As the muscles weaken in the voice box (larynx), throat (pharynx), roof of the mouth (soft palate) tongue and lips, people with amyotrophic lateral sclerosis (ALS) may find it difficult to pronounce words clearly.

Some resulting speech impairments may be:

  • Hoarse or strained voice
  • Muffled or nasal-sounding voice
  • Unclear or slurred speech

Speech-Language Pathologists

Speech-language pathologists can help people with ALS maintain as many communication skills as possible. They also teach techniques that conserve energy, including non-verbal communication skills. Speech-language pathologists are also available to:

  • Recommend appropriate communication technologies to provide treatment that will aid in the success of daily activities.
  • Treat all types of speech, language and communication problems.
  • Evaluate swallowing function and recommend changes as necessary.

Tips to Maintain and Enhance Communication

  • Choose an environment with reduced noise – it can be quite tiring to try to “talk over” the television or radio.
  • Speak slowly.
  • Be certain your listener can see your face. Look at the person while you are talking. A well-lit room enhances face-to-face conversation, increasing intelligibility.
  • Use short phrases – say one or two words or syllables per breath.
  • Over-articulate your speech by prolonging the vowels and exaggerating the consonants.
  • Choose a comfortable posture and position that provide support during long and stressful conversations.
  • Be aware that exercises intended to strengthen weakening muscles may be counter-productive. Always ask your speech-language pathologist which exercises are right for you.
  • Plan periods of vocal rest before planned conversations or phone calls. Know that fatigue significantly affects your speaking ability. Techniques that work in the morning may not work later in the day.
  • If you are soft spoken and your voice has become low, consider using an amplifier.
  • If you are on a respirator (with fully inflated cuffs), an electrolarynx or respiratory tube that provides an alternative air source may be used.
  • If some people have difficulty understanding you, the following strategies may help:
    • If you are able to write without difficulty, always carry a paper and pen as a backup so you can write down what you are trying to say.
    • If writing is difficult, use an alphabet board to point or scan to the first letter of the words that are spoken.
    • Spell words out loud or on an alphabet board if they are not understood.
    • Establish the topic before speaking.
    • Use telegraphic speech – leave out unnecessary words to communicate the meaning of the topic.

Nonverbal Communication

Nonverbal communication, also called augmentative and alternative communication (AAC), is a method of communicating without spoken words. When communication needs cannot be met through speech, the following techniques can be practiced by people with ALS:

  • Residual speech (or, making the best use out of what speaking ability is left).
  • Effective use of expressions and gestures.

Non-verbal communication can help people with speech difficulties actually speak better by:

  • Reducing the frustration and stress of being unable to communicate.
  • Alleviating the pressure to speak.
  • Allowing the person to be more relaxed and come across in a more intelligible manner.

Assistive Devices

Here’s a sample of the assistive devices that are available to help people with ALS communicate more clearly.

  • Palatal lift – a dental apparatus that is similar to a retainer. It lifts the soft palate and stops air from escaping out of the nose during speech.
  • Amplification – a personal amplifier that can be used to increase vocal loudness in soft-spoken people. The amplifier also decreases voice fatigue.
  • TTY telephone relay system – a telephone equipped with a keyboard so speech can be typed and read by a relay operator to the listener. Either the whole message can be typed or just the words that are not understood can be typed.
  • Low technology devices – notebooks and language boards can be used as an alternative communication techniques.
  • High technology electronic speech enhancers, communication devices – computers with voice synthesizers and dedicated communication devices are available.

Patients who are interested in purchasing an electronic communication aid should discuss this with the speech-language pathologist before contacting sales representatives for these devices.

Communication Partners

Here are some ways in which listeners can help people who have difficulty speaking and communicating:

  • Talk to the person only face-to-face and look at the person as he/she is speaking.
  • Ask questions that require a “yes” or “no” answer.
  • Repeat the part of the sentence that you understood. (For example, “You want me to go upstairs and get the what?”)
  • Ask the person to repeat what he/she has said, or ask him/her to speak slower or spell out the words that you did not understand.

Preparing for Emergencies

  • Use an intercom system or baby monitor to alert others that there is an emergency.
  • Use bells or buzzers if you are not able to speak. Use “codes” that signify urgency – for example, a tinkling bell may mean, “I’d like company” while an air horn means there’s an emergency.
  • Carry a portable phone that is equipped with pre-programmed numbers.
  • Pre-program all of your telephones so they can automatically dial the necessary emergency number(s).
  • Consider a “Life Call” button if you spend time alone.

This information is provided by the Cleveland Clinic and is not intended to replace the medical advice of your doctor or health care provider. Please consult your health care provider for advice about a specific medical condition.

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