Multiple sclerosis (MS) is a neurodegenerative disorder characterized by lesions in the brain and the spinal cord, which disrupt the communication between different parts of the brain, and between the brain and the rest of the body.
Nearly 40–50 percent of MS patients experience speech difficulties, which are caused predominantly by damage to the parts of the brain that control the muscles of the tongue, lips, soft palate, cheeks, or diaphragm.
Types of speech difficulties in MS patients
MS patients may experience different types of speech difficulties. These are summarized below.
- Dysarthria is a speech problem that occurs when the motor muscle components of speech are affected. The condition causes slurred, imprecise or slower speech, difficulty with resonance and pitch control, long pauses between words or syllables, and altered pronunciation.
- Dysphonia involves changes in voice quality such as harshness of voice, impaired pitch control, hypernasality, irregular pitch levels, breathiness, and hoarseness.
- Dysphasia is a language disorder where patients have difficulty understanding what’s being said (receptive dysphasia), recalling vocabulary, or finding the right way to say something (expressive dysphasia). It can occur due to cognitive issues that cause changes in memory and thinking.
Fatigue, tremors, and spasticity can also affect speech, as can some treatments because they cause a dry mouth.
Speech therapy for MS patients
There are many ways in which speech therapy can help people with MS. These include:
- exercises to help improve the strength and coordination of the muscles in the throat, tongue, cheeks, mouth, diaphragm, soft palate, and lips
- voice training including teaching patients how to slow down, articulate more carefully when speaking, sometimes by exaggerating articulation, and controlled and modified breathing
- exercises that strengthen or relax the muscles controlling the vocal cords for speech difficulties affecting volume and pitch, or making speech breathy and hoarse
- exercises that help improve breathing, emphasizing certain words in a sentence, and catching quick breaths between thoughts
- exercises that help with the movement of the jaw, tongue, and lips to assist with clear articulation and pronunciation
There is also a range of special high-tech communication devices that can help people with MS who have speech difficulties better communicate. These include alphabet cards, machines that offer speech output either by typing the message or accessing visual symbols on a screen via touch or scanning, voice amplifiers, and computers that respond to eye blinks.
Low-tech options such as an E-tram frame and partner-assisted scanning are also available.
Medical treatment of speech difficulties
While there are no medications available to specifically treat speech problems in MS patients, treatments that are used to control other symptoms of the disease can also be beneficial in improving speech.
- Medications used to treat spasticity such as Lioresal (baclofen) and Zanaflex (tizanidine) may be useful in cases where spasticity affects muscle tone in the vocal cords, tongue, lips, and soft palate or diaphragm.
- Medications used to decrease tremors such as Klonopin (clonazepam), Inderal (propranolol), Mysoline (primidone), and Doriden (glutethimide) can improve voice quality.
- Medications for managing fatigue such as amantadine, Provigil (modafinil), and Nuvigil (armodafinil) can improve muscular coordination and strength necessary for sound production.
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