Speech and Communication

Amyotrophic lateral sclerosis (ALS) is a progressive neurodegenerative disorder. In patients with ALS the gradual death of nerve cells in the brain and spinal cord that control muscles can result in the progressive weakening of muscles throughout the body.

The severity of symptoms experienced by patients with ALS can change on an individual basis, but all commonly experience some level of speaking difficulties. This is caused by the muscles of the tongue, lips, vocal cords, and chest being affected by the disease. The difficulty in speaking is referred to as “dysarthria.”

How is speech affected in ALS?

As the muscles weaken, ALS patients may experience various speaking problems that can make it difficult to be understood. This can include:

  • Speech becoming slow, slurred, and unclear
  • Difficulty managing the pitch, tone, and rhythm of the voice
  • The voice becoming increasingly soft and faint (as it becomes more difficult to take full breaths of air)
  • Issues with pronouncing certain consonants
  • The voice taking on a nasal quality

ALS also can cause increased fatigue, which may make long conversations difficult. Knowing and understanding this can make the adaptation process easier, and using shorter sentences with frequent rests may help.

Specialist help

Speech and language pathologists (SLPs, also referred to as speech-language therapists or SLTs) can assess what difficulties the patient is facing, and how they can be managed. They may be able to teach the patient techniques, such as ways to improve the clarity of speech and how to project their voice, to help them maintain their own voice unassisted for as long as possible.

Alternative and augmentative communication

As technology advances, there is a growing variety of communication aids (called alternative and augmentative communication, or AAC) that may help a patient with ALS communicate more easily as the disease progresses. An occupational therapist or speech and language specialist can help determine which technology is best for the patient. Discussing the options early on can benefit the patient, as they will need time to learn how to use some electronic devices. Also, some of these devices are expensive.

Unaided AAC includes communication through body language, gestures, and sign language. However, depending on how the disease progresses, this can be difficult for some patients.

Simple AAC includes non-electronic tools such as pen and paper, writing boards, and communication charts.

There also are high-tech electronic AAC methods available. These include various computerized interfaces that can convert text to speech, or eye gaze control systems that can track eye movement over letters and words on a screen to convert this to speech.

Before the symptoms of the disease have progressed too far, the patient also may take advantage of “voice banking” if they intend to use a system that will synthesize speech. This involves the creation of a synthetic voice based on phrases that are recorded from the patient.

ALS News Today is strictly a news and information website about the disease. It does not provide medical advice, diagnosis or treatment. This content is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. Never disregard professional medical advice or delay in seeking it because of something you have read on this website.