Therapy for Speech Problems: Frequently Asked Questions

Speech problems are common in people with MS and may include lack of precision in articulation, loss of conversational flow, and difficulty with speaking rate, loudness, or vocal quality. These problems can have a pronounced negative impact on the ability to communicate and, therefore, on quality of life. A speech/language pathologist is specially trained to evaluate and treat speech problems and becomes an integral member of the rehabilitation team for many people with MS.

What does speech therapy involve?

The type of intervention that your speech/language pathologist recommends will depend on your specific problem(s). Your speech/language pathologist will give you a thorough evaluation before recommending a treatment program. The first step in treatment for a speech problem typically involves learning about the process of normal speech, including the role of various muscles and other structures involved in speech, such as the lips, tongue, soft palate, vocal cords, and diaphragm. Treatment may include exercises to improve the strength and coordination of these muscles and structures. Self-monitoring usually plays an important role in speech/language therapy and may include a recording device, a spirometer (device that measures breathing capacity), and computer equipment, including software specially designed for speech analysis.

Are medications used to treat speech problems?

Since speech problems in MS happen because of nerve damage and underlying MS-related neuromuscular impairments, including spasticity, tremor, and fatigue, appropriate drug treatment can be combined with speech/language therapy. Medications used to treat spasticity, including Lioresal (baclofen) and Zanaflex (tizanidine), may be useful in cases where spasticity is affecting muscle tone in the vocal cords, tongue, lips, and soft palate or is keeping the diaphragm or abdominal muscles  from working normally. Several medications are available for decreasing tremors that can affect voice quality and vocal muscles directly or indirectly, as well as contribute to fatigue, which may also affect speech. These medications include Klonopin (clonazepam), Inderal (propranolol), and Mysoline (primidone). Medications for managing fatigue, which can affect muscular coordination and strength necessary for vocal production, may also be useful and include Symmetrel (amantadine), Provigil (modafinil), and Nuvigil (armodafinil).

Can a speech/language pathologist help me if I feel my ability to speak can’t keep up with my brain or thoughts?

It is a common complaint among people with MS who have speech problems to say that they feel like their thinking and speaking are out-of-sync. The result is often that speech sounds slurred or imprecise. MS can result in the muscles of your throat and mouth losing coordination and strength. Your speech/language pathologist can help you to increase the clarity of your speech. Here are some techniques that your therapist may use.

How often will I meet with my therapist and how long will therapy last?

The length of your speech/language therapy or the frequency of your sessions will depend on the specific problem and its severity. Typically speech/language therapy is done twice a week for 2 or 3 months, after which the problem is re-evaluated. Often, after a period of time working with a therapist, you can continue on your own with a home training program and see your therapist only occasionally for reassessment and to brush up on your exercises.

Why do I seem to lose control of my voice and have bursts of loudness or pitch changes or lose my voice altogether?

Abrupt changes in pitch, control, or loudness in people with MS are often caused by a lesion in a part of your brain called the cerebellum, which controls complex voluntary muscle movements, such as those involved in speech. Lesions in this part of the brain cause tremors, also known as ataxia, which can affect a wide range of muscles, from leg and arm muscles, to your head, vocal cords, and tongue. Tremors in your vocal cords can result in sudden elongation of the vocal cords, causing high pitch, or sudden shortening/loosening of the cords, causing low pitch. When you lose your voice completely mid-sentence, which is called aphonia, what happens is that the vocal folds or vocal cords separate suddenly and unexpectedly. Although there are no medications designed to control tremors, specifically, some medications do have anti-tremor activity and can help with tremors resulting from lesions in the cerebellum. These include muscle relaxants, anti-seizure medications, and beta-blockers. Other approaches, including postural approaches, head and trunk stabilization or control, breathing and relaxation techniques, and biofeedback to practice muscle control, may also help.

Do speech problems ever just go away by themselves?

If your speech problem results from fatigue or weakness, it may go away when you are rested or when you have increased energy. Your occupational therapist or physical therapist can instruct you on ways to counter fatigue and manage energy levels. If your speech problems started during a relapse or exacerbation, they may resolve as the exacerbation resolves, thus treatment with a corticosteroid may help. If your speech problems fail to resolve after an exacerbation, your doctor should refer you to a speech/language pathologist for evaluation and treatment.

What causes my voice to sound hoarse or strained and harsh?

How your vocal cords work determines the quality of your voice. In MS, weakness, lack of coordination, or spasticity can affect your vocal cords and may make you sound hoarse or strained. This problem may occur due to an exacerbation and then improve as the exacerbation resolves. If this problem (known as dysphonia) continues, you should see a speech/language pathologist for evaluation and treatment.