Changes in Speech and Communication in Patients with Amyotrophic Lateral Sclerosis

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Arvo building, Yellow Hall F025, address: Arvo Ylpön katu 34.

Tanja Makkonen

Doctoral defence of M.Sc. Tanja Makkonen

Changes in Speech and Communication in Patients with Amyotrophic Lateral Sclerosis : A two-year follow-up study

The field of science of the dissertation is Neurology.

The opponent is professor emeritus Matti Lehtihalmes (University of Oulu). Professor Jukka Peltola acts as the custos.

The language of the dissertation defence is Finnish.

Changes in Speech and Communication in Patients with ALS

Speech therapy together with communication aids make communicating possible for ALS patients

Timely provided speech therapy and versatile communication aids enable ALS patients to maintain and even to improve the effectiveness of their communication. ALS-patients who utilized a range of alternative and augmentative communication aids estimated their communication as more effective than those, who strived at communicating solely by deteriorating speech.

The results appear in the doctoral thesis of MA, SLP Tanja Makkonen, who studied the communicative ability of 30 ALS-patients. During a two-year follow-up Makkonen conducted altogether 157 speech and communication assessments and the patients completed 148 self-assessments on communication effectiveness. The ability to speak weakened in almost all patients and 60 per cent of the patients lost their speech completely. The loss of speech occurred on average in 18 months from the appearance of the first speech symptoms. The initial symptoms of the disease affected the deterioration of speech. Complete loss of speech inflicted all the patients whose disease began with speech and swallowing disorders and around 30 per cent of the patients with initial arm or leg symptoms. If the disease begins with speech disorders, problems in speech may already be very severe when the diagnosis is confirmed, Makkonen states.

Minimizing delays is important

Makkonen emphasizes the importance of minimizing delays in the care process. Patients with suspected ALS with speech or swallowing symptoms ought to be referred to a speech therapist in a specialized multidisciplinary unit without delay. Giving communication support and guidance to the patient and their close ones can well be initiated before visiting a neurologist or gaining diagnostic certainty. Professional speech therapy evaluation may even facilitate the diagnostic process.
According to Makkonen, speech therapists should pay attention to initial symptoms, the onset time of speech disorders, speech rate and motor-speech functions. The thesis reveals that speech rate retards and motor-speech functions deteriorate before speech intelligibility weakens. Further, as the intelligibility starts to degenerate, symptoms rapidly lead to loss of functional speech.

Familiarizing with alternative communication means should start before the intelligibility of speech diminishes. Several communication means are required to support impaired speech in diverse real-life situations. As the disease progresses, it should be ensured that communication aids are suited for the patient’s changing performance and altering communicative needs. Makkonen states that a patient might need seven different communication aids along the progression of the disease and simultaneously four different communication aids to support or replace speech.

ALS (amyotrophic lateral sclerosis) is a rare and progressive neurodegenerative muscle disease without a known cause or cure. The most typical initial symptoms appear in lower or upper extremities, but in some patients the disease starts with speech and swallowing symptoms. The symptoms eventually spread to encompass all voluntary muscles, including the respiratory muscles. Classical ALS leads to death within two to five years from the symptom onset, but in some cases the natural course of the disease is slower and 10 – 20 per cent of the patients may survive over 10 years.


The dissertation is published in the publication series of Acta Universitatis Tamperensis; 2414, Tampere University Press, Tampere 2018. The dissertation is also published in the e-series Acta Electronica Universitatis Tamperensis; 1924, Tampere University Press 2018.

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