Need to Know: What Is Dysarthria?
Editor’s note: “Need to Know” is a series inspired by common forum questions and comments from readers. Have a comment or question about MS? Visit our forum.
This week’s question is inspired by the forum topic “Slurred Speech” from May 14, 2018.
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What is dysarthria?
Neurologically speaking, dysarthria refers to speech abnormalities caused by nerve damage to areas commonly in charge of vocalizing. For people with MS, this nerve damage is typically the result of demyelination.
“Disturbances of the nerve supply that weaken the muscles of the lower face, lips, tongue, and throat can result in dysarthria,” says Donald A. Barone, DO, on the Multiple Sclerosis Association of America’s website. “More commonly, multiple small lesions in either of the two large lobes of the brain, known as the cerebral hemisphere, result in poor motor control and coordination of these muscles,” he adds.
This can lead to the slurred or slow speech with unusual articulations that commonly characterize speech problems in people with MS.
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MSers will describe their predicament as “sounding drunk” or “tripping over words.” It’s no surprise that it’s similar to the kinetic symptoms — spasms and incoordination — that affect the arms and legs in people with MS.
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What does dysarthria sound like?
The National Multiple Sclerosis Society (NMSS) identifies seven different kinds of speech deviations common to dysarthria in MS:
- Volume control problems (too loud, too soft, unusually variable)
- Strained or harsh-sounding voice
- Articulation problems (words are distorted as they are spoken)
- Impaired emphasis (in phrasing, speech rate, stress on sounds and syllables, and tone)
- Impaired pitch control (speaking in too high or too low a voice)
- Decreased vital capacity (relates to breathing support and control while speaking)
- Hypernasality
The NMSS further divides dysarthria into three distinct categories:
Spastic
Spastic dysarthria is caused by stiffening, spasming, or poor coordination of the muscles used for speaking. This can result in:
- Strained or “broken” voice
- Slow speech
- Unclear articulation of sounds
- Problems coordinating speaking with breathing
- Brief or unusual brief phrasing
- Problems modulating the volume of one’s voice while speaking (soft speech)
- Hypernasal speech
Ataxic
Ataxic dysarthria is caused by slurring and speech rhythm problems. This can result in:
- A vocal tremor
- Irregular articulation of sounds
- Problems with rhythms between the tongue, lips, and jaw
- Scanning speech (odd, unnatural stress on spoken rhythms)
- Problems modulating the volume of one’s voice while speaking (loud speech)
- Unusually prolonged spaces between spoken words
Mixed
Most people with MS experience a combination of both spastic and ataxic dysarthria.
How to manage dysarthria
The Multiple Sclerosis Foundation (MSF) encourages those who have trouble speaking to seek out the advice of their neurologist.
A speech-language pathologist can be an important part of your MS care team. They can test your speech to identify your chief limitations and offer appropriate therapy that can include help with breathing and moving your facial muscles.
Triggers for speech problems may be the same things that trigger other MS symptoms, so keep this in mind. If you’re tired, anxious, or stressed, it’s likely to show up in problems with speech.
Coping strategies from the MSF include practicing shorter conversation styles, communicating through writing or email instead of phone calls, and letting others know you have speech limitations so they can practice patience and compassion.
Do you stumble while speaking? How has dysarthria affected your daily life? Have you found a way to overcome your MS-related speech problems? Post your replies in the comments below or at the original “Slurred Speech” forum entry.
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Note: Multiple Sclerosis News Today is strictly a news and information website about the disease. It does not provide medical advice, diagnosis, or treatment. This content is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. Never disregard professional medical advice or delay in seeking it because of something you have read on this website. The opinions expressed in this column are not those of Multiple Sclerosis News Today or its parent company, Bionews Services, and are intended to spark discussion about issues pertaining to multiple sclerosis.
Comments
Sheryl Skutelsky
My mother had slurred speech back in 2000, but not one doctor attributed it to MS. Yet, somehow I knew that’s what it was before the doctors did. I have MS now, and I’m having every symptom that my mother had. Unfortunately, she passed in 2001 from cancer, and I never got to tell her that we both had MS since I wasn’t diagnosed until right after she passed away.
Tamara Sellman
I'm sorry to hear about your mother, Sheryl. The speech issues are very hard to live with, I'm sure you were able to glean some valuable insights from her to help you better navigate dysarthria. Good luck <3 Tamara
Venice
It's very hard for me and my family dont understand they just want me to say it when I cant even think about what I want to say it's really hard I lose my way a lot
Tamara Sellman
I completely understand, Venice, during my last relapse, I had a lot of strange speech issues myself, and trouble with finding words, or speaking the randomly wrong words in place of the ones I meant to speak! I also would hear myself speaking out loud and think I had actually spoken out loud, but then my husband would look at me and say I had stopped speaking midsentence. From what I understand, these are not instances of dysarthria (for what it's worth) but of anomia or dysnomia or something called anomic aphasia: http://www.speech-therapy-on-video.com/wordfindingdifficulty.html
Kathy Griffin
My husband and family say that I talk to loud and have to tell me to lower my voice, which I do not realize. Also he stats that I speak harshly. Don’t realize this either. I have always been a positive speaking person. I was diagnosed with PPMS 6 years ago...
Katharine
I have the same issue Kathy. Never attributed the volume or harshness to MS before. Thank you for helping me feel like I’m not alone.
Katharine L
I have the same problems with volume & harshness. Thank you for commenting. I do not feel so alone in my battle w ms now
Lisa
I inhale when I’m eating,causing me to choke. Then I forget how to cough. Soo strange ?
Brenda Shepard
I just got done doing some tests for swallowing because I told my dr that it's like I "forget" to swallow. I thought it was strange too that how can I forget to swallow? Just like when I'm going down or up a few stairs where I live, I go blank when I'm going down the steps and my right leg/ foot don't act like it knows what to do. I forget to step down. But it only does it with the right side
Tamara Sellman
Our brains make us "forget" some of the most basic things! It's the same way we suddenly don't notice we have to void our bladder or bowel, it's like our bodies "forget" to respond to that sensation. MS sure messes with normal living, doesn't it?
Good luck to you, Brenda!
Tamara
Tamara Sellman
That is strange! It's called dysphagia, and it can be a big challenge as you need to eat but don't want to choke or inhale (aspirate) your food. If this happens to you and you have MS, it's a good idea to share this information with your specialist (if you haven't already). Good luck to you, I'm sorry you're going through that!
Tamara
Michele
I frequently have aspiration pneumonia, my dr thought it was just a condition I was born with from weak muscles. Nafrer I was diagnose 2 days after Christmas it was another MS symptom. I am being thought to hold my head down when swallowing. To not aspirate.
lynn woodall
i am a smoker and a lot of times when im eating i forget wether im supposed to inhale or swallow. and i never smoke while im eating
Joyce Davenport
Does pain in the throat when singing a lot have anything to do with this?
Tamara Sellman
That's a good question, you might just have strained vocal cords, but it's worth asking your doctor about. On the other hand, singing a lot is a great thing to do! I always feel my mood is lifted after singing!
Tamara
Peggy
I have been told that I am too loud by my husband and family. I've been told that I slur my words at times, and have even been accused of "sounding drunk " when I'm not. Also been told that I come across as "harsh" when I certainly dont mean to be any of the above. Its discerning when, I tell people that I have these problems, yet they get mad at me, not understanding. I've been asked by my (former)employer if I have a drinking problem,its so frustrating.I forget words, names of people who I've known for years, even have forgotten what I was talking about mid discussion. I just hate it.
Tamara Sellman
I'm so sorry you are experiencing this, Peggy. I can understand your frustration. I have heard a strange "growl" in my voice that I didn't intend... it's weird, like my vocal cords have been possessed. I also have the problem of wordfinding during relapse, and slurring, and unfinished sentences... I hate it, too!
For me, it's a signal I need to get more rest, and to pay attention to other symptoms that have suddenly emerged to see if it's a relapse (usually it's not, just fatigue).
I also try to use that rest time to remind myself that I also didn't know anything about MS before I was diagnosed, and that well-meaning people (or former employers, sadly) don't get it without a lot of education.
On the one hand, we already have enough on our plates, so the effort it takes to educate others seems unfair.
On the other hand, it's an opportunity for "teachable moments," as well as a chance to learn just who really cares about you... the ones who do will listen, learn, and work harder not to judge are keepers! The others we just have to deal with (if we have to) or let them go.
I wish you well, we are definitely sharing similar frustrations!
Tamara
Dawn
I hate when I can't find the words I want and say the wrong one, makes me feel dumb, I also start to slur when tired, the more sleepy the more slured
Tamara Sellman
I hear you, Dawn. I'm a writer, editor, and speaker. My words are my tools, and I have forgotten so many obvious ones, or spoken completely different ones than those I intended. I also slur and stutter. People who know me understand it's my MS, but in a room full of people who don't know me, I hate it because it does make me look inarticulate or dumb when I am supposed to be an expert on my subject! You are not alone, my friend.
Tamara
Leslie
My brother was just diagnosed at the end of March. He is 53 years old. When he first called me to tell me that something was going on with his health, I thought he'd been drinking, except he doesn't really drink. Then he told me all of his symptoms, including the speech issue. The longer he speaks, the worse his voice gets. He gets very frustrated with himself and I can tell that he has to really concentrate on what he is about to say. My heart hurts for him and all of you who live with this nasty disease.
Tamara Sellman
You are sweet to be compassionate about your brother. What he describes is absolutely true, focusing just on speaking may be the only way to get the words out. <3 Tamara
Karen
I have MS this is about 42 years and i tried to say a prayer in my bible study class and random words just came out this has never happened before.
Tamara Sellman
Hi Karen, it would be funny if it weren't so alarming and scary, right? I take it as a signal I need rest. I hope your peers in the class were understanding!
Tamara
Dyan
My doctor says my confusion and pauses in my speech are not part of my ms but I know that's wrong. Where I live it's so hard to find the right doctor for ms.
Tamara Sellman
Dyan, regardless what your doctor thinks, you know that it's an aspect of MS that you have to live with. There's not much for it except for rest and good self care. I hope you do eventually find a doctor that listens to you and has a better bedside manner and/or understanding of MS. That's hard to hear: a good doctor should know this is a key part of MS symptomology. At least you came here to find you are not alone. Hang in there!
Tamara
Delma Hernandez
I have that and sound like I have an New York it Bostonian accent . Sometimes even like a 4 yr old .??♀️
Tamara Sellman
Delma, I sometimes notice a big difference in my voice and almost don't believe it's my own. This disease certainly does try to make us strangers to ourselves!
Tamara
Lisa Peterson
BY FAR, this is the best explanation I’ve ever read about one of my most misunderstood MS symptoms! My immediate family assumes that I’ve taken a medication that contains a barbiturate every single time that I slur. It’s maddening to me, because I take so few medications, and that’s the go-to assumption. Right now we’re selling a house in one state; buying a house in another state; finding a cheap apartment for my college-aged son in current state; just had a wedding in Jamaica; had to go without insurance for a while; & I have my ailing father in yet another state. Oh and my husband left to the new state & is unable to help coordinate a lot of these issues. Hhmmm, but let’s blame a medication? Heck, I could use the medication and a glass of wine, too (just kidding)! Geez Louise!
Tamara Sellman
Lisa, thanks for the feedback! I do my best to write clear articles :) I am so sorry that family members aren't very understanding, but maybe this article will help them to be more aware of your MS.
My goodness, you have a lot on your plate right now, too... Life is full of stress, even when we try to avoid it, so I'm sure any current speech issues are linked to stress and MS.
You sound like you have a good sense of humor, thank goodness! I hope you catch a break very soon!
Tamara
Melissa
Yes, I have noticed a very hoarse and strained quality in my voice the past two weeks. It seems better during the weekend when I am more rested and relaxed versus the work week.
Tamara Sellman
Yes, I do voiceover work sometimes and I prepare for it by resting my brain!
Tamara
Heather
I have issues with words coming out all sometimes. They are in my brain like they say "on the tip of the tongue", I can see them but nothing. Is this one of the symptoms you are talking about? They said something about possible seizures but I have been check for seizures and they found nothing.
Tamara Sellman
It's not dysarthria, but problems with wordfinding. Dysarthria has to do with the mechanics of speaking, whereas "tip of the tongue" problems (while still definitely being a part of life with MS) are more related to memory and executive function. I hate not being able to find my words, too!
Tamara
Carol Chamberlain
I belong to the Framingham Heart study. I had a brain MRI. They called me and asked if I had a stroke or a brain injury. The scan showed changes from my last MRI 5 years ago. I am 53 and I have to wait a few months before I can get into see a neurologist. So here I am wondering what is wrong with my brain. Do you think what they saw could be MS?
Tamara Sellman
Carol, thanks for taking part in Framingham, that's a very important research effort. Honestly, a lot of things can cause brain lesions besides MS, and even something as simple as aging. It's probably not worth asking about here, but you might be able to prompt a discussion with your primary or other physician in the interim, if only to keep anxiety about the unknown at bay. Even a radiologist could be helpful by at least sharing general information, though they cannot officially diagnose you. Good luck, that must be hard to live with! <3 Tamara
MJ
Maybe the MS person has a hearing loss and they don't realize so that might be why they speak louder! For several years I was told MS does not effect our hearing and Lo and behold they finally have agreed depending on our lesions MS does effect our hearing!!
Tamara Sellman
That could be a perfectly plausible explanation, too, MJ! Yes, all the more reason to talk to our neurologists about these symptoms; a good one will do the detective work to figure out the root cause.
Tamara
Chantal
Hi, I am French and I am teaching in English in Australia , home for 30 years. I use English 24/7 at school and with my family and grand kids. But when I am tired or stress my speech is with a very thick French accent . My own family doesn’t understand me sometime and it is the same with my collègues. Is like my tongue is stuck in my mouth..does someone has the same ?
Tamara Sellman
I cannot speak to this (pun, intended!) but I have started to speak, in my mind thinking I have spoken an entire sentence, only to be told I stopped speaking in mid-sentence. In my brain, I heard my words, but they never left my mouth! It was like my mouth just went offline!
Tamara
Robin
I hear you Tamara. I've had speech issues ever since I was first diagnosed. It was the thing that sent me to the ER. They thought I was having a stroke! After days in the ICU, they determined I had MS. At first I was relieved, until I found out what I was in for:-( Fortunately, 15 years later, I'm doing well (overall), but the speech issues have worsened. It is such a loss for me as I used to love conversation and was considered very well spoken and articulate. Now, I very seldom speak at length or in front of many people.
Tamara Sellman
I wouldn't be surprised to learn that dysarthria caused by MS is misinterpreted as stroke, especially in an ER situation.
Sorry to hear that your speaking issues have worsened over time. As a poet and speaker, I understand that loss. I'm still "good enough" when it comes to speaking and reading events, but nowhere as articulate and engaged/off the cuff as I used to be. I need a script now that I really didn't need before. Hoping it doesn't get worse. But MS will do what MS will do... <3 Tamara
Betty Banks
Hello,
I am totally blown away by all the beautiful information and stories here! I am a survivor for 45 years and deal with it all for years,now, I am a support group leader helping people to deal and alerting them to these but, wow some of these, I never spoke about and kept to myself, I ssee I am not the only one.
Tamara Sellman
Thank you, Betty, you just made my day!
Tamara
April Gorman
how do i force drs to look deeperinto whats going on i tokd drs about all these symtpoms and not one listens right... lol i jut go around the same circl for years while people avoid the factms runs in my family...and ive had problems for years
Tamara Sellman
I wish I could give you a solid answer, April, but I really can't. My best advice is to keep looking for doctors who will listen to you and keep pushing for help with diagnosis and treatment.
Tamara
Martha
HI Name Martha
You know all this about MS is new to me and my 28 yr-old son he's the one that was diagnosed five month ago with MS. I'm trying to learn so much about this the good thing his neurologist said they got it on time. He can walk and do most of his things alone but there days their good and bad. so what ever I can know more about this I would really be so greatful. i know I"m not alone cause my god will be there all the time for me and my son.
Tamara Sellman
Hi Martha
I wish you good luck with your son. Definitely check back here at MSNT for more information, we have some amazing columnists and articles that can take the mystery out of this crazy disease!
Tamara
Ismael Rodriguez
I've been having a similar, but odd experience with speaking. I was diagnosed with MS ten years ago and every three or four months I will start using totally random words that seem correct to me but my family tells me are so wrong. Apparently I use the words 'refrigerator' and 'restroom' a lot in the wrong areas. Weird.
Tamara Sellman
It's very weird, I agree! I have many stories of using the wrong--I mean, very wrong!--words and confusing others. At this point, I have turned it into a comedy of errors to deal with it!
Tamara
Munira
I am also a patient of starvation plz help me
Tamara Sellman
Munira,
I hope you have been able to find a support system to help you with your eating/swallowing issues. I wish I could do more to help! An MS specialist should be able to assist you in finding some relief, which could include IV nutrition, as necessary. Best wishes, and hang in there!
Tamara
Renauld Clare
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Monica Russell
When I got diagnosed in 2021, I had slurred speech, people couldn’t understand what I was saying(I think that was due to the right side of my body being numb and my mouth being drooped), I would talk randomly in different accents I had no control over. Also I wasn’t able to sing for about a month. Eating was troublesome as well I couldn’t tell my brain to just eat I would try to breathe and eat at the same time causing me to get choke up often so I switched to softer food for a while.
Now I’m not affected as bad. I do stumble on words often but I felt like I did that before I was diagnosed. It happened/happens so often people mention especially when they know me they’ll make fun of it (I don’t mind it is sorta funny sometimes). When I was in the hospital it would repeat a word about 15 times but the right sounds wouldn’t come out for a while. I could think them most of the time but could produce that sound. I now work with first graders and sometimes slip up but after repeating and slowing down I can correct it faster when speaking. And sometimes my accent changes not as severe as before. My accent get thicker and I can’t control and people often notice that as well.