LOTS Communication

How a speech-language pathologist (SLP) can help

Suggestions for improving communications

Of all the things that make us human, the ability to communicate is one of the most important. Any impairment of this ability can have far-reaching consequences, affecting every aspect of a person's life, from learning, to work, to interactions with family, friends, and community. Problems with communication vary in nature and severity from person to person. Although there are commonalities, no two people with LOTS are exactly alike, and as the disease progresses, the variability continues. The following list summarizes problems that people with LOTS may experience at different stages of the disease. In many cases, a person with LOTS will experience the same areas of difficulty throughout the course of the disease, with severity varying from stage to stage.

Communication problems may be caused by any of the following:

Dysarthria (muscular weakness, slowness, or incoordination of the lips, tongue, throat, and jaw)
Apraxia (disruption in programming and sequencing muscle movements for speech)
Diminished rate control (talking too fast or too slowly)
Poor voice quality (hoarse/harsh, breathy, volume too low or too high)
Discoordination of breathing and voice
Short length of utterance (person only responds with one or two words)
Misarticulations (incorrect pronunciation of sounds)
Lack of initiation (inability to initiate conversation)
Perseveration (person gets "stuck" on certain words or phrases, repeating them often and at inappropriate times)
Difficulty with monitoring pragmatic skills (turn-taking in conversation; reduced ability to maintain a topic or switch topics appropriately)
Inability to speak
Stuttering (difficulty beginning a word or sentence, with repetition of sounds)
Difficulty understanding information
Difficulty reading and writing

How a speech-language pathologist (SLP) can help

The speech-language pathologist can be helpful at all stages of the disease. In the early stages, he/she can assist with problem solving and developing strategies to help persons with LOTS compensate for some of the problems they might be experiencing. As the disease progresses, the role of the SLP evolves into helping preserve and maintain the person's highest level of communication. Early intervention and involvement with therapeutic professionals is best because people can learn compensatory strategies more successfully during the early stages of LOTS and can then apply them throughout the course of the disease.

The SLP can also evaluate a person's ability to use augmentative or alternative communication devices and techniques, which can be as simple as a word/picture board, or more complex, such as an electronic device that speaks for the person. After determining a person's level of ability for using such techniques, the SLP begins to focus on personalizing the technique or method of communication.

For example, the SLP might work with a person with LOTS and his or her family to create a word/picture board tailored to the person's environment (whether it be a private residence or a long-term care facility) or flexible enough to be carried around. Where an electronic device might be beneficial, the interest and motivation of the person with LOTS to use it should be evaluated. If there is evident motivation, then the device should be made easily accessible.

Suggestions for improving communications

Although alternative methods of communication are available, people with LOTS generally prefer to attempt verbal communication for as long as possible, even if their speech becomes hard to understand. The SLP and family members can often help by encouraging the speaker to:

Speak more slowly
Say one word at a time
Repeat the word or sentence when necessary
Rephrase the sentence
Exaggerate the sounds
Speak louder (take deep breath before speaking)
Use gestures
Keep sentences short
As a supplement to speech, use alternative communication techniques such as word boards, alphabet boards, picture boards, electronic devices

Some suggestions for the listener are:

Eliminate distractions (TV's, radios, large groups of people)
Keep questions/statements simple
Ask one question at a time
Use yes/no question format as much as possible
Pay attention to gestures and facial expressions/changes
If you do not understand what is being said, don't pretend that you do. Ask for clarification, or repeat what you think was said in the form of a question, such as, "Did you say...?"
Try to keep to familiar topics
Encourage the speaker to use his/her specific compensatory strategies
Allow enough time for the person to convey his/her message
Most importantly, be patient with the speaker

People with LOTS should seek out an SLP at the point when communication with others becomes frustrating and upsetting.