We've only recommended them for a few handfuls of patients
over the last 4 years. I can recall only four patients who got them,
primarily due to the $4000 out-of-pocket cost. Three of these
patients had ALS and one had Kennedy's Disease. They all had
improvements in both nasality and speech intelligibility. One felt
the improvement in his articulation was greater than the improvement in his
nasality. In terms of progression, they were all able to wear
them for at least a year. They remove them for meals so it wouldn't help
with nasal regurgitation during meals.
My primary criteria has been
patients with hypernasality as the predominant feature of the dysarthria.
That said, I do test out many of the criteria below. Our
neurologists also feels that palatal lifts are also more helpful with LMN
hypernasality than UMN hypernasality. Patients who complain of
a hypersenstive gag will not be able to tolerate the lift. I
have scoped some patients looking at their velopharyngeal port before the
referral to the prosthedontist. However, our prosthedontist is very
experienced and he really doesn't need information on velopharyngeal port
functioning from me to do a good job. His experience and his ears are
really all he needs.
It is at least 2 if not 3 visits of tweaking to
get a good result. Our prosthedontist gives the patient some time to get
used to it before extending or widening. Our prosthedontist also
makes them a little thicker for our patients as he feels like the thickness
can help compensate for limited lingual to palatal contact from tongue
weakness.
Jen Coggiola, MA, CCC/SLP
Speech Pathologist
ALS
Center at UCSF
400 Parnassus Ave., 8th Floor
San Francisco, CA
94143
(415) 353-2122 clinic phone
(415) 353-2524 clinic fax
(925)
323-0175 cell phone
xxxxxx@xxxxxxxxxxxxxx________________________________
From:
xxxxxx@xxxxxxxxxxxxxxxxxxxx [xxxxxx@xxxxxxxxxxxxxxxxxxxx] On
Behalf Of Betts Peters [xxxxxx@xxxxxxxxxxx]
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 state’s version
of Medicaid won’t cover palatal lifts, and private insurance
coverage varies widely, as usual. The cost is $3000-5000.
If
anyone’s 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<http://www.alsa-or.org>
Find our chapter on
Facebook<http://www.facebook.com/home.php?#!/pages/The-ALS-Association-Oregon-and-SW-Washington-Chapter/155563277808464>!
Register
TODAY<http://web.alsa.org/site/PageServer?pagename=WLK_BP_stateselect>
to join the Walk to Defeat ALS®. 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,
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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
SLP’s regularly suggest lifts for ALS patient’s? I have been
trying to find someone in my area that does them in the event that
it’s appropriate.
Erin
From:
xxxxxx@xxxxxxxxxxxxxxxxxxxx<mailto:xxxxxx@xxxxxxxxxxxxxxxxxxxx>
[mailto:xxxxxx@xxxxxxxxxxxxxxxxxxxx]<mailto:[mailto:xxxxxx@xxxxxxxxxxxxxxxxxxxx]>
On Behalf Of Tami Brancamp
Sent: Tuesday, August 09, 2011 11:40
AM
To:
xxxxxx@xxxxxxxxxxxxxxxxxxxx<mailto:xxxxxx@xxxxxxxxxxxxxxxxxxxx>
Subject:
Re:
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)
xxxxxx@xxxxxxxxxxxxxxxxxxx<mailto:xxxxxx@xxxxxxxxxxxxxxxxxxx>
www.medicine.nevada.edu/spa<http://www.medicine.nevada.edu/spa>
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 patient’s ask me this week about
what they should do for nasal regurgitation when swallowing liquids. I
don’t get asked this a lot so I don’t 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 it’s happening
so often for them because their speech is only slightly nasal. If anyone
has suggestions for me I’d love the advice!
If it’s
easier to answer off the listserv my email is
xxxxxx@xxxxxxxxxxxxxxxxxxxx<mailto: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:
xxxxxx@xxxxxxxxxxxxxxxxxxxx<mailto:xxxxxx@xxxxxxxxxxxxxxxxxxxx>
________________________________
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