Speech loss is one of the most devastating outcomes for people living with amyotrophic lateral sclerosis (ALS). However, despite its prevalence and impact, active speech intervention is rarely a focus of ALS care. A new paper published in Healthcare takes a critical look at why, and what needs to change. 

The study, “To Treat or Not to Treat: A Scoping Review of Speech Treatment for Dysarthria in Amyotrophic Lateral Sclerosis (ALS)”, reviews nearly five decades of research on speech treatment for dysarthria in ALS. The authors, led by Dr Brooke-Mai Whelan, found that evidence in this area remains extremely limited: only a handful of studies met inclusion criteria, most with small sample sizes, variable methods, and inconsistent outcome measures. As a result, current evidence offers little practical guidance for clinicians. 

This gap is not due to a lack of need. Dysarthria affects the majority of people with ALS and has a profound effect on quality of life. Instead, the review highlights longstanding challenges in the field, including the rapid progression of ALS, historical concerns that intensive exercise may accelerate decline, and the absence of clear recommendations for restorative or compensatory speech interventions in existing clinical guidelines. 

Redenlab contributed to this work as part of a broad, international research collaboration led by experts in speech science, neurology, and rehabilitation. The paper brings together researchers and clinicians from leading institutions, including the University of Manchester (UK), the University of Queensland (Australia), and other academic and clinical partners across speech and neuroscience research. 

Redenlab’s involvement, led by Chief Executive Officer Prof Adam Vogel, reflects our ongoing commitment to advancing objective, evidence-based approaches to speech and communication assessment in neurological conditions. 

Importantly, the paper does not argue against speech treatment in ALS. Instead, it calls for better, more rigorous research. As perspectives on exercise in ALS evolve, there is growing rationale to investigate speech interventions that are: 

• tailored to disease stage and individual capability, 
• minimally fatiguing, and 
• designed to make use of remaining physiological support for speech. 

By clearly outlining the limitations of the current evidence base, this review provides a foundation for future studies that can meaningfully inform clinical practice and ultimately support people with ALS to maintain communication for as long as possible.