What is the aim of speech therapy in ALS?

Experience has shown that speech therapy cannot improve speech. A realistic goal is to delay the decline in speech function. In speech therapy, particularly difficult sound combinations are “trained” through repeated applications, with the aim of strengthening the muscles of the tongue, pharynx and larynx. In a simplified view, this form of speech therapy can be understood as “physiotherapy of speech”. In addition to training the speech muscles, the conscious coordination of speech and breathing is trained and practiced. The regular speech process involves inhaling and then exhaling through the larynx (“vocal folds”), where sound and voice formation take place.

This fundamental process shows the close connection between breathing and speaking. Speech therapists support ALS patients in more consciously coordinating inhalation and speech and adjusting them to their own capacities. In ALS, both the speech muscles (larynx, pharynx and tongue) and the respiratory muscles can be restricted. It may therefore be necessary to change the “division” of speech, e.g. to formulate shorter sentences or to change the accent of longer sentences. As the disease progresses, speech may be severely restricted or lost (anarthria). In this constellation, speech therapists can provide support in identifying, adapting and training alternative forms of communication, e.g. using electronic communication aids. Although the term “speech therapy” focuses on verbal communication, supporting the swallowing function is a central domain of this form of treatment. A progressive swallowing disorder (dysphagia) is associated with motor deficits in the muscles of the tongue, pharynx and larynx. In speech therapy, patients (and their relatives) are informed and trained in the basic principles of swallowing and the necessary adaptation of swallowing processes. In this way, the altered posture and the avoidance of head and body positions that are unfavorable for the swallowing process can be “trained”. The swallowing process is also closely coordinated with the breathing process.

Swallowing only takes place when the airways at the larynx are securely closed. There is an either-or principle between swallowing and breathing. Breathing is not possible during swallowing. Coordination between the two processes (swallowing and breathing) is particularly relevant if there is a swallowing disorder (dysphagia) and respiratory weakness (hypoventilation). In this constellation, the food should be portioned so small that breathing is not interrupted for too long. Furthermore, dysphagia can be associated with a risk of “swallowing” (aspiration). Both aspects are taken into account in swallowing training. In the case of a progressive swallowing disorder, speech therapists (in addition to doctors) contribute to the diagnostic assessment to determine the need for nutritional adaptation (adaptation), a liquid diet (high-calorie supplementary nutrition) or the initiation of tube feeding (percutaneous endoscopic gastrostomy, PEG tube). There is close coordination between speech therapists and nutritional therapists when adapting nutritional therapy. Both groups of therapists are involved in the diagnosis, training, treatment and daily management of nutritional therapy.