Speech, saliva and swallowing
Speech that is harder to understand
Speech becoming slower, quieter or less clear because the muscles used for speaking have weakened.
The clinical word for this is .
Still being checked
What this is
This is about the muscles, not about thinking or language. What you want to say is unchanged; getting it out is harder. Most of what helps is about being understood rather than about the voice itself, and much of it works better if it is set up before it is urgently needed.
What people often describe
- People asking you to repeat yourself, especially on the phone or in a noisy room
- Speech that is clear in the morning and harder by the evening
- Talking becoming tiring in a way it never used to be
- Being understood by family but not by strangers
Important distinctions
The word for being unable to produce understandable speech. Speech that has become harder to understand is a different stage from speech that has gone.
Speaking and swallowing use the same muscles, so they often change together and are assessed by the same person. What helps each is different.
What may help
This page lists options that are used for this problem and says where each one comes from. It is not a ranking, it is not a recommendation, and it is not personalised to you. What suits you is a decision for you and your care team.
Practical and self-management
Things people do themselves, or with whoever is helping them.
Allied health
What a therapist can assess, teach or adjust.
Equipment
Devices and physical aids.
Who may help
Where Compass explains this
Questions
- How can communication change in ALS/MND?
- What kinds of communication tools and technology can help?
- What if my voice has already changed?
- Why have a backup communication method?
Cards
Related
Other problems
Words explained
About this page
This page lists options that are used for this problem and says where each one comes from. It is not a ranking, it is not a recommendation, and it is not personalised to you. What suits you is a decision for you and your care team.
Evidence for this page
The sources behind the statements on this page, and where to find them. Compass does not decide which option is right for anyone.
Statement 1 of 5. Recording your voice while it is still clear, so a device can later speak in something closer to it. It is time-sensitive in a way nothing else here is.
Supports this. ALS Voice Banking and Cloning — Your ALS Guide · Practical guide
A practical guide explains that recording while speech is still clear is what makes the resulting voice sound like you.
“If you are able to record your voice when you can still speak clearly, the computer-generated voice on your communication device or app will sound more like you.”
Computer-Generated Voice BankingLink checked August 2026
Statement 2 of 5. The assessment that works out what will keep you understood, and the person who arranges everything else here. NICE says this should happen without delay.
Supports this. NICE MND guideline — NICE · Clinical guideline
NICE says a speech and language therapist should carry out the assessment and review without delay.
“Ensure that the assessment and review is carried out by a speech and language therapist without delay.”
1.12.1Link checked August 2026
Supports this. Dysarthria and communication in MND — MND Australia · Practical guide · June 2021
An Australian review says timely referral is vital so that options can be discussed early enough to plan around.
“Timely referral to a speech pathologist is vital to ensure early discussion regarding options available and to support optimal decision making and planning ahead.”
Dysarthria & communicationLink checked August 2026
Statement 3 of 5. If the problem is that you are hard to hear rather than hard to follow, a small amplifier can be enough on its own.
Supports this. Speech Pathology Week: Communication aids and equipment — MND NSW · Practical guide · August 2024
An MND association describes the amplifier as the aid for a soft voice caused by weakening speech or breathing.
“A portable communication device that amplifies voice output for people with deteriorating speech or reduced respiratory strength causing a soft voice that can be difficult to hear or breathlessness when talking.”
Voice AmplifierLink checked August 2026
Statement 4 of 5. Letter, word and symbol boards. NICE names these alongside the high-technology options, and they never run out of battery, which is why they stay the backup even for people using a device.
Supports this. NICE MND guideline — NICE · Clinical guideline
NICE names both low-technology aids such as alphabet, word and picture boards and high-technology voice output aids as potentially helpful.
“The use of both low‑level technologies, for example, alphabet, word or picture boards and high‑level technologies, for example, PC or tablet‑based voice output communication aids may be helpful.”
1.12.2Link checked August 2026
Statement 5 of 5. A device or app that speaks typed messages aloud, controlled by touch, a keyboard, switches, head movement or eye gaze. NICE says complex equipment needs a specialist service, so the referral matters as much as the device.
Supports this. NICE MND guideline — NICE · Clinical guideline
NICE says to involve a specialised service where complex high-technology aids, such as eye-gaze access, are needed or likely to be needed.
“Liaise with, or refer the person with MND to, a specialised NHS AAC hub if complex high technology AAC equipment (for example, eye gaze access) is needed or is likely to be needed.”
1.12.3Link checked August 2026