Dysarthria #
Dysarthria is a common symptom of ALS, and it can include mild-severe impairment, rapid rates of progression, and loss of useful speech.
Loss of the ability to communicate, or anticipation of future loss, is one of the most distressing aspects of ALS.
Intervention #
Speech Exercises for ALS #
Individuals with ALS understandably often ask if there are any exercises that can preserve or improve speech function. Unfortunately, research demonstrates that speech (and non-speech oral motor) exercises are contraindicated, and may cause further impairment.
Don’t Miss This …
Research demonstrates that speech (and non-speech oral motor) exercises are contraindicated, and may cause further impairment. Intervention therefore focuses on communication function (including compensatory strategies to improve speech clarity, conserve energy for speech and avoid further strain or fatigue, and facilitating functional communication); acknowledging the emotional and psychosocial aspects of the disease; education & self-advocacy; and Augmentative and Alternative Communication (AAC).
Communication Function #
Intervention therefore focuses on communication function (including compensatory strategies to improve speech clarity, conserve energy for speech and avoid further strain or fatigue, and facilitating functional communication); acknowledging the emotional and psychosocial aspects of the disease; education & self-advocacy; and Augmentative and Alternative Communication (AAC).
Considerations #
When providing speech intervention, consider the following:
- Level of severity and early intervention:
- Individuals with mild or no speech impairment may be considered a candidate for Voice or Message Banking (see Voice Banking / Message Banking).
- Individuals at any level of impairment are appropriate to consider AAC; AAC intervention can be considered early or at critical periods – ensure that the client’s goals are being considered in this process.
- Presentation: compensatory strategies can be general or specific to areas of function, including articulation, phonation, respiration, prosody, and resonance (e.g. diaphragmatic breathing may not be appropriate for individuals with impaired respiratory function).
- Additional cognitive communication or language impairment (see Cognition).
- Behavioural interventions – refer to Compensatory strategies for speech; Speech and swallowing – compensatory strategies; Vocal Hygiene; and Diaphragmatic Breathing handouts
Handouts
#
Sources & Further Reading #
- Hanson, E. K. (2011). Dysarthria in Amyotrophic Lateral Sclerosis: A Systematic Review of Characteristics, Speech Treatment, and Augmentative and. Journal of Medical Speech-Language Pathology, 19(3), 12-30.
- Ng, L., Khan, F., Young, C. A., & Galea, M. (2017). Symptomatic treatments for amyotrophic lateral sclerosis/motor neuron disease. Cochrane Database of Systematic Reviews, (1). Barbara Tomik & Roberto J. Guiloff Professor (2010) Dysarthria in amyotrophic lateral sclerosis: A review, Amyotrophic Lateral Sclerosis, 11:1-2, 4-15, DOI: 10.3109/17482960802379004
- Yorkston, K., Miller, R., Strand, E., & Britton, D. (2013). Management of Speech and Swallowing in Degenerative Diseases. 3rd edn (Austin, TX: PRO-ED).
