This information is for health and social care professionals.
Many people with MND experience weakness in the bulbar region, affecting muscles of the mouth, throat and tongue. This can lead to problems with speech and voice, which will affect ability to communicate.
Spasticity, largely resulting in weakness of the:
- facial muscles
- pharynx and larynx.
Reduced palatal elevation can lead to hypernasal voice quality. Reduced breath support can lead to reduced volume or breathy voice quality.
- Progressive difficulty with articulation, slurred speech and/or loss of volume.
- May rapidly lead to anarthria, even though limb function is maintained for many months.
Early referral to speech and language therapist (SLT) who will:
- examine the patient’s range of movement in their lips, tongue and palate
- give advice on strategies for communication.
The SLT can also arrange for assessment and provision of Augmentative and Alternative Communication (AAC).
An occupational therapist (OT)/the neuro rehabilitation service/orthotics can assist with advice on:
- seating, positioning, wrist and head supports
- switches and pointers
- mobile arm supports and tables to access communication aids
- environmental controls.
Dysarthria may exacerbate emotional reactions, including:
- isolation – communication inadequate or avoided
- frustration – difficult or impossible to be understood; the person needs time that may not be available
- increased fear and anxiety – being unable to discuss these fears and anxieties
- low self-esteem – presumption by others that they are either deaf or intellectually impaired
- loss of control – because they are misunderstood or their opinion is ignored or not sought
- increased sadness.
Allow time to explore and discuss the above issues.
Be aware that cognitive impairment can cause problems with communication and the ability to learn and use alternative communication methods.