Nov 15];33(1):79-94. Available from: http://www.thieme-connect.com/DOI/DOI?10.1055/s-0031-1301165 http://www.thieme-connect.com/DOI/DOI?10... )
Anartria( ⁷7 Kühnlein P, Gdynia H-J, Sperfeld A-D, Lindner-Pfleghar B, Ludolph AC, Prosiegel M, Riecker A. Diagnosis and treatment of bulbar symptoms in amyotrophic lateral sclerosis. Nat Clin Pract Neurol[Internet]. 2008[cited 2015 Dec 02];4(7):366-74. Available from: https://www.rku.de/files/Diagnosis_and_treatment_of_bulbar_symptoms_in_amyotrophic_lateral_sclerosis_Khnlein_et_al__2009.pdf https://www.rku.de/files/Diagnosis_and_t... , ⁹9 Brownlee A, Palovcak M. The role of augmentative communication devices in the medical management of ALS. NeuroRehabilitation[Internet]. 2007[cited 2016 Jan 03];22(6):445-450. Available from: https://www.ncbi.nlm.nih.gov/pubmed/18198430 https://www.ncbi.nlm.nih.gov/pubmed/1819... , ¹⁹19 Tomik B, Guiloff RJ. Dysarthria in amyotrophic lateral sclerosis: a review. Amyotroph Lateral Scler[Internet]. 2010[cited 2016 Feb 12];11(1-2):4-15. Available from: http://www.tandfonline.com/doi/full/10.3109/17482960802379004 http://www.tandfonline.com/doi/full/10.3... )	Decrease of ability and/or willingness to social interaction( ⁸8 Ball LJ, Beukelman DR, Pattee GL. Communication effectiveness of individuals with amyotrophic lateral sclerosis. J Commun Disord[Internet]. 2004[cited 2015 Dec 18];37(3):197-215. Available from: https://linkinghub.elsevier.com/retrieve/pii/S0021992403000789 https://linkinghub.elsevier.com/retrieve... , ¹¹11 Mckelvey M, Evans DL, Kawai N, Beukelman D. Communication styles of persons with ALS as recounted by surviving partners. Augment Altern Commun[Internet]. 2012[cited 2016 Jan 22];28(4):232-42. Available from:https://www.ncbi.nlm.nih.gov/pubmed/23256855 from:https://www.ncbi.nlm.nih.gov/pubmed... 12 Murphy J. Communication strategies of people with ALS and their partners. Amyotroph Lateral Scler Other Motor Neuron Disord[Internet]. 2004[cited 2016 Feb 28];5(2):121-6. Available from: https://www.ncbi.nlm.nih.gov/pubmed/15204014 https://www.ncbi.nlm.nih.gov/pubmed/1520... - ¹³13 Ray J. Real-life challenges in using augmentative and alternative communication by persons with amyotrophic lateral sclerosis. Commun Disord Q[Internet]. 2015[cited 2016 Mar 12];36(3):187-92. Available from: http://journals.sagepub.com/doi/abs/10.1177/1525740114545359 http://journals.sagepub.com/doi/abs/10.1... )
Aphasia( ⁸8 Ball LJ, Beukelman DR, Pattee GL. Communication effectiveness of individuals with amyotrophic lateral sclerosis. J Commun Disord[Internet]. 2004[cited 2015 Dec 18];37(3):197-215. Available from: https://linkinghub.elsevier.com/retrieve/pii/S0021992403000789 https://linkinghub.elsevier.com/retrieve... , ¹⁶16 Roberts-South A, Findlater K, Strong MJ, Orange JB. Longitudinal changes in discourse production in amyotrophic lateral sclerosis. Semin Speech Lang[Internet]. 2012[cited 2015 Nov 15];33(1):79-94. Available from: http://www.thieme-connect.com/DOI/DOI?10.1055/s-0031-1301165 http://www.thieme-connect.com/DOI/DOI?10... - ¹⁷17 Ferguson JH, Boller F. A different form of "pure agraphia": syntactic writing errors in patients with motor speech and movement disorders. Neurol Neurocir Psiquiatr[Internet]. 1977[cited 2015 Nov 22];4(3):382-89. Available from: https://www.ncbi.nlm.nih.gov/pubmed/616562 https://www.ncbi.nlm.nih.gov/pubmed/6165... , ¹⁹19 Tomik B, Guiloff RJ. Dysarthria in amyotrophic lateral sclerosis: a review. Amyotroph Lateral Scler[Internet]. 2010[cited 2016 Feb 12];11(1-2):4-15. Available from: http://www.tandfonline.com/doi/full/10.3109/17482960802379004 http://www.tandfonline.com/doi/full/10.3... )	Augmentative and alternative communication( ⁹9 Brownlee A, Palovcak M. The role of augmentative communication devices in the medical management of ALS. NeuroRehabilitation[Internet]. 2007[cited 2016 Jan 03];22(6):445-450. Available from: https://www.ncbi.nlm.nih.gov/pubmed/18198430 https://www.ncbi.nlm.nih.gov/pubmed/1819... , ¹¹11 Mckelvey M, Evans DL, Kawai N, Beukelman D. Communication styles of persons with ALS as recounted by surviving partners. Augment Altern Commun[Internet]. 2012[cited 2016 Jan 22];28(4):232-42. Available from:https://www.ncbi.nlm.nih.gov/pubmed/23256855 from:https://www.ncbi.nlm.nih.gov/pubmed... 12 Murphy J. Communication strategies of people with ALS and their partners. Amyotroph Lateral Scler Other Motor Neuron Disord[Internet]. 2004[cited 2016 Feb 28];5(2):121-6. Available from: https://www.ncbi.nlm.nih.gov/pubmed/15204014 https://www.ncbi.nlm.nih.gov/pubmed/1520... - ¹³13 Ray J. Real-life challenges in using augmentative and alternative communication by persons with amyotrophic lateral sclerosis. Commun Disord Q[Internet]. 2015[cited 2016 Mar 12];36(3):187-92. Available from: http://journals.sagepub.com/doi/abs/10.1177/1525740114545359 http://journals.sagepub.com/doi/abs/10.1... , ¹⁸18 Bloch S, Clarke M. Handwriting-in-interaction between people with ALS/MND and their conversation partners. Augment Altern Commun[Internet]. 2013[cited 2015 Dec 23];29(1):54-67. Available from: http://www.tandfonline.com/doi/full/10.3109/07434618.2013.767497 http://www.tandfonline.com/doi/full/10.3... 19 Tomik B, Guiloff RJ. Dysarthria in amyotrophic lateral sclerosis: a review. Amyotroph Lateral Scler[Internet]. 2010[cited 2016 Feb 12];11(1-2):4-15. Available from: http://www.tandfonline.com/doi/full/10.3109/17482960802379004 http://www.tandfonline.com/doi/full/10.3... - ²⁰20 Hanson EK, Yorkston KM, Britton D. Dysarthria in amyotrophic lateral sclerosis: a systematic review of characteristics, speech treatment, and augmentative and alternative communication options. J Med Speech Lang Pathol[Internet]. 2011[cited 2016 Apr 13];19(3):12-30. Available from: https://www.asha.org/articlesummary.aspx?id=8589955557 https://www.asha.org/articlesummary.aspx... )
Fatigue from conversation( ⁹9 Brownlee A, Palovcak M. The role of augmentative communication devices in the medical management of ALS. NeuroRehabilitation[Internet]. 2007[cited 2016 Jan 03];22(6):445-450. Available from: https://www.ncbi.nlm.nih.gov/pubmed/18198430 https://www.ncbi.nlm.nih.gov/pubmed/1819... , ¹¹11 Mckelvey M, Evans DL, Kawai N, Beukelman D. Communication styles of persons with ALS as recounted by surviving partners. Augment Altern Commun[Internet]. 2012[cited 2016 Jan 22];28(4):232-42. Available from:https://www.ncbi.nlm.nih.gov/pubmed/23256855 from:https://www.ncbi.nlm.nih.gov/pubmed... - ¹²12 Murphy J. Communication strategies of people with ALS and their partners. Amyotroph Lateral Scler Other Motor Neuron Disord[Internet]. 2004[cited 2016 Feb 28];5(2):121-6. Available from: https://www.ncbi.nlm.nih.gov/pubmed/15204014 https://www.ncbi.nlm.nih.gov/pubmed/1520... ,16,1 ⁹9 Brownlee A, Palovcak M. The role of augmentative communication devices in the medical management of ALS. NeuroRehabilitation[Internet]. 2007[cited 2016 Jan 03];22(6):445-450. Available from: https://www.ncbi.nlm.nih.gov/pubmed/18198430 https://www.ncbi.nlm.nih.gov/pubmed/1819... )	Negative emotions( ⁹9 Brownlee A, Palovcak M. The role of augmentative communication devices in the medical management of ALS. NeuroRehabilitation[Internet]. 2007[cited 2016 Jan 03];22(6):445-450. Available from: https://www.ncbi.nlm.nih.gov/pubmed/18198430 https://www.ncbi.nlm.nih.gov/pubmed/1819... , ¹¹11 Mckelvey M, Evans DL, Kawai N, Beukelman D. Communication styles of persons with ALS as recounted by surviving partners. Augment Altern Commun[Internet]. 2012[cited 2016 Jan 22];28(4):232-42. Available from:https://www.ncbi.nlm.nih.gov/pubmed/23256855 from:https://www.ncbi.nlm.nih.gov/pubmed... 12 Murphy J. Communication strategies of people with ALS and their partners. Amyotroph Lateral Scler Other Motor Neuron Disord[Internet]. 2004[cited 2016 Feb 28];5(2):121-6. Available from: https://www.ncbi.nlm.nih.gov/pubmed/15204014 https://www.ncbi.nlm.nih.gov/pubmed/1520... - ¹³13 Ray J. Real-life challenges in using augmentative and alternative communication by persons with amyotrophic lateral sclerosis. Commun Disord Q[Internet]. 2015[cited 2016 Mar 12];36(3):187-92. Available from: http://journals.sagepub.com/doi/abs/10.1177/1525740114545359 http://journals.sagepub.com/doi/abs/10.1... , ²⁰20 Hanson EK, Yorkston KM, Britton D. Dysarthria in amyotrophic lateral sclerosis: a systematic review of characteristics, speech treatment, and augmentative and alternative communication options. J Med Speech Lang Pathol[Internet]. 2011[cited 2016 Apr 13];19(3):12-30. Available from: https://www.asha.org/articlesummary.aspx?id=8589955557 https://www.asha.org/articlesummary.aspx... )

[1] CORRESPONDING AUTHOR: Amanda Holanda Severo. E-mail: amandah_severo@hotmail.com

Brasil

Brasil

Comunicación Verbal Prejudicada: revisión del diagnóstico en pacientes con Esclerosis Lateral Amiotrófica

RESUMEN

Objetivo:

Método:

Resultados:

Conclusión: