Curriculum standards
Knowledge guides
LG22: Weakness and disorders of speech, language, and swallowing
Key presentations and conditions
Advanced Trainees will have a comprehensive depth of knowledge of these presentations and conditions.
Less common or more complex presentations and conditions
Advanced Trainees will understand these presentations and conditions.
Advanced Trainees will understand the resources that should be used to help manage patients with these presentations and conditions.
Epidemiology, pathophysiology, and clinical sciences
Advanced Trainees will have a comprehensive depth of knowledge of the principles of the foundational sciences.
Investigations, procedures, and clinical assessment tools
Advanced Trainees will know the scientific foundation of each investigation and procedure, including relevant anatomy and physiology. They will be able to interpret the reported results of each investigation or procedure.
Advanced Trainees will know how to explain the investigation or procedure to patients, families, and carers, and be able to explain procedural risk and obtain informed consent where applicable.
Important specific issues
Advanced Trainees will identify important specialty-specific issues and the impact of these on diagnosis and management and integrate these into care.
Presentations
- Breathing difficulties / Shortness of breath
- Cardiac arrhythmia
- Confusion
- Decreased urine and dark red / brown colour
- Difficulty speaking, swallowing, and/or chewing
- Disordered movement of facial muscles, including:
- drooping
- Fatigue
- Headaches
- Muscle cramps, spasms, and/or twitches
- Muscular difficulties, such as aching, coordination problems, difficulty walking, stiffness, swelling, weakness, and/or paralysis
- Numbness
- Pain
- Purple-red skin rash
- Sciatica
- Sensory sensitivity
- Slurred speech
- Vision problems, including:
- pain
- vision loss
- Weakness
Conditions – brain and brain stem
- Acute disseminated encephalomyelitis (ADEM)
- Bickerstaff encephalitis
- Brain malformation disorders
- Degenerative disease, such as:
- mucopolysaccharidoses (MPS)
- Degenerative genetic disease
- Multiple sclerosis (MS)
- Myelin oligodendrocyte glycoprotein (MOG) disorders and myelin oligodendrocyte glycoprotein antibody-associated disease (MOGAD)
- Neuromyelitis optica spectrum disorders (NMO)
- Static encephalopathy
- Stroke
- White matter disorders, such as:
- leukodystrophy
Conditions – muscle
- Becker muscular dystrophy
- Dermatomyositis
- Duchenne muscular dystrophy
- Inflammatory myopathy
- Inherited muscle disease, including:
- congenital myopathies
- metabolic myopathies
- Myotonic dystrophy
- Other muscular dystrophy, such as:
- facioscapulohumeral
- limb girdle
- Polymyositis
- Rhabdomyolysis
Conditions – neuromuscular junction
- Botulism
- Lambert–Eaton myasthenic syndrome
- Myasthenia gravis
Conditions – peripheral nerves
- Bell’s palsy
- Entrapment neuropathies
- Guillain–Barré syndrome
- Miller Fischer syndrome
- Other acquired and inherited peripheral neuropathies
- Plexopathies
- Radiculopathies
Conditions – psychological
- Functional neurological disorder
Conditions – spinal cord
- Demyelination
- MS
- Neuromyelitis optica
- Spinal cord compression
- Spinal muscular atrophy
For each presentation and condition, Advanced Trainees will know how to:
Synthesise
- recognise the clinical presentation
- identify relevant epidemiology, prevalence, pathophysiology, and clinical science
- take a comprehensive clinical history
- conduct an appropriate examination
- establish a differential diagnosis
- plan and arrange appropriate investigations
- consider the impact of illness and disease on patients and their quality of life when developing a management plan
Manage
- provide evidence-based management
- prescribe therapies tailored to patients’ needs and conditions
- recognise potential complications of disease and its management, and initiate preventative strategies
- involve multidisciplinary teams
Consider other factors
- identify individual and social factors and the impact of these on diagnosis and management
Conditions
- Dystrophia myotonica
- Poliomyelitis
For each presentation and condition, Advanced Trainees will know how to:
Synthesise
- recognise the clinical presentation
- identify relevant epidemiology, prevalence, pathophysiology, and clinical science
- take a comprehensive clinical history
- conduct an appropriate examination
- establish a differential diagnosis
- plan and arrange appropriate investigations
- consider the impact of illness and disease on patients and their quality of life when developing a management plan
Manage
- provide evidence-based management
- prescribe therapies tailored to patients’ needs and conditions
- recognise potential complications of disease and its management, and initiate preventative strategies
- involve multidisciplinary teams
Consider other factors
- identify individual and social factors and the impact of these on diagnosis and management
- Acute, chronic, common, and rare diseases that cause weakness, as well as disorders of:
- dysarthria
- dysphagia
- dysphasia
- language
- speech
- swallowing
- Neuroanatomy and neurophysiology of the pathways involved with speech and swallowing
- Neuroanatomy, neuropharmacology, and neurophysiology of the:
- motor pathways
- neuromuscular junction
- peripheral nerves
- somatic musculature
Cerebrospinal fluid (CSF) procedures and investigations
- Lumbar puncture (LP) and interpretation of investigation results, such as:
- basic CSF analysis:
- cell count
- cytology
- glucose level
- immunological tests
- microbiological tests
- protein level
- special tests:
- NMDAr antibodies and autoimmune encephalopathy panel
- oligoclonal bands
- basic CSF analysis:
Clinical neurophysiology investigations
- Electromyography (EMG):
- needle EMG
- single-fibre EMG
- Evoked potentials:
- brainstem
- somatosensory
- visual
- Nerve conduction studies (NCS):
- motor and sensory studies
- repetitive nerve stimulation
Neurogenetic investigations
- Genetic testing, including, but not limited to:
- chromosomal testing, such as:
- karyotype
- microarray
- genomic testing, including whole exome or genome sequencing
- mitochondrial genome sequencing
- targeted panel testing
- chromosomal testing, such as:
- Referral to a neurogeneticist
Neuroimaging investigations
- Magnetic resonance:
- angiography (MRA)
- spectroscopy (MRS)
- venogram (MRV)
- MRI
- Myelography
Neuroimmmunology investigations
- Autoantibody measurement:
- anti-acetylcholine receptor antibodies
- anti-aquaporin 4 antibodies
- anti-MOG antibodies
- paraneoplastic antibodies
- Referral to a neuroimmunologist
Neuropathology investigations
- Biopsy:
- muscle
- nerve
Neuropsychological investigations
- Cognitive screening
- Referral to a neuropsychologist
Other investigations
- Cardiac investigations:
- 24-hour electrocardiogram monitoring
- ECG
- echocardiography
- Lung function tests:
- formal lung function tests
- vital capacity
- Other laboratory tests:
- B12 level
- creatine kinase
- fasting glucose and HbA1c
- thyroid function testing
- videofluoroscopy and swallow assessments
- Overlap with other allied health and medical specialties, such as:
- immunology
- medical genetics
- physiotherapy
- rehabilitation medicine
- speech pathology
- Prognosis and implications of these disorders