ALS/MND can weaken the muscles used for speaking: the lips, tongue, jaw, throat, and the muscles that control breathing. It can also weaken the hands and arms, which makes writing and typing harder.
Speaking is how most people express their needs, share ideas and feelings, and stay connected to others. It is closely linked to a person’s sense of identity. This page explains how speech can change, the tools that support communication, and how to plan ahead.
On this page
Speech changes │ Planning ahead │ Communication aids │ Voice preservation │ Tips for communication partners │ Who can help │ Resources
How speech changes
Changes to speech are different for each person. For some, speech is one of the first things affected. For others, it changes later or only a little. There is no way to know in advance when or how quickly speech will change.
Speech difficulty caused by weak muscles is called dysarthria. Common signs include:
- Slurred or less clear speech
- Speaking more slowly
- A quieter, hoarse, or nasal-sounding voice
- Becoming tired after speaking for a short time
- Difficulty being understood on the phone or in noisy places
Speech often becomes harder when a person is tired, so it may change during the day.
Plan ahead for communication changes
The best time to plan for communication changes is early, while speech is still clear. Ask to see a speech-language pathologist soon after diagnosis, even if speech has not changed.
Early planning gives time to:
- Learn strategies that make speech easier to understand
- Try different communication aids before they are urgently needed
- Record your own voice for future use (see Voice Preservation)
- Arrange funding or loans for equipment, which can take time in many countries
Communication aids
Communication aids support or replace speech. They are also called augmentative and alternative communication (AAC). Most people use a combination of methods, depending on the situation and how their abilities change.
No-tech methods use the body only: gestures, facial expressions, eye blinks, or agreed signals for “yes” and “no.”
Low-tech aids need no power: pen and paper, a whiteboard, alphabet or word boards, and cards that explain the person has difficulty speaking. They are quick, reliable, and useful as a backup.
High-tech aids include text-to-speech apps on phones and tablets, and dedicated devices that speak typed or selected messages. They can be controlled in different ways as hand strength changes: by touch, a switch, head movement, or eye gaze.
A speech-language pathologist or occupational therapist can assess which aids suit a person best and help them practise before speech becomes difficult.
Voice preservation
Recording your voice early allows a communication device to speak in a voice that sounds like you. Options include message banking, voice banking, and voice cloning, including free AI voice cloning through the ElevenLabs Impact Program. See Voice Preservation.
Tips for communication partners
Family, friends, and caregivers play an important role in helping communication work. Simple changes help:
- Allow extra time, and do not finish sentences unless asked to
- Reduce background noise and face the person when talking
- Ask questions that can be answered with “yes” or “no” when speech is tiring
- Repeat back what you understood to check it is correct
- Keep a low-tech aid nearby as a backup to devices
Who can help
- Speech-language pathologist (also called a speech and language therapist): assesses speech, teaches strategies, and recommends communication aids
- Occupational therapist: helps with access to devices, including switches, mounts, and positioning
- Assistive technology specialist: sets up and adjusts high-tech communication devices
For help with writing, computers, and other technology, see Technology.
Videos about speech and communication
Watch videos about speech changes, communication aids, and communication support for people living with ALS/MND.
Resources from our members
Explore additional resources about speech, communication, and communication aids developed by Alliance member associations.
Speech and communication
Speech and Communication
MND Association · English
Information about how MND can affect speech and communication, and the support and equipment available.
Speech and Communication Support
MND Association · English
Answers to common questions about how speech may be affected, strategies to maintain speech, communication aids, and where to find further support.
ALS and Communication
Les Turner ALS Foundation · English
A guide to speech changes that can occur with ALS/MND, including changes to writing and typing, with practical tips and communication options.
Communication aids
Communication Tools and Resources
ALS Centrum Nederland · Dutch and English
Information about communication aids, writing aids, and other tools for people living with ALS/MND and their caregivers.
Communication Card
MND Association · English
A printable card that explains to others that the person has difficulty speaking but can hear and understand.
For health professionals
E-Course: Communication Aids in ALS
ALS Centrum Nederland · Dutch
An e-course for speech therapists, occupational therapists, and nurses who support people living with ALS/MND. It covers communication needs and technological aids, and may also be useful for caregivers.
Dysarthria
MND Association · English · For health professionals
Information for health and social care professionals about dysarthria in MND, its causes and impact, and how it is managed.