[Predictors the progression of communication impairment in ALS tracheostomy ventilator users]

We investigated predictive factors associatied with progression of communication impairment in 76 patients with amyotrophic lateral sclerosis (ALS) using tracheostomy ventilation. We classified the patients into the following three groups: patients capable of communication (stage I), patients with difficulties in communication (stage II to IV), and patients incapable of communication (stage V: so-called totally locked-in state) (Hayashi, et al. Clin Neurol 2013). There were no significant difference of disease duration across stages. Statistically significant differences were noted in the time of ventilator use, the time of tube feeding, and the time of complete quadriplegia among the 3 groups (Kruskal-Wallis). Multivariate analyses showed that the durations from onset to the time of ventilator use and complete quadriplegia had significant effecte on the progression from stage I to II, and that the duration from onset to the development of overt oculomotor limitation had signicant effect on the progression from stage IV to V. Faster progression may predict the extent of communication impairment after ventilator use.Accurate prediction of communication impairment after ventilator use may promote medical and social preparation including early application of the brain-machine interface for future communication problems in ALS patients.