What is the role of speech therapy in ALS regarding AAC for people with ALS (pALS)?

From the Guidelines

The statement that is TRUE about the role of speech therapy in ALS is that few speech therapists are specially trained to evaluate for AAC (Augmentative and Alternative Communication). While speech therapy remains an essential component of care for people with ALS (pALS) throughout their disease progression, there is a shortage of speech-language pathologists with specialized training in AAC evaluation and implementation 1. This is significant because as ALS progresses and affects speech production, patients benefit greatly from appropriate AAC solutions tailored to their specific needs and abilities. AAC encompasses a wide range of communication methods beyond just speech generating devices, including low-tech options like letter boards and high-tech eye-tracking systems. The goal of AAC evaluation is not to find a single method but rather to develop a comprehensive communication strategy that may include multiple approaches that can adapt as the disease progresses. Even when patients become anarthric (unable to articulate speech), speech therapy continues to provide value through AAC training, swallowing management, and communication strategy development.

Some key points to consider in AAC evaluation include:

• Assessing the patient's current functional abilities, environmental situations, and personal preferences 1
• Using a team approach to evaluate and select AAC devices, including speech-language pathologists, physical therapists, occupational therapists, and other specialists 1
• Considering the entire spectrum of AAC options, from low-tech to high-tech devices 1
• Providing proper training and monitoring for the use of AAC devices, as well as ongoing support and evaluation 1

Overall, speech therapy plays a critical role in the care of patients with ALS, and AAC evaluation and implementation are essential components of this care. By prioritizing the development of comprehensive communication strategies and providing ongoing support and evaluation, speech therapists can help improve the quality of life and communication abilities of patients with ALS.

From the Research

Role of Speech Therapy in ALS

• Speech therapy is useful even when the person with ALS (pALS) is anarthric, as it aims to maintain communication abilities and devise alternative communication strategies when oral communication is ineffective 2.
• The goal of Augmentative and Alternative Communication (AAC) evaluation is not limited to finding a single most beneficial method of communication, but rather to provide individualized communication systems that can be implemented and changed over time to capitalize on the patient's strengths 3.
• Many speech therapists are trained to evaluate for AAC, and AAC services are an integral part of medical speech-language pathology practice 3.
• AAC does not specifically refer to speech-generating devices, but rather encompasses a range of communication supports, including low- and high-tech solutions, to support patients with complex communication impairments 3, 4.

AAC Evaluation and Intervention

• AAC evaluation and intervention should be tailored to the individual needs of the pALS, taking into account the progression of the disease and the patient's communication goals 3, 4.
• Early referral and regular re-evaluations are essential to ensure that AAC interventions are effective and meet the changing needs of the patient 3.
• Communication partners should be included in the AAC evaluation and intervention process to establish acceptance and use of AAC supports 3.
• Telepractice can be a viable option for providing AAC services to pALS, particularly those who are geographically remote or have mobility impairments 5.

Speech Deterioration in ALS

• Speech deterioration in ALS can be rapid, with many patients experiencing severe dysarthria and loss of adequate speech within 18 months of the onset of bulbar symptoms 6.
• The initial type of ALS (bulbar or spinal) can affect the rate of speech deterioration, with bulbar-onset ALS patients being more susceptible to delayed evaluation and AAC intervention 6.