APMHC

Abstract

Background: Amyotrophic lateral sclerosis (ALS) causes progressive loss of speech and motor function, making communication and daily self-management difficult. Rapid advances in voice technology ranging from voice assistants and smart-home integrations to augmentative and alternative communication (AAC) and voice banking-offer new pathways to preserve autonomy and quality of life. Objective: To evaluate the extent to which voice technologies assist people with ALS and other chronic mobility disorders, considering functional, emotional, ethical, and access dimensions. Methods: Narrative synthesis of peer-reviewed literature, guidance from major medical/advocacy organizations, and patient/clinician accounts. The analysis focuses on communication efficacy (AAC, speech-generating devices, voice banking), activities of daily living (smart-home control, reminders), emotional outcomes (agency, identity), limitations (speech deterioration, usability), ethics (privacy, consent, data ownership), and equity (affordability and training). Results: Voice technologies substantially improve communication, preserve personal voice identity through banking/synthesis, and enable hands-free control of the home environment, supporting independence, safety, and caregiver relief. Benefits are moderated by disease stage, speech clarity, device quality, training, and coverage. Emerging AI/ML models improve recognition of dysarthric speech and personalize synthetic voices, but raise important concerns around privacy, informed consent, and data stewardship. Access gaps-cost, digital literacy, geography-remain a primary barrier. Conclusions: Taken together, voice technologies assist individuals with ALS to a significant extent by sustaining communication, agency, and daily functioning. Maximizing impact will require inclusive design that adapts to changing speech, robust privacy protections, and policies that expand coverage, training, and support. For preventive medicine and healthcare delivery, these tools may reduce complications, bolster medication adherence, and enable safer, longer independent living.