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Purpose: When nonnative speaking patterns emerge following neurologic insult or injury, it has often been referred to as foreign, or nonnative, accent syndrome (FAS). In many other cases, FAS can occur as a manifestation of a functional speech disorder (FSD). The purpose of this clinical focus article is to (a) describe the methods utilized in identifying and managing a functional communication disorder characterized by nonnative speech, language, and nonverbal communication intrusions, accompanied by a functional movement disorder and (b) describe the patient's lived experience. Method and Results: The patient is a 59-year-old monolingual English-speaking gentleman with a remote history of episodic stuttering, who later developed an abrupt onset of a nonnative speaking style that changed in quality over time. He also developed gait difficulties that, after visiting with several neurologists, were judged to reflect a functional neurological disorder. During the speech evaluation session, an “Eastern European accent” was noted, along with nonnative word use and word order. A diagnosis of FSD characterized by foreign accent was made, and intervention was undertaken as detailed in the clinical focus article and demonstrated in the accompanying video. With behavioral intervention, the patient was able to correct sound-level changes in structured tasks such as reading and repetition and then in conversation. Language dialect–like changes resolved without direct intervention. The nonspeech movement disorder was addressed with intensive occupational and physical therapy. Conclusions: The patient presented with functional FAS, which was effectively managed with symptomatic, targeted behavioral intervention. His experience demonstrates the importance of patient advocacy in acquiring an accurate diagnosis and appropriate management recommendations. Supplemental Material: https://doi.org/10.23641/asha.24653430
Purpose: When nonnative speaking patterns emerge following neurologic insult or injury, it has often been referred to as foreign, or nonnative, accent syndrome (FAS). In many other cases, FAS can occur as a manifestation of a functional speech disorder (FSD). The purpose of this clinical focus article is to (a) describe the methods utilized in identifying and managing a functional communication disorder characterized by nonnative speech, language, and nonverbal communication intrusions, accompanied by a functional movement disorder and (b) describe the patient's lived experience. Method and Results: The patient is a 59-year-old monolingual English-speaking gentleman with a remote history of episodic stuttering, who later developed an abrupt onset of a nonnative speaking style that changed in quality over time. He also developed gait difficulties that, after visiting with several neurologists, were judged to reflect a functional neurological disorder. During the speech evaluation session, an “Eastern European accent” was noted, along with nonnative word use and word order. A diagnosis of FSD characterized by foreign accent was made, and intervention was undertaken as detailed in the clinical focus article and demonstrated in the accompanying video. With behavioral intervention, the patient was able to correct sound-level changes in structured tasks such as reading and repetition and then in conversation. Language dialect–like changes resolved without direct intervention. The nonspeech movement disorder was addressed with intensive occupational and physical therapy. Conclusions: The patient presented with functional FAS, which was effectively managed with symptomatic, targeted behavioral intervention. His experience demonstrates the importance of patient advocacy in acquiring an accurate diagnosis and appropriate management recommendations. Supplemental Material: https://doi.org/10.23641/asha.24653430
BackgroundFunctional Communication Disorders (FCDs) are one specific presentation of Functional Neurological Disorder (FND). FND is characterised by neurological symptoms, such as sensory and motor symptoms, which are not explained by neurological disease. Speech and language therapists (SLTs) have expertise in managing communication disorders, including FCDs, though is not known is what clinicians do in practice to treat and manage FCDs.AimTo explore the clinical practices of SLTs who regularly manage FCDs in the UK, including the assessment and intervention approaches taken.Methods & ProceduresAn online survey was developed using Qualtrics software and piloted before dissemination. Participants were experienced SLTs working in the UK who managed at least three FCD referrals a year. The survey was developed with a mix of qualitative and quantitative questions. The survey was disseminated via social media and professional networks.Outcomes & ResultsThere were 73 completed responses to the survey. Participants reported working with a range of FCDs clinically, with functional stuttering and articulation disorders seen most frequently. SLTs reported working with a wide range of multidisciplinary professionals when managing patients with FCDs, though lack of access to mental health professionals was raised as an issue. SLTs reported using a combination of formal and informal communication assessments. Interventions varied, with a wide range of psychological approaches informing treatment. Lack of specific training, evidence base and negative attitudes around functional neurological disorder (FND) were raised as ongoing issues.Conclusions & ImplicationsTherapists encountered a wide range of FCDs as part of their clinical practice, though there was a significant disparity in the service and interventions offered. SLTs feel their input can be effective, but lack the resources, training and evidence‐based interventions to provide adequate care.WHAT THIS PAPER ADDSWhat is already known on the subject FCDs are one manifestation of FND and can present as a wide range of communication disorders. SLTs encounter FCDs as part of clinical practice, but report feeling unsure and underprepared to manage these disorders. Consensus recommendations have provided some guidance on how to manage these disorders, though what was not known was what practising SLTs are doing in practice with FCD patients: what assessment, intervention and management strategies they use, and what they feel are the facilitators and barriers to effective management.What this study adds to the existing knowledge This is the first UK‐wide survey of FCD SLT clinical practice. The survey found that SLTs are seeing a range of FCDs as part of their clinical practice. SLTs reported that they feel their input is effective, that they had confidence in their ability to provide assessment and intervention, and that SLT for FCDs should be routine. SLTs reported using a wide variety of approaches to assessment and intervention. Barriers to effective management included a lack of resources, training, negative staff attitudes towards FND, and lack of research and evidence‐based interventions.What are the practical and clinical implications of this work? This survey has found that SLTs working across the UK are providing input for patients with FCDs, but frequently reported feeling isolated and lacking clinical peer support. This shows the potential for networking groups to support SLTs to learn and share resources. There is a training need for SLTs and other healthcare professionals to tackle pervasive negative attitudes towards FND. Common themes in intervention approaches were found, but there was variability in the specific approach taken. This requires further research to guide SLTs on the best evidence‐based practice.
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