Voice health guidelines for people with ALS / MND

How we use our voice and our breath in daily situations has significant effect on our respiratory and vocal functions. It is important to gently exercise your voice, but it is even more important to not overuse it and to give it proper care. Following these simple rules may help you to develop healthy breathing and voice habits.

By Alisa Apreleva, MT-BC, NMT, board certified music therapist, researcher


  • Aim to maintain aligned posture all the time to form a habit, but especially as you speak or swallow.
  • Practice abdominal breathing regularly so it becomes natural. Deep, abdominal breathing is more efficient that “shallow”, chest breathing.
  • Practice muscle relaxation regularly, paying special attention to face, neck and shoulder muscles.
  • Warm up you voice in the morning. Take deeps breaths, do light tongue and lips stretching, hum gently.
  • Avoid singing or speaking over background noise, such as TV, radio, traffic noise, in the car, on public transportation, at the parties, etc. Keep cell phone conversations brief in noisy surroundings.
  • Avoid talking or singing in situations when you have to twist your neck or head (for example, in the car).
  • Avoid speaking when you are tired.
  • Speak comfortably. Avoid shouting, screaming, loud talking – and whispering. Even though it may not appear so, whisper is more taxing for our voice than regular talking.
  • To get attention, use a bell or special signal rather than shout.
  • Speak in your range: not too low, not too high.
  • Slow down your speech and exaggerate the sounds, especially at the ends of words, as if you were singing.
  • Make sure your conversation partners are looking at your face when you speak.
  • When possible, communicate in smaller groups (up to 3 persons).
  • If conversation is too fast for you, develop a signal to let everyone know that you have something to add.
  • Use gestures to emphasize your speech.
  • Breath abdominally as you speak. Make sure you always have enough air. You may pause to take a deep breath as you need.
  • If your voice is tired, take a break.
  • If speaking hurts, do not speak. Do not use cough drops to numb throat pain and continue speaking: they only mask the symptoms, and you may damage your voice.
  • Get enough sleep.
  • Drink plenty of water.
  • Avoid breathing smoke, dust or fumes.
  • Do your best to reduce stress in your life and to have positive experiences: our emotions affect our voice and breathing.
  • Consult with your doctor, if excessive salivation is a problem: it can be treated.


These voice health guidelines have been developed by Alisa Apreleva, MT-BC, NMT, for participants of the upcoming study on the effect of neurologic music therapy on breathing, swallowing, cough and speech of people with ALS. This is a self-funded PhD research. Kindly consider supporting this study



Anon, 2016. Speech and communication support. [online] MNDA. Available at: [Accessed 8 Feb. 2018]

McClosky, D.B., 2011. Your voice at its best – fifth edition. Long Grove: Waveland Press.

Peckham, A., 2010. The contemporary singer: elements of vocal technique. Berklee Press Publications.

Roman, A., 2016. Suggestions and Information about Speech Changes & Augmentative Alternative Communication (AAC). [online] ALS Association. Available at: [Accessed 8 Feb. 2018]

Written by

Picture of Alisa Apreleva, PhD, MT-BC, NMT

Alisa Apreleva, PhD, MT-BC, NMT

International expert on harnessing the power of live and recorded music to improve people's lives. Certified music therapist, neurologic music therapist. Entrepreneur. Speaker. Performing musician, composer. Educator. Author. Storyteller. Researcher focused on vocal therapy for wellbeing and responsive music environments.