A 42-year-old client with advanced ALS has progressive severe dysarthria with articulatory weakness. Which will most effectively improve communication?

• A. Augmentative communication system
• B. Palatal-lift prosthesis
• C. Amplification device
• D. Teflon injection into one or both vocal cords

Answer: (A)

Severe dysarthria with articulatory weakness in ALS means speech intelligibility is limited, so the most effective way to communicate is to use an augmentative communication system that provides an alternative means of expression, such as symbol-based communication boards or a speech-generating device controlled by eye gaze or other residual movement. This approach directly addresses the communication bottleneck by bypassing the weakened speech muscles and can be adapted as the disease progresses, preserving functional communication longer.

A palatal-lift prosthesis aims to reduce hypernasality by elevating the soft palate, but it relies on coordinated soft-t palate control and may not yield meaningful gains in someone with widespread neuromuscular weakness. An amplification device helps with hearing but does not fix the underlying speech production problem. Teflon injections into the vocal cords can improve voice quality for certain glottic issues but do not restore clear, reliable communication when articulatory strength is lost.