Speech Therapy involves helping stroke patients relearn their language and speaking skills that may be damaged after suffering a stroke.  A therapist helps the patient once again understand speech, comprehend written words, and overcome difficulty forming words.  Speech therapists also train patients to use alternative forms of communication and help them deal with the frustration of not being able to communicate properly.

    Given time, a stroke survivor usually regains part and sometimes all of their language and speaking skills.

Sherry Pierce

    As a speech-language pathologist, I specialize in helping people with ALS who have speech or swallowing difficulties.

    Speech therapists — or speech-language pathologists, as they're usually called nowadays specialize in helping people with speech, language, cognitive and swallowing problems. People with ALS generally have deficits in speech and swallowing sooner or later.

    In ALS, which is progressive, we don't look so much at trying to "fix" a speech or swallowing deficit as we do at trying to compensate for the deficit. For example, as speech is lost, we help people find alternative means with which to communicate. As swallowing competence is lost, we look to change the way an individual may eat or change what they eat to keep them eating as long as possible.

    Speech is affected mostly because of weakness in the muscles of articulation — the tongue, the palate and the lips — and because of lack of breath support for speech. It's the tongue, which is composed of multiple muscles, that's primarily responsible for forming the sounds that we make into words. So, even if you can make a sound, it becomes very difficult to form it into words that can be understood, because the tongue is no longer moving as effectively as it once did.

    Also, in ALS, the soft palate [back part of the roof of the mouth] doesn't elevate as it used to, closing off the nasal passage and separating the mouth from the nose. In ALS, when the palate doesn't elevate, almost all sound will go up in the nasal cavity and be resonated there. This is called hypernasality and can have a dramatic effect on your speech.

    The "energy" for speech and for sound is breath support. When you breathe in and prepare to speak, the vocal cords come together and you build up pressure below them. When you begin to speak, they come apart, allowing the air to rush between them and causing them to vibrate quickly, which generates sound.

    In ALS, as the disease progresses, you usually are unable to get good, deep breaths, so you have reduced breath support for speech. Without adequate breath support, you're unable to talk very loudly or produce long sentences.

    Many of the muscles involved in speech are also involved in swallowing, and they weaken in the same manner. As ALS progresses, you can have problems with things getting "caught in the throat," or with food or liquid going down the trachea into the lungs instead of down the esophagus into the stomach. Sometimes it can take so long to eat a meal (an hour and a half or so) that people get tired and don't eat or drink enough to support their nutritional and fluid needs.

    Early on, we can educate and prepare a person for the changes that will take place in speech and swallowing functions as the disease progresses. Another thing that can be done, if the person can get started early, is voice banking, which means taping some messages so that you can use them later if you lose the ability to speak. There are lots of devices that enable you to do this, but the key is doing this early enough.

    When people still have some functional speech but it's no longer as clear as it used to be, we can teach strategies that will increase their ability to be understood.

    For example, most of my patients complain that talking can be exhausting, so we teach them to budget their energy. If you're in an environment where your spouse or family members are familiar with your speech, it's not as important to use "good" speech. However, with an unfamiliar listener, that's when you really want to focus on good speech.