title: 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.
authors.affiliation: a Laboratory of Nursing Research for Intractable Disease, Tokyo Metropolitan Institute of Medical Science , Tokyo , Japan.
authors.forename: Yuki
authors.initials: Y
authors.lastname: Nakayama
authors.affiliation: b Department of Neurology , Tokyo Metropolitan Neurological Hospital , Tokyo , Japan.
authors.forename: Toshio
authors.initials: T
authors.lastname: Shimizu
authors.affiliation: c Department of Pathology , Tokyo Metropolitan Neurological Hospital , Tokyo , Japan.|d Department of Neurology , Tokyo Metropolitan Kita Medical and Rehabilitation Center for the Disabled.
authors.forename: Yoko
authors.initials: Y
authors.lastname: Mochizuki
authors.affiliation: b Department of Neurology , Tokyo Metropolitan Neurological Hospital , Tokyo , Japan.
authors.forename: Kentaro
authors.initials: K
authors.lastname: Hayashi
authors.affiliation: a Laboratory of Nursing Research for Intractable Disease, Tokyo Metropolitan Institute of Medical Science , Tokyo , Japan.
authors.forename: Chiharu
authors.initials: C
authors.lastname: Matsuda
authors.affiliation: b Department of Neurology , Tokyo Metropolitan Neurological Hospital , Tokyo , Japan.
authors.forename: Masahiro
authors.initials: M
authors.lastname: Nagao
authors.affiliation: e ALS and Neuropathy Project, Tokyo Metropolitan Institute of Medical Science , Tokyo , Japan.
authors.forename: Kazuhiko
authors.initials: K
authors.lastname: Watabe
authors.affiliation: b Department of Neurology , Tokyo Metropolitan Neurological Hospital , Tokyo , Japan.
authors.forename: Akihiro
authors.initials: A
authors.lastname: Kawata
authors.affiliation: f Department of Brain Disease Research , Shinshu University School of Medicine , Nagano , Japan.
authors.forename: Kiyomitsu
authors.initials: K
authors.lastname: Oyanagi
authors.affiliation: b Department of Neurology , Tokyo Metropolitan Neurological Hospital , Tokyo , Japan.
authors.forename: Eiji
authors.initials: E
authors.lastname: Isozaki
authors.affiliation: b Department of Neurology , Tokyo Metropolitan Neurological Hospital , Tokyo , Japan.
authors.forename: Imaharu
authors.initials: I
authors.lastname: Nakano
mesh_terms: D000328:Adult; D000368:Aged; D000690:Amyotrophic Lateral Sclerosis / Q000175:diagnosis / Q000453:epidemiology* / Q000534:rehabilitation; D015984:Causality; D003147:Communication Disorders / Q000175:diagnosis / Q000453:epidemiology*; D015897:Comorbidity; D004750:Enteral Nutrition / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D015994:Incidence; D007564:Japan / Q000453:epidemiology; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D015840:Oculomotor Nerve Diseases / Q000453:epidemiology*; D011183:Postoperative Complications / Q000453:epidemiology; D011379:Prognosis; D011782:Quadriplegia / Q000453:epidemiology*; D018570:Risk Assessment / Q000379:methods; D012307:Risk Factors; D014139:Tracheostomy / Q000706:statistics & numerical data*; D012122:Ventilators, Mechanical / Q000706:statistics & numerical data*; D055815:Young Adult
keywords: Amyotrophic lateral sclerosis; communication ability stage; communication impairment; predictors; totally locked-in state; ventilation