For a patient with ALS experiencing progressive dysarthria, which proactive management approach is best?

• A. Strict reliance on effortful articulation drills during long monologues
• B. Voice banking and early AAC assessment
• C. Delayed intervention until the patient is completely non-verbal
• D. Oral motor strength training exercises using progressive resistance

Answer: (B)

Progressive dysarthria in ALS means speech will continue to worsen over time, so planning how to communicate needs to start early. Voice banking creates a personalized synthetic voice from the patient’s own recordings, and an early AAC assessment ensures a suitable device and training are in place before speech becomes unusable. This approach helps maintain identity and social connection, reduces frustration, and lets the patient participate in decisions about how to communicate as needs change. It also gives caregivers a clear plan and skills to support communication.

Relying solely on effortful articulation drills isn’t a durable or efficient solution here, especially as motor control declines. Waiting until the patient is completely non-verbal misses a window to practice and adapt, making the transition harder. Trying oral motor strengthening with progressive resistance isn’t consistently beneficial for preserving functional speech in ALS and can add fatigue without changing the disease trajectory.