Speech problems are common in MS, affecting as many as half of all people with the disease, and can have a pronounced negative impact on quality of life. Problems are often identified by an individual with MS, a family member or caregiver, or a member of the healthcare team and often include lack of precision in articulation, loss of conversational flow, and difficulty with rate of speech, loudness, or vocal quality. When these or other symptoms or signs are noticed, a referral may be offered to consult with a speech/language pathologist who is specially trained to evaluate and treat speech problems. Because speech problems (and related swallowing problems) are common in MS, the speech/language pathologist is an integral member of the rehabilitation team for persons living with MS.
It is easy to take speech for granted. However, only when we develop a speech problem do we discover how complex the activity of normal speech is. It relies on a number of systems to work together smoothly: respiration, phonation, resonance, articulation, and prosody. These are the areas that a speech/language pathologist will focus on in assessing and treating speech problems.
Systems Involved in Normal Speech
Different types of speech problems
There are two major types of speech problems associated with MS: (1) dysarthria, a loss of control over the muscles involved in speech, and (2) dysphonia, a problem with voice quality.
Speech Problems in Order of How Commonly They Occur in MS
- Strained vocal quality
- Excess tone in vocal cords
Evaluating speech problems
After referral for a speech problem, the first step taken will be for your speech/language pathologist to make a thorough evaluation of the problem. This typically involves:
(1). Evaluation of the muscles and structures in your mouth and body that contribute to making speech. These include components that allow you to articulate speech, including your lips, teeth, tongue, hard and soft palates, structures that provide breath support and control for speech, and structures such as your larynx that control volume, pitch and voice quality.
(2). Classification of type and severity of speech problem.
(3). Rating of intelligibility and naturalness of speech in conversation.
During the evaluation, you may be asked to read out loud so that your oral reading rate can be measured. A brief recording may be made of you speaking spontaneously to be analyzed for variables of speaking rate, number of words per breath, between-word pauses, precision of articulation, intelligibility, and conversational flow. Your speech/language pathologist has many different tools (systems for rating and analyzing speech) that he or she can use to assess these variables.
Therapy for speech problems
Your speech/language pathologist will tailor a treatment plan according to your specific problems, with the goal of improving intelligibility and restoring naturalness of speech. Typically, your speech/language pathologist will instruct you in exercises and behaviors to improve breath support and control, reduce the rate of speech (employing strategic pauses between words), exaggerate articulation, and practice active self-correcting and -monitoring of speech.
Interventions to Address Speech Problems in MS
Improve breath support
- Biofeedback to gauge breathing during speech
- Learning new breathing pattern with deeper inhalation and increased force during exhalation
- Abdominal breathing
Improve coordination between breathing and phonation
- Develop awareness of irregular breathing-speech pattern
- Determine optimal word-breath groups and practice, gradually increasing them
Improve phonatory functioning
- Harsh voice quality difficult to modify
- Soft, breathy voice quality can be modified using method to increase loudness by increasing phonatory effort
- Speaking rate control techniques may also be useful
- Use of external aids (finger tapping, metronome) to slow rate and allow greater articulation
- Biofeedback and rhythmic systems can be used to train individual to slow rate
- Improve precision of articulation of consonants