Predictors of impaired communication in amyotrophic lateral sclerosis patients with tracheostomy-invasive ventilation

Abstract

Predictors of communication impairment in patients with amyotrophic lateral sclerosis (ALS) using tracheostomy-invasive ventilation (TIV) were investigated. Seventy-six ALS patients using TIV were enrolled and classified into three subgroups of communication ability: patients who could communicate with communication devices (Stage I), patients who had difficulty with communication (Stage II, III, or IV), and patients who could not communicate by any means (Stage V). Predictors of communication impairment were analysed by the Cox proportional hazard model.

Results demonstrated that there were no significant differences in disease duration between subgroups. Within 24 months after disease onset, patients who needed TIV and tube feeding, developed oculomotor impairment or became totally quadriplegic and progressed from Stage I to II and V significantly earlier. Multivariate analyses revealed that within 24 months from onset, the need for TIV and progression to total quadriplegia were significant events in patients who progressed to Stage II, whereas the development of oculomotor limitation was significant in patients who progressed to Stage V. In conclusion, TIV, impaired oculomotor movement and total quadriplegia are predictors of severe communication impairment. Rapid disease progression might indicate future communication impairment after the use of TIV. We highly recommend early detection of impaired communication and identification of the best methods of communication.

Key words::

• Amyotrophic lateral sclerosis
• ventilation
• communication ability stage
• predictors
• communication impairment
• totally locked-in state

Acknowledgements

The authors are grateful to Pamela Cazzolli, RN at ALS Care Project for her excellent suggestions in relation to this study. This work was supported by JSPS KAKENHI (Grant-in-Aid for Scientific Research [B] No25293449), Grants-in-Aid from the Research Committee of CNS Degenerative Diseases (2012 and 2013), the Ministry of Health, Labour and Welfare of Japan, and the Joint Program for ALS Research, Tokyo Metropolitan Institute of Medical Science.

Declaration of interest: The authors report no conflicts of interest. The authors alone are responsible for the content and writing of the paper.