Old 09-04-2015, 05:35 PM #1 (permalink)
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Default Problems "getting speech started" - how to help?

Hi
I'm an SLP and am trying to help a patient with ALS. He is having increasing difficulty getting his words started. It is almost like a stuttering block. He knows what he is trying to say - it isn't a word finding problem. I'm sure it is some sort of motor corodination/control issue. I don't know what to suggest that might help. Any ideas?

We are working on getting him an augmentative communication system but of course want to help him maximize his ability to verbalize.

Thanks for your help.
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Old 09-04-2015, 06:10 PM #2 (permalink)
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Default Re: Problems "getting speech started" - how to help?

Hmm. Tough question. You write that he's having trouble getting words started. Does that mean he can clearly say the words once you assist him? That's not the way ALS works. Perhaps his "stuttering block" is due to something else, not ALS. That's not likely.

ALS degrades the ability to speak by paralyzing muscles in the tongue. The motor nerves in the brain that operate those muscles are destroyed. There is no improvement possible. The brain can't send a signal through destroyed motor nerves, so the muscles in the tongue are not directed to move. They lay limp and useless. The resulting slurring is obvious to all. Eventually all ability to speak coherently is lost. If the patient lives long enough, the unused tongue atrophies.

Let's hope his speech problem is something else that can be improved.
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Old 09-04-2015, 10:33 PM #3 (permalink)
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Default Re: Problems "getting speech started" - how to help?

I currently have pure umn symptoms so personally unfamiliar with the full spectrum of issues a person with ALS may have. You haven't indicated if your client has any form of bulbar umn issues- however, this sounds familiar to me. Particularly if I am under stress or excited I have a hard time initiating movement, whether it's jaw, leg, hand, etc. It seems to be part of my spasticity issues. Maybe some others with PLS or bulbar umn symptoms can chime is as well with some pointers. The introduction of Lamictal to my daily cocktail of drugs has seemed to reduce the "catch" before finally getting my words out.
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Old 09-04-2015, 10:51 PM #4 (permalink)
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Default Re: Problems "getting speech started" - how to help?

Not an ALS issue as it's slurring that happens.

There are some language issues however that happen with semantic FTD which could be an issue here.

Any motor control issues can't be fixed in ALS, it's a degenerative disease due to dying nerves. It could be some kind of clonus happening however.

The best solution is to get him working on using technology as early as possible.

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Old 09-06-2015, 04:14 PM #5 (permalink)
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Default Re: Problems "getting speech started" - how to help?

FWIW, I had a similar problem when I first began having speech issues and IMO it was pretty well psychological. What would happen is that I would catch myself listening to myself whenever I would start to speak and it would cause me to have to struggle to get the first word started.

The closest I could compare it to would be trying to talk on a speaker phone with an echo where you hear every word you say shortly after you speak it.
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Old 09-07-2015, 12:00 AM #6 (permalink)
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Default Re: Problems "getting speech started" - how to help?

I'm with you SK.
When tired, stressed, nervous etc. The short stutter. Like brad, I am pretty sure it's physco logical.
My right side of my face is affected, so i have trouble with forming words. That's probably the worst part. Because I have trouble moving my actual mouth, it creates that hitch at the beginning of a word, but as I say that happens because I become nervous!
Can win either way.
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Old 09-07-2015, 04:02 AM #7 (permalink)
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Default Re: Problems "getting speech started" - how to help?

Brad that reminded me of how it was for Chris in the early stages.

He would think of what he wanted to say in a flash, but then he would try to think of simple, short words with few syllables that would convey what he wanted to say. By the time he worked that out he had half forgotten how to even start the sentence he had made in his head. Then he would realise the conversation had moved on ...
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Old 09-07-2015, 04:34 PM #8 (permalink)
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Default Re: Problems "getting speech started" - how to help?

The worst was conference calls with clients. I design and program (well did anyways) complex tiered computer systems distributed across many different systems/networks/companies and ALL of the calls involved lots of big multi-syllable words, talk about fun...

I read somewhere that this is actually fairly common among people with speech issues. I'd liken it to the yips when putting (golf reference)
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Old 09-07-2015, 04:48 PM #9 (permalink)
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Default Re: Problems "getting speech started" - how to help?

I can relate to some degree, as I had a time when I was on a medical treatment that had cognitive side effects that I had to just put up with. (for 9 months) As a part of that I became very slow of speech because my brain had trouble finding the right words. Not fun when talking to clients!

My Chris owned a cafe - so talking, laughter and food were his life. He could cook 10 meals at once and be holding 3 different conversations. He was one who would talk as much by facial expression and hand gesturing as just with words.

First he lost speech and swallowing, then rapidly after his hands.

He often said if it had taken the legs first it would have been easier to adjust instead of taking the most precious first.
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Old 09-08-2015, 10:29 AM #10 (permalink)
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Default Re: Problems "getting speech started" - how to help?

Hi
Thanks much for all the replys. The psychological part is interesting. I hadn't thought of that side. His speech when he is able to get it out is still fairly clear. A bit of dysarthria - slur - but not bad. That is why he finds the inability to get speech started so frustrating. Sadly though the comments saying that it is degenerative are of course true. Overall things are getting worse. I will definately focus on the augmentative system with him.

I'll look into the Lamictal too.

Thanks again for all the help.
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Old 09-08-2015, 05:45 PM #11 (permalink)
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Default Re: Problems "getting speech started" - how to help?

Quote:
Originally Posted by affected View Post
I can relate to some degree, as I had a time when I was on a medical treatment that had cognitive side effects that I had to just put up with. (for 9 months) As a part of that I became very slow of speech because my brain had trouble finding the right words. Not fun when talking to clients!

My Chris owned a cafe - so talking, laughter and food were his life. He could cook 10 meals at once and be holding 3 different conversations. He was one who would talk as much by facial expression and hand gesturing as just with words.

First he lost speech and swallowing, then rapidly after his hands.

He often said if it had taken the legs first it would have been easier to adjust instead of taking the most precious first.

Tillie
Agreed. My hardest moment is going to be losing my hands. I also know what you mean about the talking, at my last clinic Dr. Goslin commented about it must be nice to not have the lability issues due to the nuedexta, the crying must have been horrible to deal with and I told her the laughing actually bothered me more because any time I was talking with friends and had a funny comment to make I couldn't do anything except sit there laugh like an idiot while everyone wondered what the hell was so funny.
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Old 09-09-2015, 12:11 AM #12 (permalink)
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Default Re: Problems "getting speech started" - how to help?

Brad yes!

Chris had EL from early on and he rarely cried, it was hysterical laughter.

Now he was someone who laughed most of the time, but it was controlled most of the time too. He would say something in the cafe, go into hysterical laughter and have to walk out the back as he could not control it until he had been alone for a few minutes. Then he would become very concerned.

He would laugh at things that were not the least bit funny, which is what EL is really about.

One day he went to town to do some shopping. 2 women who had been customers approached him and said they were so sorry the cafe had closed and asked why. His speech of course was very poor at this point and he tried to explain it was MND (as we call it here). Both women exclaimed very loudly in shock which caused people around to turn and look and before he knew it there were at least 6 women standing in a circle around him, some beginning to cry and all so upset at the diagnosis.

He went into hysterical laughter.

I still shudder trying to imagine how distressing it was for him, let alone what those stupid loud women thought!
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