Hi Betts and listserv,
I am interested in hearing what others have to say since I too rarely recommend palatal lifts.  I have suggested that a few patients with slowly progressive, predominantly upper motor neuron, bulbar symptoms explore this option with  prosthedontists.  I recommend this when the main problem is hypernasality and the patient's articulation is otherwise fairly good.  The cost has been about 4K out of pocket and requires many visits to the prosthedontist's office. 
 
Of those ten or so (over the past 12 years) that got palatal lifts, about 50% reported that it lead to a big improvement for 5 months or more.  The other half didn't feel it made enough of a difference to use it.  Many did not like the added difficulty experienced with oral secretions. 
 
The prosthedontists who have had sucess with patients from our clinic slowly build up the device and seem to be able to get past the gag refllex that goes along with UMN involvement.  Some patients never could get past this.  I really like the list Duffy put together and it confirms for me why I rarely recommend palatal lifts for pALS though I do think some issues on this list can be overcome.  As I mentioned, I have seen the gag reflex delt with through desensitization. 
 
One prosthedontists, to whom I have referred about 6 patients over the years,  mentioned to me that the biggest problem he had in recommending a palatal lift for  the pALS I have sent his way, was the insufficeincy of the lateral pharyngeal wall movement.  He felt that even with a lift for the velum an adequate seal would be lacking due to this.  This conversation made me even more hesitant to suggest this costly process. 
 
 
Sincerely,

Amy Roman, MS, CCC-SLP
Augmentative Communication Specialist

Forbes Norris ALS Research Center
2324 Sacramento Street
San Francisco, CA 94115
P (415)600-1263
F (415)673-5184



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--- On Tue, 8/9/11, Smith, Karen <Karen.Smith3@xxxxxxxxxxxxxx> wrote:

From: Smith, Karen <Karen.Smith3@xxxxxxxxxxxxxx>
Subject: RE: more info and questions about palatal lifts
To: "xxxxxx@xxxxxxxxxxxxxxxxxxxx" <xxxxxx@xxxxxxxxxxxxxxxxxxxx>
Date: Tuesday, August 9, 2011, 12:51 PM

I took a Motor Speech Disorders continuing education from Jay Rosenbek in 2009, and he said that they frequently fit patients with ALS with palatal lifts.

 

Karen L. Smith, MS/CCC-SLP
Speech Language Pathologist

 

Hours:  Mon, Tues, Thursday 9-5:30

Portland Providence Medical Center-Plaza

5050 NE Hoyt #156

Portland, OR 97213

Phone: 503-215-1665

Fax:  503-215-6485

 

From: xxxxxx@xxxxxxxxxxxxxxxxxxxx [mailto:xxxxxx@xxxxxxxxxxxxxxxxxxxx] On Behalf Of Betts Peters
Sent: Tuesday, August 09, 2011 12:42 PM
To: xxxxxx@xxxxxxxxxxxxxxxxxxxx
Subject: more info and questions about palatal lifts

 

I did some research on palatal lifts for our clinic a few months ago.  We got a list of dental prosthodontists from another SLP who works with the head & neck cancer population.  However, we have not actually had any PALS actually go through with the process.  Part of that is because there are few PALS who seem to be appropriate for them (see list of recommended patient attributes below), and part of it is because of the cost.  When I contacted the local prosthodontists, they said that Medicare will cover it, but that Medicare reimbursement is less than what it costs the prosthodontist to make the prosthesis.  That means that none of our local prosthodontists will bother billing Medicare, and the patient cannot get reimbursed if they pay out of pocket.  Our stateâs version of Medicaid wonât cover palatal lifts, and private insurance coverage varies widely, as usual.  The cost is $3000-5000.

 

If anyoneâs interested, I found this list of patient attributes favorable for benefiting from a palatal lift in Motor Speech Disorders by Joseph Duffy:

         Slow rate of progression

         Adequate respiratory function and articulation

         Resonance change with occlusion

         Evidence of lateral pharyngeal wall movement during speech

         Pressure sounds less adequate than others

         No hyperactive gag reflex

         No significant spasticity

         Adequate swallowing & saliva management

         Adequate dentition

         Able to insert and remove prosthesis without assistance

 

I would be very interested to hear the experiences of anyone who has experience working with PALS and palatal lifts.  If you recommend them at your clinic or practice, how do you determine which PALS should get them?  Are your criteria similar to those listed above?  How are PALS getting funding for these prostheses?  What kind of feedback do you get from PALS that have them?  Thanks!

 

Betts Peters, MA, CCC-SLP

Assistive Technology Services Coordinator

The ALS Association Oregon and SW Washington Chapter

700 NE Multnomah St, Suite 870

Portland, OR 97232

503-238-5559

800-681-9851

Fax: 503-296-5590

Website: www.alsa-or.org

 

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Register TODAY to join the Walk to Defeat ALSÂ.  Participate because YOU CAN!

 

From: xxxxxx@xxxxxxxxxxxxxxxxxxxx [mailto:xxxxxx@xxxxxxxxxxxxxxxxxxxx] On Behalf Of Tara Klucker
Sent: Tuesday, August 09, 2011 11:48 AM
To: xxxxxx@xxxxxxxxxxxxxxxxxxxx
Subject: RE:

 

I have had someone recently ask me about a lift, also.  I have asked our local SLP, and got a resource in St. Louis, but looking for someone much closer to the Bloomington area.  Does anyone know how to go about finding someone that can do this?  This is a  first for me.

 

Tara Klucker, MA, CRC, LPC
Case Manager and Outreach Specialist
The ALS Association, St. Louis Regional Chapter
 
314-432-7257 ext. 7
1-888-873-8539
 
Where Patients Matter Most
 
The information transmitted (including attachments) is covered by the Electronic Communications Privacy Act, 18 U.S.C. 2510-2521, is intended only for the person(s) or entity/entities to which it is addressed and may contain confidential and/or privileged material. Any review, retransmission, dissemination or other use of, or taking of any action in reliance upon, this information by persons or entities other than the intended recipient(s) is prohibited. If you received this in error, please contact the sender and delete the material from any computer.

 

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From: xxxxxx@xxxxxxxxxxxxxxxxxxxx [mailto:xxxxxx@xxxxxxxxxxxxxxxxxxxx] On Behalf Of Erin Singleton
Sent: Tuesday, August 09, 2011 1:50 PM
To: xxxxxx@xxxxxxxxxxxxxxxxxxxx
Subject: RE:

 

Thanks Tami

 

Do other SLPâs regularly suggest lifts for ALS patientâs? I have been trying to find someone in my area that does them in the event that itâs appropriate.

 

Erin

 

 

They could be assessed for a palatal lift.

Tami

 

Tami Brancamp, PhD

Assistant Professor

Speech Pathology & Audiology

University of Nevada School of Medicine

775.784.4887

775.682.7020 (office)

 

On Aug 9, 2011, at 11:33 AM, Erin Singleton wrote:

 

Hey everyone,

 

I realize we typically focus on augmentative communication on this list serve so it may not be the most appropriate forum for this question.

 

I have had two ALS patientâs ask me this week about what they should do for nasal regurgitation when swallowing liquids. I donât get asked this a lot so I donât feel as though I have the best suggestions for them. The two men that asked are brothers and oddly enough have almost no pharyngeal dysphagia. Their most frustrating symptom is nasal regurgitation. It surprises me that itâs happening so often for them because their speech is only slightly nasal. If anyone has suggestions for me Iâd love the advice!

 

If itâs easier to answer off the listserv my email is http://us.mc812.mail.yahoo.com/mc/compose?to=xxxxxx@xxxxxxxxxxxxxxxxxxxx

 

Thanks so much.

 

Erin Singleton M.A., CCC-SLP 
Neuroscience Outpatient Rehabilitation Center 
2335 East Kashian Lane, Suite 301 
Fresno, California 93701 
Office: (559) 459-6056 
Fax: (559) 459-2957 
Email: http://us.mc812.mail.yahoo.com/mc/compose?to=xxxxxx@xxxxxxxxxxxxxxxxxxxx

 

 

 

 

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