The person who cannot speak may write his sins down and show them to the priest. Deaf people do this all the time. Not being able to receive Holy Communion because of a feeding tube does not prevent one from being a practicing Catholic. Someone who is physically impeded from receiving our Lord in Holy Communion is encouraged to make spiritual communions. Expressing one’s desire to receive Jesus can be a means for receiving the graces of the sacrament without actually receiving the sacrament in these extraordinary cases.