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                    English
                
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            | Number of pages / Number of words: | 
            
                4 / 1054             | 
        
                
    
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Other limb onset patients first see the effects of the disease on a hand or arm as they experience difficulty with simple tasks requiring manual dexterity such as buttoning a shirt, writing, or turning a key in a lock. About 25% of cases are bulbar onset ALS. These patients first notice difficulty speaking clearly...
        
        
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About 25% of cases are bulbar onset ALS. These patients first notice difficulty speaking clearly. Speech becomes garbled and slurred. Nasality and loss of volume are frequently the first symptoms. Difficulty swallowing, and loss of tongue mobility follow. Eventually total loss of speech and ability to protect the airway when swallowing are experienced...
        
        
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