Jay S. Fishman ALS Augmentative Communication Program | Speech Strategies

For some people with ALS, changes to speech production and swallowing are the very first symptoms they experience. This is often referred to as "Bulbar onset" of symptoms. For others, changes in speech are noted only after other symptoms, such as weakness in limbs is noticed. In both cases, the condition that causes speech to become more difficult to understand is referred to as dysarthria.

Environmental strategies

Speaking with competing noise in the environment is difficult under any circumstance. For people with ALS, trying to speak when there is lots of noise can be extremely difficult. While you should consider using a voice amplifier throughout the day (link to voice amplifier page) here are some other considerations:

• Make sure you have your partner’s attention.
• Mute the television, radio or other sound source when speaking.
• Make sure your communication partner can SEE your face and hear you (in the event partner has hearing loss) as you are speaking.  Not only can seeing you speak make it easier to understand words or sounds that are not clear but also gestures, facial expressions and your eyes add a great deal of information to the message.
• When going to restaurants, consider choosing a table that is away that is in a quieter section of the restaurant.
• When in noisy environments such as grocery store, shopping plaza, sports events or when in the car (even in a well insulated car, traffic and road noise can be significant), use a voice amplifier.
• Avoid speaking while eating  (when food is in your mouth) or drinking.    

Speech-production strategies

By making some modifications to the way you speak, you can enhance the intelligibility of your speech. These modifications include:

• Pace your speaking rate. Providing a brief stop after each word you speak can slow the pace of your speech and improve intelligibility. As one man with ALS recently stated to us: “When I think of all of my partners as non-English speakers, I naturally pause between each word and speak at a clearer pace”. Providing this pause after each word will also eliminate the merging/slurring of the last sound of a word and the first sound of the next word. NOTE: Pacing does mean speak slowly. Speaking slowly will often require more energy and will likely be less intelligible. Also, resist trying to talk louder. Speaking louder will only use more energy and does not impact your intelligibility.
• Produce each syllable of a word. If it is difficult to speak clearly and sometimes parts of words are not intelligible. While the most important advice is to preserve your energy, consider producing multi-syllabic words in a deliberate and paced manner. This way, every part of the word is clear.
• Consider producing sounds that are sometimes glossed over in words. In American English, the "t" sound is normally softened when followed by a vowel, but with typical speech production they are understood. An example of this is the word "water," which is most often produced "wader" with the "t" distorted. For people with ALS, it may be helpful to produce some sounds more deliberately so, in this case, one may speak in a paced manner "wa – ter." Examples of other words include: button, kitten, waiter, theater, etc.
• Economize/phrase words per breath.  Many people try to speak as many words per breath as possible. For the natural speaker, this often results in some words being softer or less clear. A person with ALS should ‘economize’ words per breath so each word has strong breath support. When pacing one’s speech, it can be easier to also speak fewer words per breath so, if you feel out of breath while speaking, consider pausing and taking a new breath.

Your positioning while speaking

Growing up, many of us we were told, "Sit up straight" or "Don’t slouch." When it comes to clarity of speech and ALS, positioning is key. To maximize breath support for speech production, be sure you are comfortably positioned. If you are sitting, be sure you are not leaning forward, you are not too reclined or leaning to the side as it will be harder to speak loud enough or clearly.