Speech Problems

Amyotrophic lateral sclerosis (ALS) is a progressive neurological disease characterized by the deterioration of motor neurons or nerve cells that control voluntary muscle movements.

Speech problems (dysarthria) are common and among the first symptoms of ALS. They occur during the early stages and usually worsen as the disease progresses.

How ALS leads to speech problems

The speaking process involves many different nerves that control the movement of the lips, jaw, tongue, and vocal cords. ALS causes a reduction in the stimulation of these muscles by motor neurons such that their proper use becomes difficult. Some muscles that are involved in the speaking process also become weak over time because they are not used.

Examples of speech problems

ALS patients find speaking to be tiring, especially towards the end of the day. Because voice projection becomes difficult, patients tend to talk less or in shorter sentences.

Examples of speaking problems include:

  • Slow, slurred, and difficult-to-understand speech.
  • Difficulties in managing the tone, pitch, and rhythm of the voice.
  • The voice becoming weak, with decreasing volume.
  • Problems pronouncing certain consonants.
  • Nasal-sounding voice.
  • Hoarseness.

How to manage speech problems

Speech-language pathologists (SLP) can help ALS patients maintain their communication skills as long as possible. They can also teach and recommend alternative ways to communicate. Therapy should start as early as possible when the first signs of speech or voice changes appear. Therapists also assess speech rate and characteristics so that they can measure the progression of problems and determine the best timing for interventions.

The following strategies can improve communication for ALS patients:

  • Message recording, also known as message banking. Speaking is not only a primary tool of communication but it also helps to express emotions. Declining speech abilities and voice changes can have an impact on relationships, so patients may find it helpful to record important or frequently used phrases and expressions for later use.
  • Voice banking is a method to create a custom synthesized voice.
  • Family and friends can learn to interpret non-verbal language by paying attention to lip movements, facial expressions, and gestures.
  • Speaking abilities vary throughout the day and usually decline in the evening. Social events and conversations should be scheduled for daytime or high-energy times.
  • Muscles involved in speaking work hard and become strained during the day. Refraining from talking helps the muscles to recover and can improve speech.
  • Massaging the jaw and area around the mouth can help reduce muscle tension and improve range of motion.
  • If the volume of the voice has decreased but the voice is still clear, an amplifier or a small microphone can help increase comprehensibility and conserve the patient’s energy.
  • Sign language can facilitate communication, as well as the use of alternative and augmentative communication applications, including electronic communication devices.

Oral exercises that are designed to strengthen muscles usually provide no benefit to ALS patients because these muscles are already challenged through speaking.


Last updated: Oct. 03, 2019


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 healthcare providers 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.