Speech difficulties in MND are caused by weakness and reduced coordination of the lips, facial muscles, tongue, larynx and pharynx. Speech is not the only form of communication that can be affected by MND. Muscles used for non-verbal forms of communication can also be weakened by MND. These include muscles used for facial expressions, hand gestures and body language; and the muscles used for writing, typing and operating a mouse. Not all people with MND will experience difficulties with speech and non-verbal forms of communication.
Allied health support
A person with speech or other communication difficulties will benefit from regular reviews from allied health professionals such as speech pathologists and occupational therapists. A speech pathologist assessment will lead to a thorough understanding about how a persons ability to communicate has been affected by MND and what strategies, such as communication devices, can assist. Occupational therapists can assist a person with the physical requirements of communicating (particularly in instances where communication devices are being used) by offering a range of strategies.
Low technology communication devices
It seems that every day a new technological device is being released to the market. Consequently, a range of high tech items are available to assist with communication.
This includes computers, smart phones, tablet devices and software to support these devices. There are also specific communication devices such as voice amplifiers and lightwriters (a device similar to a computer keyboard that allows you to type sentences that can be viewed on a small screen or announced as a simulated voice). A Speech Pathologist can assist you in selecting a device that will best suit your needs now and into the future.
Many devices can be adapted so that a person with MND can continue using it even when there ability to move particular parts of their body changes. For instance, a laser pointer may be attached to a cap to assist someone in using a communication board or a light touch switch (a large button) maybe attached to a computer. Occupational therapists in consultation with a speech pathologist can assist in setting up a devices appropriately for a person with MND.
High technology communication devices
Low technology communication aids include writing, communication charts and gestures and signs.
Writing is often preferred if hands are unaffected.
There are many simple ways of making a pen or pencil easier to grip:
- Build it up with elastic bands, pimple rubber or foam, special pen grips or Plastazote tubing.
- Push the pen through the holes in a practice golf ball.
- Use a pad of paper rather than loose sheets.
- Use a non-slip mat to prevent the paper slipping.
- Use a felt-tip pen it requires less pressure than a ball-point.
- Markers are easy to hold and make bold strokes.
- White boards and note books can be used.
Some people keep an identity card for use when they go out; including their name, contact details and a short explanation of their communication difficulty.
Communication charts and books can be made up according to each person’s need. These may include phrase, letter and picture charts. They can also be created in dual languages. Sample communication chart are usually available from a speech pathologist or may be available from the MND Association.
When using a board as a communication device it is usually a good idea for the other person to have a pencil and paper to write down letters and numbers as they are communicated.
An agreed set of eye-movements can also be used for simple communication. For example one blink or raising the eyebrows for ‘yes’ and two quick blinks or closing the eyes for ‘no’.
Signing with the hands is not usually an effective communication tool for most people with MND. This is because shoulder, arm and hand muscles may also be deteriorating, or may start deteriorating once the technique is established, resulting in additional communication issues as the disease progresses.
Source: MND NSW Aspects of care - residential care facilities