Speech disorders are a common symptom among those who suffer from MS. The brain is the organ responsible with speech, so when the brain is affected by this medical condition, the brainstem can experience lesions that prevent people from speaking as they normally would. The medical term used to describe speech disorders is “dysarthria”, and it range from mild to severe, varying from one patient to another.
Dysarthria vs. dysphonia
When it comes to speech disorders caused by multiple sclerosis, there are two different categories. The first one is known as dysarthria, and manifests itself through:
- The inability to control the volume of your voice. People with MS can often find themselves talking too loud or too quiet.
- Impaired articulation is also a characteristic of dysarthria, and it is recognized by slurred speech.
- Impaired emphasis is when the patient has difficulties in maintaining a rhythm in their speaking pattern. As a consequence, it takes them longer to pronounce a single word, use inadequate pauses, stresses out syllables in world differently, or shows signs of different voice pitches.
Dysphonia, on the other hand, manifests itself through a series of different symptoms:
- Disorders in voice quality.
- Voice becomes harsh, due to spasticity.
- Soft palate becomes uncoordinated, which causes hypernasality.
- Vocal cords can no longer be coordinated, which causes breathiness.
- Differences in pitch and tonality, because the muscle tone is subject to change.
Evaluating speech problems in MS patients
A speech or language pathologist can perform a thorough evaluation of this problem. This evaluation consists of several steps and tests that the specialists perform in order to understand more about the issue at hand.
During this evaluation, patients may be asked to read out loud several texts, in order for the specialist to determine if there are any problems with the reading rate. Some specialists like to record their patients while they are spontaneously speaking, in order to analyzed different variables that are related to speech (such as words per breath, number and frequency of pauses, intelligibility, articulation, etc.).
Another step consists of evaluating the mouth’s structures and muscles. It involves an examination of components that help people speak, ranging from tongue and teeth, to lips and soft palates. This analysis can help classify the speech disorder and determine the severity of the issue at hand.
A speech pathologist can determine what is the best individual plan to follow to help an MS patient gain as much control over the speech function as possible. This plan is best developed after the evaluation steps, in order to tailor the plan to a patient’s individual needs. Speech therapy depending on determining the specific problem, and work towards implementing exercises that can help people take a little bit of their lives back.
There are different forms of interventions that specialists recommend to MS patients, in order to address their speech-related problems:
- Breath support is something that normally needs to be improved in MS patients, as shortness of breath is quite a common symptom, especially when dealing with heavy episodes of fatigue. The process of improving breath support requires exercises that involve abdominal breathing. Patients can also learn new breathing patterns. This implies deep inhalation and using more force when exhaling.
- Another intervention is focused on improving coordination between phonation and breathing. When patients become aware of their irregular breathing pattern, specialists are able to come up with a plan that determined which are the best word-breath groups. Patients can then practice these optimal groups and increase them as they go along.
- Phonary functioning is another step towards improving speech patterns in MS patients. This process is a bit more complicated, as the harsh voice quality isn’t subject to modification, but soft voice quality is.
- Intervention in the speech patterns will also require improving intelligibility. External aids can be a great help here, including metronomes and finger tapping. This allows the patients to slow the speech rate and improve word articulation.
Cognitive changes and speech
When a person suffers from MS, there are several changes happening at a cognitive level which can interfere with the ability to speak. There cognitive changes are quite varied, and also affect people’s ability to focus, express their ideas and through, or remember certain words or phrases. There are cases where MS patients can fully understand the information they receive, but find themselves unable to respond properly, or have difficulties in processing that information in a timely manner.
This is not a matter of comprehension, as people who suffer from MS do understand what they hear. The problem is in the ability to process the details, as the brain loses the capacity to learn/encode the information as fast as a person without this condition does.
Alternative & augmented communication
AAC is a system that MS patients turn to when they discover that verbal communication alone isn’t enough. In severe speech disorders caused by MS, people may need different devices to carry on their means of communication. These devices can range from low-tech options to even the most complex gadgets.
An example of a low-tech device is the letter board, which an MS patient can use to express their thoughts. Other high-tech solutions include text-to-speech software, which are an effective tool that convert written text to verbal communication.
In some cases, MS patients can be reimbursed for the money they pay for these AAC devices, but it really depends on the government and insurance policies available in each country and region.
While speech problems are inevitable in most cases where people have been diagnosed with multiple sclerosis, there are many ways in which these people can compensate for the speech deficit that may occur. With the help of specialists and assistive devices, people can learn to cope with this problem, discovering new ways to communicate, to train their brain into remembering things. There are always tools and devices at hand that can improve communication issues. The first and most important step is seeking help and getting the proper evaluation.