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This is a Quantitative Study study.

October 15, 2025Open Access

International Survey of Practice Patterns of Speech-Language Pathologists Working With Patients With Amyotrophic Lateral Sclerosis

Key Points

Wide variability exists in the practice patterns of speech-language pathologists treating patients with ALS, affecting care quality.
Most respondents (69%) worked in metropolitan areas, with 41% in multidisciplinary ALS clinics and 16% in outpatient settings.
Cranial nerve examinations were included in 91% of evaluations, while only 32% of clinics performed instrumental swallowing assessments in most patients.
Barriers to effective ALS management included time constraints, access to resources, and lack of standardized treatment protocols.

Abstract

Background: Speech-language pathologists (SLPs) evaluate and treat swallowing and communication impairments in individuals with amyotrophic lateral sclerosis (ALS). Standardized clinical practice guidelines for the evaluation and management of bulbar dysfunction in ALS have not yet been established. This study aimed to describe current international practice patterns of SLPs evaluating and treating bulbar dysfunction in ALS. Hypothesis: Significant variability in practice patterns will exist across SLPs working in different clinical settings with varied resources. Method: A 26-item Qualtrics survey was electronically distributed to SLPs via e-mail, social media, and professional discussion boards. Results: Data from 245 respondents across 20 countries and 32 states within the United States were collected, with the final analysis including 214 respondents. Most respondents practiced in metropolitan areas (69%) and worked in multidisciplinary ALS clinics (41%), outpatient clinics (16%), and home health settings (17%). Cranial nerve examination (91%), swallow trials (79%), speech intelligibility tasks (85%), and diadochokinetic speech rates (65%) were frequently included in evaluations. Although 81% of clinics had access to instrumental swallowing evaluations, 32% reported performing them in fewer than 25% of patients. Communication evaluations were offered directly by 58% of clinicians, while 26% referred to an outside SLP and 16% collaborated with device representatives. Most clinicians provided patient education on swallowing (87%) and oral health (83%). However, managed practice varied widely, revealing no standardized treatment that is routinely offered. Barriers to optimal ALS care included time constraints, relevant clinical training, timing of treatment, addressing psychosocial components of care, access to resources, interdisciplinary communication, and insurance coverage (United States only). Discussion: Findings reveal little consensus on symptomatic bulbar management and intervention timing. Results emphasize the urgent need for the development of a standardized minimal data set to best guide the evaluation and management of bulbar dysfunction in ALS. Supplemental Material: https://doi.org/10.23641/asha.30249997

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