My mum has a cuffless trach, but has difficulty producing sounds sometimes. I figured it could be due to her secretions and impatience (she sometimes forgot to swallow her saliva before trying to talk), but just want to confirm.
I think that speech therapy can be useful for several reasons. First, a speech therapist can teach exercises that will make "mouthing" words and swallowing (for those who can enjoy "pleasure feedings") more effective. The second reason is to assess and train for alternative communication devices, such as a computer that responds to eye movements. The third (and, in the longterm, perhaps most important reason) is to work with family caregivers so that communication will be efficient and effective. Speech therapists who are familiar with ALS can help with means of communication other than traditional "speech." Vocalization is only one means of communicating. The anthropologist/philosopher Claude Levi-Strauss argued that if a society collectively agreed upon it, scent could actually be used as a way of communicating, rather than articulated words.