Can speech therapy be discontinued during the course of the illness?

Speech therapy for ALS focuses on treating two symptoms: speech disorders (dysarthria) and swallowing difficulties (dysphagia).

As ALS progresses, it can lead to a complete loss of the ability to speak (anarthria). In this situation, some ALS patients discontinue speech therapy.

As ALS progresses, patients may also experience a loss of the ability to swallow (dysphagia). In such cases, nutrition is provided via a feeding tube (PEG tube). Guidance on the use of PEG feeding is primarily provided by dietitians.

At this advanced stage of the disease, speech-language therapy aims to strengthen existing swallowing function and enable a combination of tube feeding and oral nutrition. In fact, for a large proportion of patients with a PEG tube, concurrent oral feeding (and the associated enjoyment of food’s taste) can be maintained.

In particular, when PEG feeding is initiated, some ALS patients discontinue speech therapy. In advanced stages of the disease, with complete dysphagia and the use of a PEG tube, the therapeutic benefit of speech therapy is viewed very differently on an individual basis, leading a group of ALS patients to discontinue speech therapy.

From a therapeutic and medical perspective, the decision to discontinue treatment must be respected, as all therapeutic measures—including speech therapy—may involve time and physical demands (time spent on transportation and therapy; the physical exertion involved in treatment) and social burdens (involvement of family members and the social environment to facilitate therapy).

The option to discontinue speech therapy is an essential element of patient autonomy and therapeutic self-determination in ALS.