By: MSF Staff and reviewed by the Multiple Sclerosis Foundation Medical Advisory Board
The conversation skips along until… the long pause. That word that just won’t come out, or the odd quality to your voice that starts when it does, can be frustrating and embarrassing.
As many as 40 percent of people who are diagnosed with MS will face speech difficulties at some time. The most common problems are loudness, a harsh quality to the voice, and problems with articulation and pitch.
The symptom could hit hard with a relapse, or come and go several times a day on a regular basis. It might be so subtle that your spouse or doctor notices it before you do, or so frustrating that you don’t want to leave the house.
MS AND SPEECH
Human speech ends with the mouth but starts with the brain. The lungs, vocal cords and tongue all play a role, as well as the lips, throat and jaw. That leaves several places along the way that speaking can get complicated when MS is involved.
“When there is damage to the nerves that stimulate the muscles, they may not work as quickly or precisely,” according to Bonnie Schaude, outpatient speech pathologist at the MS Institute at the Shepherd Center in Atlanta, Ga.
Motor speech disorders, including those most commonly associated with MS, are called dysarthrias. Some dysarthrias can cause words to slur. A person’s speech might be slow. Vowel sounds could be distorted or speakers might have problems varying their tone. The speaking pattern that can result, particularly when there are long pauses between words or syllables, has its own term: scanning speech.
WALKING AND TALKING: SPEAKING AND OTHER SYMPTOMS
Speech symptoms with MS aren’t about not knowing the right word, even though some people also could have speaking difficulties linked to cognitive issues.
Sometimes problems talking might be a side effect from medications, particularly those that cause a dry mouth, but more often, just as when MS hinders mobility, the muscles you use to speak simply aren’t getting the message.
In addition, those same symptoms that play havoc with other parts of the body can show up in speech. Ataxia, muscle weakness and tremor all can come into play.
Someone with MS who has problems speaking could also have difficulty walking. Speech and swallowing problems also can come as a package. Because similar muscles are involved, if you are having problems speaking, you might also notice difficulty swallowing, a symptom known as dysphagia. Swallowing can be delayed or ineffective. You might cough or choke. In some cases, food or liquid could end up in the lungs, a serious condition known as aspiration.
TALK ABOUT IT
For some people, difficulty speaking might be one of the most problematic symptoms they have. For a teacher, actor or salesman, communication can be a factor in livelihood.
Problems talking tied to MS can start out subtly, so your doctor or nurse might notice it before you do. Some medical professionals suggest that people learn ways to cope with speech problems as early as possible, so they become familiar with speaking strategies and techniques they might need later.
A speech language pathologist can conduct testing to see which part of your speech is impacted and provide appropriate therapy. They will look at your breathing control and the way you move your lips, among other things.
Depending on why you are having problems, the speech pathologist could suggest a prescription. Some drugs that have been found to be effective for other MS symptoms can alleviate speech problems, as well. It is more likely though, that you will begin speech therapy. A speech pathologist can help you with communication strategies that help make talking easier.
Bonnie Schaude works with her clients on energy conservation and techniques to control their rate of speaking, as well as strengthening exercises. She also looks at what circumstances trigger speaking problems.
The most important thing, she said, is to make sure those with speech difficulties are able to continue to communicate effectively, interact with other people and pursue a good quality of life.
SPEECH SOLUTIONS: STRATEGIES TO COPE
MS is just one reason a person might have a dysarthria. Another is alcohol or drug use. Even though speech problems can be a symptom of a number of neurological conditions, some people worry others will assume they are drunk and are embarrassed to talk. Other people are discouraged when they know what they want to say, but their body will not cooperate. Unfortunately, speech problems can get worse with stress and anxiety.
Your speech pathologist could suggest trying other ways to communicate.
Since speaking problems can worsen when you are tired, you might consider trying to keep conversations shorter or writing an email or letter instead.
If you find talking particularly difficult, assistive devices such as a microphone or textphone could help. Other tools can translate writing into spoken word.
Speech impairment as an MS symptom can be hard on the listener as well. Family members and caregivers often feel uncomfortable mentioning the problem. Even so, experts say they should speak up. Communication will not improve if the speaker doesn’t realize they aren’t being understood.
If you are trying to understand someone with a speech problem, give them time to express themselves. Try asking closed-ended questions, those can be answered with a simple “yes” or “no”, and repeat key parts of conversation back so that the speaker can confirm what they meant.
That’s what I said
Strategies for speaking
1) If the listener isn’t aware you might have difficulty speaking, let them know.
2) Take your time and don’t get frustrated. Speak slowly, pause frequently and consider shortening your sentences to get the basic message out.
3) Let body language lend a hand. Face your listener, and use gestures and expressions to help people understand.
4) Take a break if you get tired. Try sending an email or writing down what you want to say.
5) Use notes if you have issues with memory or word recall.
Being a better listener
Advice for families and caregivers
1) Don’t raise your voice. This isn’t related to hearing.
2) Be patient and pay close attention. Reduce distractions in the room such as a radio or television.
3) Ask questions that can be answered simply or with a “yes” or a “no” if you notice the speaker struggling or consider taking a break from a long conversation. Speech difficulties can worsen when muscles are tired.
4) Repeat back important pieces of information to avoid miscommunication.
5) Be honest. Politely let the speaker know if you don’t understand.
At the doctor’s office
Terms you might hear
There is a name for each kind of speech problem you might have.
When spasticity strikes the muscles used for speaking it is called spastic dysarthria.
When air flow is to blame for the difficulty, the diagnosis might be peripheral dysarthria.
Speech and rhythm problems, as well as slurring, could be types of dyskinetic dysarthria, also called ataxic dysarthria.
What is a speech language pathologist?
Commonly called speech therapists, speech language pathologists diagnose and treat problems with speaking voice and fluency, as well as language, communication and even swallowing.
(Last reviewed 7/2009)