In a patient with amyotrophic lateral sclerosis (ALS) and a swallowing evaluation, what is the most appropriate treatment approach?

• A. ROM/oral-motor exercises
• B. No intervention because ALS is a progressive neurodegenerative disease, so oral-motor exercises or any rehabilitation are inappropriate
• C. Compensatory swallowing strategies only
• D. Schedule regular speech therapy to improve swallowing

Answer: (B)

In ALS, swallowing weakness tends to progress, and evidence shows that efforts to strengthen or retrain oral-motor function often don’t lead to lasting improvements. Because the condition is degenerative, pursuing rehabilitation aimed at restoring swallowing can be burdensome and unlikely to provide durable benefit. Therefore, the most appropriate approach in this scenario is to refrain from active swallowing rehabilitation and focus on management that prioritizes safety and comfort rather than trying to restore function. (In practice, clinicians often rely on compensatory strategies or dietary modifications to maintain safety, but the exam’s choice reflects avoiding rehabilitation aimed at improvement.)