Symptom Management
Sp eech
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f others are asking you to repeat words, if it’s getting harder to carry on conversations because your speech is slurred, slow, or quiet, or if you can’t talk fast enough to keep up with your thoughts — you may be experiencing a speech disorder. Speech and voice problems occur in approximately 25 to 40 percent of people with MS, particularly during relapses or periods of extreme fatigue. The problems are of two types: dysarthria and dysphonia. Dysarthria is the change in the production of speech, including slurring, unclear articulation of words, and difficulty controlling loudness. Dysphonia is the term used for changes in voice quality, including hoarseness, breathiness, nasality and poor control of pitch. Because speech patterns are controlled by many areas in the brain, lesions caused by MS in different parts of the brain can cause several types of changes in normal speech patterns. Changes may range from mild difficulties to severe problems that make it difficult to speak and be understood. One pattern that is commonly associated with MS is called “scanning speech.” Scanning speech produces speech in which the normal “melody” or speech pattern is disrupted, with abnormally long pauses between words or individual syllables of words. People with MS may also slur words. This is usually the result of weakness and/or incoordination of the muscles of the tongue, lips, cheeks and mouth. Other speech problems include nasal speech, which sounds as though the person has a cold or nasal obstruction. The good news is that most speech and swallowing problems can be managed with the help of a speech/language pathologist (SLP). “Anytime an individual experiences a decline in their speech or voice, it is advisable to consult with a speech pathologist,” said Kim Winter, M.A., CCC-SLP, a speech pathologist with Hospital for Special Care, located in New Britain. “This is particularly true when the individual’s communication skills are compromised by the speech and/or voice changes. If individuals are being referred to me, it is most often due to a change in their speech and voice abilities.” During an evaluation, the SLP will examine the oral muscles that are necessary for speech including the lips, tongue and soft palate to assess how controlled movement is in terms of strength, speed, range, accuracy, timing and coordination. The SLP will 12
check breath support and control, how precisely words are pronounced and how well an individual is understood by others. “Treatment is always individualized to the unique needs of each person, based on the severity of their speech deficits,” Winter said, who has been working as a speech pathologist since 1996. “Speech therapy activities might include: focusing on over-articulating when speaking if speech sounds are imprecise and unclear; attempting to improve breath support by working on better breathing using the diaphragm muscles; and slowing down the rate of speech by making use of natural pauses between phrases and sentences.” Additionally, use of the Lee Silverman Voice Treatment – LOUD Program has been shown to be beneficial for some individuals with MS, as it focuses on improving all of these parameters (i.e. breath support, speech volume, articulation and rate) with an intensive training program. Many persons with dysarthria also have dysphagia, which causes difficulty with swallowing. Speech therapists are trained to evaluate, diagnose and relieve these problems. Changing the types of food and their consistencies can be helpful for some. If a person with MS becomes unable to speak, there are many assistive devices available, ranging from alphabet cards, to hand-held communicators that print out a tape, to computers that respond to eye blinks. Medications that relieve other MS symptoms can sometimes help speech disorders. For example Baclofen, which relieves spasticity, may improve a harsh, strained voice quality. In some cases, injections of small amounts of botulinum toxin into affected muscles can relieve spasms and allow for a smoother voice. There are also exercises to promote relaxation and improve breath support. “No one living with MS or who has a family member living with MS has to try to figure it out on their own,” shared Winter. “If they consult with a speech pathologist, we can evaluate speech needs and determine the most appropriate course of action to help with improving communication difficulties. Treatment of speech and voice deficits associated with MS is not a ‘one size fits all’ paradigm, but we’re here to help.” For more information on speech disorders, visit www.nationalMSsociety.com/symptoms.