Therapy for Speech Problems

Speech problems are common in people with multiple sclerosis (MS), affecting as many as half of all people with the disease. They can have a pronounced negative impact on quality of life.¹

Speech problems are often identified by a person with MS, a family member or caregiver, or a member of the healthcare team. They often include lack of precision in articulation, loss of conversational flow, and difficulty with rate of speech, loudness, or vocal quality.¹

When these or other symptoms or signs are noticed, your doctor may refer you to a speech/language pathologist. Because speech problems and related swallowing problems are common in MS, the speech/language pathologist is often a key member of the rehabilitation team for people living with MS.¹

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.

Systems involved in normal speech

These are the areas that a speech/language pathologist will focus on in assessing and treating speech problems:¹

• Respiration – Use of diaphragm to fill lungs and slow, controlled exhale for speech
• Phonation – Use of vocal cords (with flow of air) to produce sounds that vary in pitch (high or low), loudness, and quality
• Resonance – Adjusting the height of the soft palate to control whether the voice vibrates in the mouth or nose (affecting quality of sound)
• Articulation – Use of lips, tongue, and soft palate (with quick movements) to make fine adjustments in sound for clarity of speech
• Prosody – A natural flow of speech that results from combining all the systems above, while making appropriate adjustments in speaking rate, pauses, and changes in loudness and emphasis to serve communication goals

Different types of speech problems

There are 2 major types of speech problems associated with MS:¹

• Dysarthria – a loss of control over the muscles involved in speech
• Dysphonia – a problem with voice quality

These speech problems may impact things like:¹

• Loudness control – Reduced or excess volume, monotone speech, variability in volume
• Harsh voice quality  – Strained vocal quality, excess tone in vocal cords
• Imprecise articulation – Articulation of speech that is distorted, prolonged, or irregular
• Impaired emphasis– Problems with phrasing, rate, stress, or intonation
• Impaired pitch control – Pitch breaks, mono-pitch, high or low pitch
• Decreased vital capacity – Impaired breath support and control
• Hyper nasality – Excessive nasal resonance

Evaluating speech problems

After referral for a speech problem, your speech/language pathologist will thoroughly evaluate 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 such as your larynx, which controls volume, pitch, and voice quality
• Classification of type and severity of speech problem
• Rating of intelligibility and naturalness of speech in conversation

During the evaluation, you may be asked to read out loud so your oral reading rate can be measured. Your speech/language pathologist may also record you speaking so they can analyze your:

• Speaking rate
• Number of words per breath
• Between-word pauses
• Precision of articulation, intelligibility, and conversational flow

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 the naturalness of speech.¹

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.¹

Interventions to address speech problems in MS

Improve breath support

• Biofeedback to gauge breathing during speech
• Learning new breathing patterns 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 methods to increase loudness by increasing phonatory effort
• Speaking rate control techniques may also be useful

Improve intelligibility

• Use of external aids (finger tapping, metronome) to slow speech rate and allow greater articulation
• Biofeedback and rhythmic systems to slow speech rate
• Improve precision of articulation of consonants