How to Manage Speech Problems Linked to MS

Speech problems in MS occur when the brain’s ability to send messages to the muscles used in speaking is disrupted. These symptoms may come and go or become more persistent over time, especially as the disease progresses and causes more lasting nerve damage.

Not being able to communicate effectively is not only frustrating, but it can also contribute to isolation and even depression in people with MS. The good news is, research shows that speech therapy is an effective tool in managing many of the most common speech difficulties.

Learn more about the different ways MS can impact speech, and get expert advice on how to treat MS-related speech problems.

Changes in speech depend on what part of the brain is affected, and like other MS symptoms, difficulties can range from mild to severe.

The type of speech changes in MS can vary from person to person but typically fall into a few key categories.

Dysarthria

The most common is dysarthria, a motor speech disorder caused by weakness or poor coordination of the muscles used for speaking. This can make speech sound slurred, slow, or effortful, and can affect the way you control your breathing, voice volume, and pitch.

There are three main types of dysarthria seen in MS:

• Spastic dysarthria often results in tight, strained-sounding speech due to stiff muscles.
• Ataxic dysarthria may make speech sound uneven or jerky because of poor coordination.
• Mixed dysarthria combines features of both and is frequently seen in MS as multiple areas of the brain are affected.

Anomia and Aphasia

Ataxia, Dystonia, and Other Causes

Speech difficulties can also occur as a result of other MS symptoms, including ataxia, which is poor muscle control that causes involuntary movements, and dystonia, when muscles contract involuntarily. Muscle spasms, muscle stiffness, cognitive changes, and tremors can also contribute.

Early Signs and Symptoms of Speech Problems

Early signs of speech issues can include reduced vocal intensity or spoken volume; slurred, slowed, disfluent speech; nasal-sounding voice quality; scanning speech (speech that is slow, deliberate with noticeable pauses); and dysarthria, says Nidhi Mahendra, PhD, a professor of head and neck surgery and the division chief of speech language pathology at Duke University School of Medicine in Durham, North Carolina.

In MS, your immune system mistakenly begins to attack the insulating layer of the neurons, called the myelin sheath.

“The myelin sheath is what allows our neurons to communicate very quickly and rapidly, which is essential for reflexes, quick movement, and rapid muscle coordination, which you need for speech and swallowing,” says Dr. Mahendra.

The myelin normally prevents any leaking or weakening of nerve signals racing between neurons, and when it breaks down, many problems result, she says.

“When myelin is damaged, these signals to the muscles used for speaking can be slowed down or disrupted, making it harder for the brain to coordinate the movements needed for clear speech,” says Danielle Brown, a speech-language pathologist at the Mellen Center for MS at Cleveland Clinic in Ohio.

When it’s harder to talk or be understood, everyday things — like chatting with friends, making a phone call, or speaking at work — can become more challenging or stressful, says Brown.

This might lead to frustration, embarrassment, or even a desire to avoid certain situations altogether — which in turn can lead to isolation.

“We also see in MS that the constant fatigue and weakness exert a further negative effect on communication and the motivation to communicate, because MS is also known to result in anxiety and depression,” says Mahendra.

“Overall, speech difficulties can affect not just how a person communicates, but also how they feel about themselves and how connected they are to others. But with the right support, like speech therapy or communication tools, people can find ways to express themselves and stay connected in meaningful ways,” she says.

If someone with MS has speech concerns, they should be evaluated by a speech-language pathologist (SLP), says Brown.

The evaluation usually includes:

• A review of your medical history and a discussion of your symptoms and concerns
• An assessment of the strength, coordination, and movement of the muscles used for speaking
• Observing how clearly you can produce sounds, words, sentences, and conversation
• A conversation about your goals, and the therapist’s recommendations for therapy or treatment

Work With a Speech-Language Pathologist

The goal of speech therapy is to help people feel more confident and effective in their communication, says Brown. It can also help loved ones and friends learn how to handle the speech problem.

An SLP can help with MS speech issues by teaching you exercises to strengthen and improve the function of the muscles involved in breathing and speaking. They can also help you with techniques to improve speech clarity, such as slowing your speech down, overarticulating sounds, and making shorter units of communication paired with pauses.

Speech therapy often starts with regular sessions over a period of weeks or months, depending on the person's goals and needs, says Brown. “After that, there may be a break in therapy while the individual continues to work on the home program created by their therapist to help maintain their abilities. It’s common for people to return to therapy from time to time for a check-in or a ‘tune-up,’ if they feel they need more support,” she says.

Self-Help

“Some people have MS types that involve flare-ups or ‘attacks’ followed by periods of remission or partial to full recovery,” says Brown. As with other symptoms, some speech changes are impacted by disease activity, especially fatigue.

For these individuals, speech difficulties may appear during an attack and then improve or stabilize afterward — especially with support from speech therapy,” says Brown.

The skills and techniques taught in speech therapy can be practiced at home, and include the following.

Exercise for your speech muscles: The exercises you learn in therapy can be practiced daily to improve function and strengthen the muscles that support breath control and speech production.

Speech techniques: When speaking, practice slowing down your speech with the skills learned in therapy. You can also get help with your phrasing, adding pauses to help make your speech clearer, and overarticulate words to make your speech more understandable.

Assistive Devices

There are many tools and apps that can help people with MS communicate more easily, especially if speaking becomes difficult, says Brown.

Examples of assistive devices for speech issues in MS include:

• Text-to-speech apps and LCD tablets if speech is difficult
• Specialized tablets or computers designed to make it easier to create messages, even if hand movement is limited
• Voice amplifiers to help make speech louder and clearer

“A speech therapist can identify the tools that best match each person’s needs and goals,” Brown says.

• Speech issues are a common symptom of MS, affecting nearly half of those living with the condition.
• Problems can include slurred or slow speech, changes in voice quality, and difficulty finding words or coordinating speech muscles.
• Damage to the brain and nervous system caused by MS disrupts the communication between the brain and the muscles used for speaking, leading to various speech and communication challenges over time.
• Speech-language pathologists (SLPs) provide therapy that strengthens the muscles used for speaking and improves breath control, and they teach practical techniques to improve clarity and confidence in communication.