EVOLUTION OF BULBAR FUNCTIONS IN PATIENTS WITH AMYOTROPHIC LATERAL SCLEROSIS. APPLICATION OF WD SCALE

Abstract

INTRODUCTION
ALS is a neurodegenerative disease that affects the motor neurons of the cortex, brain stem and spinal cord. It can impair bulbar functions. Objective: to determine the degree of bulbar involvement (articulation, voice, swallowing and facial movements) at different times of the pathology by applying the WD Scale designed by speech therapists.

Material and methods
We evaluated 126 patients, 60% men. Age: 19 to 79 years. There were 75.4% with definitive ALS defined according to criteria in El Escorial and 34% with bulbar onset. We assessed articulation, voice, swallowing and facial, lingual, and labial movements using the WD scale; we obtained the degree of severity 0 (normal) to 4 (total loss of function). We did 3 evaluations (baseline, one and two) every 3 months.

RESULTS
According to WD scale, a compensation and stabilization in the swallowing and lingual and labial movements was found comparing baseline and first follow up evaluation. In relation to voice and articulation, the worsening rate was lower between the baseline and the first follow up evaluation that between the first and second follow up evaluation. In the latter period, a significant deterioration was found in all the functions studied.

Conclusions
The deterioration of voice, articulation, swallowing and facial, lingual and labial movements in this group of patients did not evolve in the same way. It was important to determine how each of these functions evolved to offer appropriate treatment to each patient. The control with speech therapists at the beginning of the disease was favorable in these patients.