*Please note this library article has two parts, each answered by different MS medical professionals.

Managing Speech Challenges in MS
By: Pamela H Miller, MA, CCC-SLP

Difficulty with speaking clearly (dysarthria) may occur in up to 40% of people with Multiple Sclerosis (MS). Problems may interfere with how easily a person’s speech can be heard and understood. They are typically mild to moderate, or worsened intermittently by MS-related fatigue. Changes in voice quality (dysphonia) may also occur, resulting in hoarseness, breathiness, and/or reduced loudness.

Common speech and voice problems for those with MS may include:

  • Reduced loudness due to poor breath support/control.
  • Imprecise articulation due to weakness, slowness, or incoordination of the lips, tongue, and soft palate. This may affect overall speech intelligibility.
  • Flow of speech which may be slow, have irregular pauses, or excess and equal emphasis due to poor timing of respiration and articulation.
  • Voice quality which may be hoarse, harsh, breathy or hypernasal if there is neuromuscular impairment of the vocal cords or soft palate.

A speech language pathologist (SLP) can evaluate specific speech/voice problems and provide treatment. When voice changes are noted, referral to an otolaryngologist (ENT) for a scope exam is recommended to assess the vocal cords. Primary therapy goals are to improve intelligibility and naturalness of speech with communication partners, and to use proper voice techniques with less vocal strain.

The following strategies can be used to speak more clearly:

1) Fill Your Lungs Fully: Use your diaphragm.

2) Speak Louder: With conscious effort.

3) Slow Down: Allow extra time for your lip and tongue movements.

4) Exaggerate Articulation: Make precise contacts with your lips and tongue to reduce slurring.

5) Pause strategically: Every few words, to allow for better breath support, loudness, and articulation.

6) Actively Self Evaluate: Watch for feedback from the listener, and correct your speech if it appears not to be understood.

At times specialized equipment may be recommended, such as:

  • Voice amplifier (with headset microphone) when adequately increasing loudness is too difficult.
  • Speech generating devices (although a rare need in MS) when severe dysarthria and unintelligible speech

Cognitive and Linguistic Challenges with MS
By: Janet DeClark, MA, CCC-SLP

Cognitive/communication challenges affect approximately 50-66% of those with MS. Impairment can range from mild to severe, but most cognitive changes in MS fall within the range of mild to moderate. However, even subtle changes in cognition can have a significant impact on daily functioning. In fact, cognitive and fatigue issues cause people with MS to leave the workforce more than mobility issues cause people to leave their jobs. The most common cognitive-linguistic complaints associated with MS are problems with forgetfulness, finding the right word, and feelings of being overwhelmed or paralyzed by indecision and too much information. Fortunately, compensatory strategies can enhance and maximize cognitive function. Visual or verbal associations can assist with learning new information. Gestures, synonyms, and initial letter cues are useful tools for word retrieval. External aids such as calendars, smartphones or pocket logs ease planning, organization and memory challenges. However, it is important to remember that if language or cognitive challenges have a significant impact on safety or ability to function in work or daily life, a consult with a speech/language pathologist, occupational therapist or neuropsychologist is advisable to address individual needs in greater depth.

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