Communication should be routinely assessed by a speech and language therapist (SLT). The goal of management of communication difficulties in ALS patients is to optimize the effectiveness of communication for as long as possible and to concentrate not only on the disabled person, but on personal partner-to-partner communication as well (Andersen and others 2007).
Andersen and others 2007
Practice points:
- regular assessment (i.e. every three to six months) of communication by a trained SLT (speech and langauage therapist) is recommended
- the use of appropriate communication support systems (ranging from pointing boards with figures or words, to computerized speech synthesizers) should be provided as required
Most commonly, communication difficulties in ALS result from progressive dysarthria, with language functions remaining largely intact.
However, changes of language function may occur, especially in patients with cognitive impairment of frontal type. This is shown by reduced verbal output (in rare cases leading to mutism), reduced spelling ability, word finding difficulty and auditory comprehension of more complex input. In others, the deficits are subtle and only exposed on formal testing.
Murphy 2004
Communication is a collaborative effort, and therapy needs to be provided with that in mind, not concentrating soley on the speech fo the person with ALS. Any therapy should always consider the person's communcation partner or partners.
Management - (MND Australia 2011)
Dysarthria requires a coordinated, multidisciplinary approach and regular review
- early referral to a speech pathologist
- advice on strategies for communication
- assessment for and provision of communication aids and training in their use
- the speech pathologist will work with an occupational therapist who can advise on seating, positioning, wrist supports, switches, pointers, mobile arm supports and tables, access to communication aids, computers and environmental controls.
