Problems with speech are a common symptom of multiple sclerosis (MS). Difficulties can result when lesions occur in the area of the brain that facilitates speech. In addition, fatigue can affect the voice, making it very weak, especially towards the end of the day when you are tired or during periods of relapse.
The most common changes in speech and communication in MS are listed below.
This is the medical term for difficulty in finding the right words or forming sentences. It is considered the most common communication disorder in those with MS. It is caused by neuromuscular impairment, which results in disturbances in motor control of the speech mechanism. For example, damage in one part of the brain might affect the muscles of the tongue and lips, making it difficult to pronounce precise sounds. Damage in another area might weaken the diaphragm, affecting breath control and volume.
This voice disorder often accompanies dysarthria because the same muscles, structures and neural pathways are used for both speech and voice production. Therefore, voice quality, nasal resonance, pitch control, loudness and emphasis may also be affected in those with MS.
This is a language disorder; difficulty in finding the right words or forming sentences. The symptom in MS is usually about recalling the correct words when they are needed at a particular moment rather than the permanent loss of knowledge. This can cause language difficulties, such as difficulty understanding language (receptive dysphasia) or difficulty with language output (expressive dysphasia).
These may worsen or trigger speech, language and cognitive problems. Some medications cause dry mouth, which can make it hard to speak and swallow. Medications also might aggravate weakness, reduce alertness or cause fatigue, all of which can hamper a person’s ability to communicate.
In summary, the changes MS can cause to your speech include
If you are having problems with your speech, you may find it helpful to
Communication problems may affect your relationships with family and friends, and can make social situations challenging. Failing to speak clearly or make yourself understood can have a huge impact on your self-confidence and quality of life. However, a speech and language therapist (SLT) is almost certain to be able to offer you help. They will devise strategies and exercises to help you cope with your speech problems by achieving more control over the way in which you form words and sentences. This may include
Swallowing is such an automatic response that we give it little thought, unless it starts to give us a problem. The medical term for swallowing difficulties is dysphagia. Over 30% of people with MS have some degree of difficulty in swallowing. This is due to myelin damage in the part of the brain that controls the swallowing mechanism or in the nerves connected to it.
We use around 50 pairs of muscles and a number of nerves in order to swallow safely. In order to swallow safely the following functions of the body are used – motor activity, sensory, coordination and autonomic functions. All of which are functions of the body that can be affected by MS.
It is a complex process that happens in three stages, the oral phase, the pharyngeal phase and the esophageal phase.
The oral phase is when food is placed into the mouth. When chewing starts, saliva mixes with the food and it is moved around the mouth by the tongue and jaw. This process makes the food the right size and texture to swallow. The tongue and other muscles propel the food towards the back of the mouth in a front-to-back squeezing action. At this point, sensory receptors are activated to start the involuntary phase of the swallow.
In the pharyngeal phase, a number of things are all happening at once. As food enters the upper portion of the throat (pharynx), the soft palate rises to make sure food does not enter the nose. The larynx (voice box) elevates and also moves forward allowing the epiglottis to drop down covering the trachea (windpipe). This prevents food from entering the airway and the lungs. Food is propelled down the throat, the esophageal sphincter opens and food is entered into the esophagus. During this phase breathing stops temporarily.
The final phase, the esophageal phase, a number of motor contractions occur to move the food down the esophagus – the tube that carries food and liquid to the stomach. As it moves through the lower esophageal sphincter opens allowing the food/liquid to pass in to the stomach.
This whole process takes just seconds but can easily be impacted if just one of those functions is affected.
Some of the affects that are caused by swallowing difficulties can be
Dysphagia can lead to complications such as dehydration, malnutrition, upper respiratory infections and aspiration pneumonia.
Early detection and appropriate treatment can successfully reduce the problems associated with swallowing difficulties. It is important that carers, family members and friends also recognise this as a potential problem and understand that it is not limited to people with more advanced MS and can in fact happen to anyone with MS.
To help prevent issues with swallowing you can try the following
If you are seeking the support of health professionals, depending on your needs, there may be a multidisciplinary approach taken to supporting speech and swallowing difficulties. This means that there will likely be many professionals involved in assessing and addressing your speech and swallowing issues.
If swallowing problems become prolonged and an ongoing issue that could potentially put you at risk, nutrition can be provided through a procedure called a ‘percutaneous endoscopic gastrostomy’ (PEG). This involves a tube being inserted through the abdomen directly into your stomach bypassing the part of the swallowing mechanism that is not working effectively. Family carers or paid carers can easily be trained to use a PEG feeding system and should be taught to do so by the health professionals involved. It is recommended that first aid treatment should be learned by you and your family carers if you are concerned about the risk of choking. The Red Cross or the St John Ambulance service may offer free or discounted first aid training courses in your area.
It is recommended that first aid treatment should be learned by you and your family carers if you are concerned about the risk of choking. The Red Cross or the St John Ambulance service may offer free or discounted first aid training courses in your area.
A referral to a speech and language therapist (SLT) can be made by your MS nurse, GP, member of your neurology support team, or a social care professional such as a social worker. Often the perception of speech and language therapists is that they are only in place to help with talking, this is not the case. Speech and language therapists are trained professionals in all aspects of communication and swallowing. Speech and language therapists are often the key health professional to work with if there is an issue with speech or swallowing. You may be seen in your own home or a clinic depending on services in your area.
For more information on all of the above conditions please see the following links. If you would like to discuss anything mentioned in this booklet then please call our helpline on 0800 783 0518. If you would like a plain text version of this booklet please email info@ms-uk.org
