Because multiple sclerosis treatments focus more on mobility, which is the most common complication of the disease, many overlook some other major symptoms, including issues with speech. Not only can the speech pattern of a multiple sclerosis patient be affected; so can their voice, as well as the ability to swallow. And having problems swallowing can literally be life-threatening.
What causes speech and swallowing issues in MS?
Symptoms of multiple sclerosis are due to nerve damage. While doctors don’t know the cause behind it, MS begins with an overreaction of the immune system and an attack on myelin – the protective coating of protein that covers the nerve fibers in the central nervous system (CNS), which consists of the spinal cord and brain. As this autoimmune disease takes action, it first destroys the myelin, which helps process electrical impulses faster through the body for better response. Then, the same attacks cause irreparable damage to the nerves in the CNS.
The nerve damage can affect a lot of different areas of the body, but patients typically see the first problems with mobility. However, when evaluating the symptoms of patients being treated for MS, as many as forty percent of them experience symptoms related to speech and swallowing, making it a very real concern.
Complications of speech and swallowing
One of the biggest problems with the fact that an MS patient can have reduced ability to speak clearly is that it makes it more difficult for them to communicate. That’s especially concerning when a patient needs help of any kind and can’t speak well enough to have someone understand them.
The most common speech pattern problem is slurring, but other issues can occur, including:
- Difficulty with articulation
- Dysarthria – difficulty controlling the volume of their voice (too loud or too soft)
- Hoarseness or other changes to voice, including breathiness or dysphonia (nasal quality)
In addition to experiencing these concerns – and the panic that can come with them – patients diagnosed with MS can suffer from difficulty swallowing. This can cause problems with excess saliva buildup, issues with drinking fluids to stay hydrated, inability to eat at all or to do so safely (as this becomes a choking hazard), and can actually lead to death.
As with other symptoms related to multiple sclerosis, there are treatment options that don’t change the course of the disease but can help manage complications, especially to reduce the way symptoms affect everyday life and reduce the quality of living. With speech pathology, rehabilitation involves helping the patient to identify and overcome problems with speaking as well as swallowing.
Therapists focus mainly on the mouth and throat, specifically improving motion of these areas. This is especially true of patients who have seen lesions on the brain in the speech center or display weakness in the facial muscles. Several techniques can be employed, and the way the therapy works is customized to the individual, since each case of MS presents differently.
Some of the recommendations a therapist could make include:
- Oral exercises to strengthen the muscles around the mouth and throat so that, even during a relapse, there is less likelihood of problems with speech or swallowing
- Using special devices for communication, in the event that a patient is completely unable to speak and needs to tell someone else what’s happening or what they need
- Voice training, which can help with control of volume, reduce the effects of hoarseness and other voice changes, and improve articulation and force from deep in the abdomen rather than only speaking from the throat
- Modification of diet to avoid choking hazards, especially during a relapse, when the patient is most likely to suffer from symptoms related to speaking and swallowing
- Changing positions when eating to help open up the throat and modify the way the body responds to eating
- Assisting with cognitive issues related to speech, including memory of speech patterns, for improved enunciation and communication skills
- Slowing down when speaking so that thought and words can stay aligned, and the patient can focus more on how to pronounce and where to make volume and other changes to tone
- Use of exaggerated articulation to compensate for loss of muscle control around the mouth
- Breathing control to assist in voice modulation and the ability to stay on track, which also assists with reduction of fatigue when energy is already waning and needs to be preserved
Most of these exercises are to help reduce communication issues and improve speech patterns. In order to address swallowing issues, other suggestions are made to help the same set of muscles compensate for the loss of definition and control caused by damage to the CNS.
- Patients can learn to identify the sensations of food and drink and location within the mouth and at the opening of the throat prior to swallowing, gaining the ability to maximize success for their efforts in swallowing.
- Therapists may recommend changes to the position of the patient’s body and/or head that will improve the ability to swallow.
- In some cases, foods with certain consistencies will be determined as the main culprit, and these will be removed from the diet to avoid great risk of choking, gagging, or otherwise blocking the ability to breathe.
Changes to speech, difficulty with speaking, and issues swallowing when related to multiple sclerosis should not be ignored, especially since these typical appear or worsen during a relapse and could lead to other significant health issues.
With so many patients suffering from these particular problems, the use of speech-language pathology, therapy, and rehabilitation is essential to helping obtain a higher quality of life and be self reliant in ways the patient might otherwise require dependency. Mobility may be the most common symptom of multiple sclerosis, but impeded swallowing and speech could very well be the most dangerous, and addressing these the most important in seeking treatment and therapy beyond medication administration.