Thus, reiterates the fact that we need to return patients to physicians if they do not respond to tx. Most ALS patients, however, do not show voice signs first. A cerebellar lesion. Stress and intonation a problem. Like some other motor speech disorders, early on relaxation techniques may help, but this is very controversial.
Some patients can keep oral speech, although impaired.
Others are unintelligible and need aug comm. Can appear as vocal fold paralysis, but never compensates. May want to teach pushing exercises to get louder voice, but this person can sound like cerebellar ataxia and be unintelligible, thus aug comm. Gilles de la Tourette syndrome. Can have many varieties and degrees of severity, some not including voice.