Learning More about Speech and Swallow Dysfunction in MS
Most of us are pretty well versed in the variety of symptoms that MS can cause, mostly thanks to our vast first-hand experience. I also have the advantage (or disadvantage depending on the day) of working in Neurology, so I know the anatomy and physiology behind all those peculiar MS symptoms. Throughout the years there have been several occasions where my expertise as a patient defy or even directly contradict my expertise as a clinician. For instance certain symptoms are thought to typically only happen in more advanced MS, or once a person has lived with it for a really long time. Issues with speech and swallowing are typically placed in this category, and are not generally thought by clinicians to be an issue early on. Imagine my surprise when only a year after my diagnosis I was eating my favorite food, bread (mmmm, bread), and it slipped right down the wrong pipe. That was the first “holy cow I’m really choking somebody give me the Heimlich QUICK” moment I’ve ever had. As scary as it was to choke, it happens to the best of us and I didn’t immediately leap to it being MS related…until it happened again, and again, and again. Either chunks of meat and bread were out to kill me, or this was definitely an MS symptom. I was hoping it was the latter, because a life spent avoiding meat and bread would be pretty bleak for this carnivorous Italian!
Luckily my best friend is a Speech Language Pathologist, so I called her up and picked her brain a bit. She was also surprised, wasn’t this something that only happened in advanced stages of MS?? Hmmmm. She gave me some professional pointers, and luckily over time it happened less and less. Pass the meatballs and garlic bread please!
Now as I treat more and more people with MS in my practice I make a point of asking about speech and swallowing during follow-up visits. At first I was somewhat surprised to learn that people of all ages and levels of disability reported having issues with at least one, if not both. Because we don’t have good data on MS prevalence it is tough to know exactly how many people with MS run into these issues. After doing a little bit of research on the topic I learned that around 40% of the MS population has difficulty with speech and/or swallowing at some point! That’s a significant number of people! To me it certainly means these symptoms are occurring across the MS spectrum, not just in the advanced stages. I thought it would be worthwhile to go over some of the basics and help spread awareness about these issues. I also want to go over what can be done to help both speech and swallowing.
MS can cause two different types of speech disorders. Dysarthria is slow, slurred, or quiet speech that is a result of poor or limited articulation. Dysphonia causes your voice change making it sound harsh, hoarse, overly nasal, or breathy. If you have a speech disorder it can be difficult for others to understand you, and sometimes people only realize they have an issue because other people point it out. If you think you are experiencing dysarthria or dysphonia you should bring it to your neurologist’s attention. Of course if you notice that your speech is slurred suddenly and you have other signs of a stroke you must to seek immediate medical attention.
Talking might seem like a pretty straightforward task, but it requires the coordination of around 100 different chest, neck, jaw, and facial muscles. If the nerves to any of these muscle groups or the movement of the vocal cords are affected by MS, you may suddenly find out first hand how difficult it can be to speak eloquently. If your neurologist agrees that it is a MS symptom they will likely recommend that you get an evaluation by a Speech Language Pathologist (SLP). The SLP will take a careful look at how all those muscles are moving and your breath control. Then, just like a physical therapist, they can suggest devices to help alleviate your symptoms and even give you exercises and that strengthen the muscles that control speech. Some people find that practicing their speech in a group or recording themselves talking helps them get the most out of their therapy. In some instances changes in your speech can be caused by muscle spasticity, and oral muscle relaxers and/or Botox can be used to alleviate symptoms.
The same muscles that you use to talk are used when you swallow. Difficulty with getting yourself to swallow, choking, coughing while eating or drinking, or frequently clearing your throat during meals can be indications of dysphagia, or a swallowing disorder. This is a potentially life-threatening issue because it can lead to choking and/or the aspiration of food or fluids into your lungs which can cause pneumonia. If you think you are experiencing dysphagia you should bring it to the attention of your neurologist immediately, and once again they will probably recommend an evaluation by a Speech Language Pathologist (SLP).
SLPs have a variety of diagnostic tests that they can do to figure out the exact cause of your swallowing issue. They start by watching you swallow different foods and liquids and observing how the muscles involved. They also have x-ray and video studies that can show them how each muscle group is moving while you chew and swallow. Based on these exams and tests they will recommend an individualized approach that will hopefully minimize your symptoms. For a lot of people changing the position of your head, paying close attention to the amount of food or liquid you take in at a time, alternating a bites of food with sips of liquid, and swallowing each bite twice can greatly reduce the risk of choking. The SLP may also have specific recommendations for what types or consistencies of food are best for you. It is also generally important to alway eat and drink while sitting straight up, and to keep your tongue and teeth as clean as possible to decrease the amount of bacteria in your mouth. If you find yourself getting really fatigued during mealtime it is very important to take a break, because that could increase your risk for choking. Small, more frequent meals might be the key if you are easily fatigued.
Have you ever had difficulty with your speech or with swallowing? Feel free to share your experiences with the community!