Speech and Swallowing
Katherine Parsons, MA, CCC-SLP and Allison Cecil, BS
MS causes damage to the central nervous system and can cause lesions in the part of the brain responsible for controlling the vocal cords, diaphragm, soft palate, tongue, and lips. As a result, speech problems such as slurred speech, difficulty articulating, and dysphonia can arise. Difficulty swallowing, known as dysphagia, can also be caused by MS-related neural damage. Since MS affects each person differently, the severity and duration of symptoms will vary person to person. An individual’s symptoms may change over the progression of MS as well.
Approximately 44% of people with MS experience impairments in speech or voice, and 33% of people with MS have trouble swallowing. Yet, only around 2% of people with MS receive speech therapy. Rehabilitative therapies and strategies can help manage symptoms to maintain independent function and improve quality of life.
Speech
Speech is a highly complex process that depends on finely controlled and coordinated muscles. Dysarthria, a speech disorder common in people with MS, can present with slurred speech, nasal speech, and a low or inappropriate volume. Some people with MS may have trouble with language production and thinking of words they want to say, which is called aphasia. Speech difficulties can also occur secondary to other MS symptoms such as ataxia (poor muscle control that causes involuntary movements), dystonia (muscles contract involuntary), muscle spasms and stiffness, cognitive changes, and tremors.
For a thorough evaluation of your speech disorder, it is important to see a speech and language pathologist (SLP). They can help you develop skills and techniques to manage your speech impairment such as...
Exercise your speech muscles. Your SLP can provide you with exercises that can be practiced daily to improve function and strengthen muscles that support breath control and speech production. These exercises will also promote relaxation of these muscles.
Practice speech techniques. Your SLP can teach you techniques that can slow down your speech, help with your phrasing and pausing to help make speech clearer, and can demonstrate how to over-articulate words to make your speech more understandable.
Self-monitor your speech patterns. Use a recording device to capture how you speak. This allows you to correct some of your speech issues by adjusting your volume or phrasing.
Use new devices and current technology to assist with your speech. Devices like voice amplification, electronic aids, and other computer-assisted communication systems are readily available and easy to use. Many programs can be downloaded for free over the Internet.
Experiment with cognitive-linguistic compensatory strategies. Your SLP can teach you strategies to help with word retrieval, information processing, organization, and more, to improve your communication.
Practice, practice, practice. Working towards clear goals based on a thorough understanding of your speech difficulties is key. Try to practice in group settings with supportive friends and family who can provide you with feedback on your speech patterns.
Consider medications. Check with your provider about medications that can improve speech by helping affected muscles or related symptoms like dystonia or tremors.
Swallowing
Swallowing is a complex process that requires the muscles in the mouth and throat to work in a coordinated way. If nerve damage causes these muscles to become weak or uncoordinated, or numbness affects the areas, swallowing can become difficult. People with MS might have difficulty managing solids or liquids, feel like food gets stuck in their throat, or feel the need to cough while eating or drinking. Some people with MS may also feel like food “goes down the wrong pipe,” which is called aspiration. Around a quarter of people with MS experience diminished sense of taste, which can cause even more difficulty during mealtime.
Even though most people with MS experience fairly mild symptoms, swallowing dysfunction can cause serious issues such as dehydration, poor nutrition, and aspiration pneumonia. As a result, it is important to identify and treat swallowing difficulties to maximize the safety and efficiency of eating. To create a safe eating environment, incorporate modifications and routines such as…
- Brush your teeth and tongue thoroughly twice a day to reduce bacteria in your mouth and decrease your risk of aspiration pneumonia.
- Sit upright when eating or drinking. Keep your chin parallel with the table, unless instructed by a professional to do otherwise.
- Take smaller bites of food, one at a time. Eat slowly, and sip drinks, don’t gulp.
- Double swallows might be needed. Double swallows refers to swallowing once to send liquids or food down, then doing a dry swallow to clear any leftover particles.
- It might be recommended that, after you swallow, you clear your throat and swallow again.
- Add moisture/liquid to foods. Foods with moisture are easier to swallow. You can also try alternating between bites of food and sips of liquid.
- Eat smaller portions. If you are experiencing fatigue, which can interfere with swallowing, try to consume smaller meals throughout the day instead of one or two large meals.
- If you feel like you are getting tired while eating, take a break. It’s better to have smaller meals more frequently than a few large meals that cause fatigue.
- Eat meals in a quiet environment and try not to speak when food is in your mouth.
- If swallowing problems persist, consider seeing a Speech Pathologist. They can evaluate your swallow with special imaging, such as modified barium swallow studies, to recommend targeted treatment strategies, dietary changes, or exercises.
Optimal MS management includes a multidisciplinary healthcare team focused on treating a person’s unique profile of symptoms, including speech and swallowing difficulties. This team includes the person with MS and their support systems who provide essential feedback to providers as to what is working in the home environment and when modifications are needed to address these problems.
Speech and swallowing deficits can limit your quality of life, but managing the symptoms with the help of an SLP can increase your ability to communicate with others, function effectively, and eat and drink safely. It is important to have a SLP complete a full evaluation so specific treatment recommendations can be made. Check with your provider about VA services that can help improve your speech and swallowing.
