Multiple sclerosis affects many aspects of an individual's life. One of these aspects that are usually affected is a person's ability to communicate. As a way to combat this, an individual with multiple sclerosis might be referred for speech therapy. This article will discuss some of the areas of speech that are directly affected by multiple sclerosis as well as how a speech-language pathologist can be of help in treating these affected areas.
In this article, we will discuss:
What is Multiple Sclerosis (MS)?
Multiple sclerosis is an autoimmune disorder in which the immune system attacks what is known as the myelin sheath. This myelin sheath is meant to carry signals between neurons and when it is destroyed, the transfer of these signals is inhibited. This results in what we know as multiple sclerosis. MS is often broken down into a few categories depending on certain criteria:
Relapsing Remitting Multiple Sclerosis (RRMS): Characterized by autoimmune attacks happening months or even years apart. An individual with RRMS might experience deficits when the attacks occur, but then improvements between attacks. Typically though, these attacks will leave lasting effects.
Secondary Progressive Multiple Sclerosis (SPMS): SPMS is similar to RRMS, however overtime the time frame between attacks lessens and eventually the attacks will often become constant, resulting in the steady progression of deficits.
Primary Progressive Multiple Sclerosis (PPMS): PPMS is different from RRMS and SPMS because PPMS is a constant attack on the myelin sheath, resulting in constant disability progression.
Progressive-Relapsing Multiple Sclerosis (PRMS): Similar to PPMS, this is one constant attack. However, the disability will often progress even faster than with PPMS.
Other types of multiple sclerosis exist, however they are less common. But as MS studies continue to change, so do the classifications.
Reduce the impact of MS on your speech skills
Multiple Sclerosis Symptoms
Depending on the type and the extent of the progression, MS can look different for many people. However, some common symptoms include:
Tingling sensations
Numbness/weakness in the limbs
Double vision
Incoordination
Difficulty walking/unsteadiness
Cognitive deficits
Fatigue/Tiredness
Slurred speech
Multiple Sclerosis Speech Symptoms
As mentioned above, MS can cause slurred speech. But 'slurred speech' does not encompass the entire picture of how MS can affect a person's ability to communicate and overall thrive.
An individual with MS may struggle to coordinate the movements needed to articulate speech in a manner that is comprehendible to a listener or communication partner. This is where the slurred speech comes from. But the speech is not always slurred. Sometimes an individual may sound strained, hoarse, or raspy. This is dependent on how the MS is affecting the motor speech functions of the body/brain.
Communication Disorders and Multiple Sclerosis
Multiple sclerosis can cause what is known as dysarthria, dysphonia, and dysphagia in affected individuals. However, these three areas are not necessarily the limit to what speech areas can be affected by multiple sclerosis and the symptoms do not always present themselves the same way in all individuals.
Spastic-Ataxic (Mixed) Dysarthria
There are several types of dysarthria, which is a motor speech disorder. However, spastic-ataxic dysarthria is most commonly associated with multiple sclerosis. A mixed dysarthria occurs when symptoms from two or more dysarthria types are present. Ataxic dysarthria is most commonly associated with uncoordinated/slurred speech. Spastic dysarthria is usually characterized by a strained voice, monotonous speech, and a slow rate of speech. Spastic-ataxic dysarthria is characterized by the presence of both of these dysarthria types in a singular individual.
Dysphagia
Dysphagia is characterized by problems with swallowing. This can present itself in obvious symptoms, such as choking on saliva, liquids, or foods. It may be less obvious, and an individual may only choke on certain consistencies (i.e., thin liquids, solid foods, etc.) Or there may be no outward signs of choking at all, which is known as silent aspiration. A person with MS can experience all of these symptoms, making it difficult for them to acquire the nutrition they need on a day to day basis.
Dysphonia
Dysphonia is characterized as a voice disorder. It can present itself as breaks between words or sentences in which the voice seems to disappear and return. It may also sound like a hoarse or grating voice that seemingly appears without cause (i.e., illness). It can also sound like breathy or nasally speech.
How Speech Therapy Can Help Individuals with Multiple Sclerosis
Adult speech therapy can assist in the lessening of MS symptoms on speech as well as assist in coping with what affects may be permanent. Speech therapy includes methods to treat the communication deficits discussed above: dysarthria, dysphagia, and dysphonia. A speech therapist is also equipped to educate patients about said communication deficits, in order to help the patient feel more prepared and knowledgeable about what is happening to their speech and swallowing. This can also, ideally, assist the patient in educating others about their condition should the situation arise in which they feel the need to do so.
A speech therapist will often times begin with an assessment, in most cases to specifically assess the dysarthria, dysphagia, or the dysphonia. These assessments are tailored specifically to the affected area and can give the speech therapist an idea of where to begin in treatment and what areas the individual is in need of assistance in.
Goals of Speech Therapy Treatment for Multiple Sclerosis
A speech therapist's goals vary depending on the individual's affected areas. The ultimate goal of the speech therapist is to improve the patient's quality of life and to take into account the patient's desires for their treatment and what they would like to focus on in therapy, while also making it realistically achievable in home life.
Dysarthria Goals
Treatment and goals for dysarthria tends to depend on the type of dysarthria that is present. However, an overarching goal for dysarthria treatment, especially when it comes to people with MS, is to retrain and strengthen the muscles that are affected. These muscles are uncoordinated and weak, and the speech-language pathologist will in many cases, give oral motor exercises. Just like going to the gym to exercise the body, the individual will exercise the muscles utilized for speech to rebuild the muscle's abilities as well as retain what remains.
Dysphagia Goals
For many speech therapists, the ultimate goal of dysphagia treatment is to give the individual access to an adequate and safe diet. Dysphagia treatment can look different in a variety of ways, depending on the patient's wants a needs. The goals might be centered around exercises to strengthen the swallowing mechanisms. Goals might focus on making eating and drinking safer. Or the goals might even focus on simply modifying the patient's diet to maintain nutrition. Depending on the severity of the dysphagia, a patient might not be able to maintain an oral diet at all and might be in need of an alternative form of nutrition intake. A combination of all of these treatment plans may also be required for an individual, as they might only need diet modifications temporarily while also performing exercises to strengthen their swallowing mechanisms.
Dysphonia Goals
The goal of dysphonia treatment might involve implementing vocal exercises into the patient's treatment plan. The goal of these exercises could be to improve the individual's prosody (as mentioned above, patients with MS can sometimes have monotonous speech). Also, the goals might center around improving the patient's volume and rate of speech. Many times, with MS a patient might speak at an inappropriate volume, whether it be what is considered too loud or too quiet for a social situation. Or they may speak at a rate of speech that is difficult to comprehend, whether that be a rate of speech that is considered too fast or a rate of speech that is considered too slow.
Goals for Alternative Forms of Communication
In some cases, restoring speech to its former functions may not be possible in the case of MS. However, a speech-language pathologist can assist patients in coming up with an alternative form of communication. This might involve acquiring an AAC device (Augmentative and Alternative Communication). This could be in the form of a device that has been programmed with options for communication in which the device may 'speak for' the patient. Or this can be without the assistance of technology through writing or picture boards with common phrases accessible and individualized to the patient.
Speech-language pathologists might make learning to utilize these forms of communication a goal for their patient.
Preventing Communication Isolation in Individuals with Multiple Sclerosis
An unfortunate side effect of dysarthria, dysphagia, and dysphonia can sometimes be communication isolation. Individuals with dysarthria and dysphonia struggle to communicate with their communication partner and may have difficulty getting their wants and needs across verbally. Socially, they may struggle to participate in conversation with groups. An individual with dysphagia may feel isolation during social eating settings. They may be unable to eat the same food that is being serviced to their peers. These are all things to be considered if you or a loved one is struggling with MS. Group speech therapy exists to connect people experiencing similar situations, and can be very beneficial to one's emotional state.
It is sometimes helpful to prepare for social situations by prepping social partners beforehand. Many times, this isolation is not intentional on the part of the social partners and a simple briefing beforehand or sharing how one feels emotionally with the assistance of an AAC device can make the experience much more enjoyable.
In many cases, a speech therapist can act as a mediator with the family to assist the patient in expressing their desires for their communication and their personal goals for social situations.
At Better Speech we know you deserve speech therapy that works. We have experts in your needs and assign the right therapist, not just the therapist that happens to be in your area. Having multiple sclerosis can be difficult, but with the right support, you or your loved one can learn to lead a happy and successful life.
At Better Speech, we offer online speech therapy services convenient for you and tailored to your child's individual needs. Our services are affordable and effective - get Better Speech now.
Frequently Asked Questions
How does multiple sclerosis affect speech?
Multiple sclerosis can affect speech in different ways, depending on the location and severity of the damage to the central nervous system. It can cause slurred or slow speech, difficulty with pronunciation or articulation, voice tremors, and changes in pitch or volume.
Can speech therapy help with multiple sclerosis-related speech problems?
What other communication problems can multiple sclerosis cause?
How long does speech therapy for MS-related speech problems typically last?
About the Author
Denni Hickman
I am a speech-language pathologist with six years of academic experience and two years of workforce experience. I have completed a Bachelor of Science in Speech-Language Pathology and a Master of Science in Speech-Language Pathology, as well as a minor in English. I have worked with both children and adults in the school setting, private practice setting, as well as medical setting (hospital inpatient and outpatient).
I love speech-language pathology because it offers such a wide variety of experiences with so many different groups of people, with different backgrounds and ages. For fun I enjoy reading, writing, and spending time with my loved ones.
