Breathe, Eat, Talk: Three Essential Ingredients to Quality-of-Life Outcomes in Movement Disorders

Breathing, eating, and talking (BET) impairments are common yet frequently underrecognized features of movement disorders. Deficits in respiration, swallowing, voice, and speech may emerge early in the course of a disease, adversely affecting safety, participation, and quality of life. Routine neurological examinations may not adequately capture their impact.

To characterize the clinical importance of BET dysfunction across several movement disorders by comparing neurological and speech-language pathology (SLP) approaches to assessment and recommendations for improved early identification, referral and multidisciplinary management.

Case examples were used to illustrate and compare clinical findings obtained through standard neurological evaluation versus comprehensive SLP assessment. A targeted literature review and comparison of commonly used neurology and SLP clinical tools were also conducted to examine current approaches to BET evaluation and referral.

Case examples illustrated how routine neurological examinations underestimated the severity and functional impact of BET impairments. This was contrasted with SLP identification of clinically meaningful deficits in respiratory function, cough, swallowing safety, communication effectiveness, and quality of life not captured by standard disease rating scales. Review of the literature demonstrated that commonly used neurological rating scales provide limited evaluation of BET dysfunction, whereas multidisciplinary assessment incorporating caregiver input, patient-reported outcomes, perceptual evaluation, and instrumental testing improves detection and treatment planning.

BET dysfunction is prevalent across movement disorders and substantially influences quality of life. Early referral to SLPs and integration of multidisciplinary BET assessment can improve diagnostic precision, facilitate timely intervention, reduce preventable complications, and support person-centered care throughout disease progression.