Which method would the nurse utilize to best facilitate communication when caring for a client with end stage amyotrophic lateral sclerosis (ALS)?

A. At end stage ALS, hand and arm strength are often severely impaired, making writing ineffective. B. Eye movements are typically preserved in ALS, and pre-arranged eye signals provide a reliable method of communication. C. ALS affects motor function, not hearing or understanding; speaking louder or slower does not aid communication. D. Muscle weakness may make hand squeezing inconsistent or impossible, especially at end stage.