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Multiple Sclerosis and Communication Difficulties

Speech and Language Therapy (SaLT)

Multiple sclerosis (MS) is the commonest disease of the central nervous system (CNS) among young adults. It affects more than one million people world-wide and about 85,000 in the UK. About twice as many women as men are diagnosed with MS.

The CNS comprises the brain and spinal cord, which, with the nerves connecting to the rest of the body, form the body’s communication network. Nerves are protected by a covering called the Myelin sheath. This is often likened to insulation materials around an electric wire. In MS, the myelin sheath is damaged. This damage alters the way messages (nerve impulses) are conducted to and from the brain, which will disrupt normal functioning of the body.
MS can affect any part of the body. The most common symptoms are: double or blurred vision; loss of sight in one eye; spasticity or tremors; bladder and bowel problems; poor co-ordination; weakness and fatigue; tingling, pins and needles, numbness and itching. People with MS could also experience difficulties with their speech and swallowing (see ‘Multiple Sclerosis and swallowing difficulties’ sheet).

Speech difficulties affect between 40 and 50 per cent of people with MS. These difficulties can come and go throughout the day; perhaps lasting only a few minutes at a time, and may be a symptom that appears during a relapse. A speech and language therapist can help you find practical ways to manage these changes.

There are different types of speech difficulties, which may be caused by MS. This is because different parts of the brain can be affected. The most common form is when muscles of the tongue and lips become weak and do not move as precisley or as quickly as they used to. Therefore speech can sound slurred. This is known as dysarthria.

MS can affect the diaphragm, which controls breathing and volume of speech. Therefore speech can be very quiet or you may run out of air when you are talking. This is known as dysphonia.

MS can affect the way speech movements are coordinated therefore speech can sound halting, monotone and uncontrolled. This is known as ataxic speech.

Managing speech difficulties may be more effective if the problem is picked up early, even if changes are small. Some of the signs will be obvious, others may be more subtle. Sometimes, changes in speech are so small that you may not notice them yourself. It could be friends and family who are first aware of a change.

A speech and language therapist can help diagnose your speech problem and work with you to find ways to manage it that suit you best – tailored to your own needs and situation. MS is an unpredictable condition, so a speech and language therapist may assess your needs regularly, to see if your situation has changed, and if treatments are still effective. The first step in managing speech difficulties is to identify the specific problem, or problems, you are having. A speech and language therapist will carry out different tests with you to see exactly which parts of the speech process are affected.

For many people, overcoming changes in speech involves learning how to compensate for problems, and finding ways to make communication as easy as possible. Speaking is the main way we communicate, so if it becomes difficult to talk, this can be distressing, frustrating and tiring. It is important that the emotional side of speech difficulties is not ignored because stress and anxiety, for example, may make difficulties worse.

What can help

Tips for you:

  • When you need to communicate, don’t try and compete with other noises, such as the television or radio.
  • Make sure you have someone’s full attention before starting to tell them important information, and be prepared to repeat things if necessary.
  • Sometimes speech can become less clear if a conversation goes on for a long time, so you may want to explain that you need a break.
  • If you have problems finding the right word, or remembering what you are trying to say, take your time and use notes if necessary.
  • You might find it useful to put the emphasis on communicating the message, rather than accuracy of the sounds.
  • If you have not been understood think of another way to say the same thing.

Tips for your family, friends and carers:

  • Understanding the difficulties someone experiences can make it easier to work around the problem and keep communication clear for everyone.
  • Most people who have MS speech difficulties have problems with the physical process of creating speech. Don’t assume that someone has trouble finding words or understanding what you are saying.
  • When speaking with someone who has speech difficulties, remember that it can be frustrating and tiring for them to talk.
  • Be honest when you really have not understood something.
  • It may help to ask ‘closed questions’ to clarify things and be sure you have understood (“Do you mean… or ….?”, for example).

Treatment

Treatment

  • Good posture: pillows and foam supports might be useful to support good posture when sitting or lying down and help you speak more easily. A physiotherapist can help with posture.
  • Breath control: a speech and language therapist may encourage you to practice breathing in and out in a controlled way – so that you can make longer sentences in one breath. Other exercises can help with accenting certain words in a sentence and with catching quick breaths between thoughts. They can also show you how to monitor your own breathing and be sure you are doing it in the most effective way.
  • A speech and language therapist may recommend exercises that strengthen or relax the muscles controlling the vocal cords. Speech difficulties affecting volume and pitch, or making speech breathy and hoarse, may be caused by problems with the vocal cords.
  • Other exercises, to help with the movement of the jaw, the tongue and the lips, can help with clear articulation and pronunciation.
  • Simple adjustments, aids and equipment: if you have difficulty making yourself heard, something as simple as raising the volume control on your telephone might help. Specialist gadgets could also be helpful. For example, a textphone could give you the option of speaking when you feel able to, or typing when not. If you need to speak in public, using a microphone could be useful.

Augmentative and alternative communication

Some people find that their speech becomes very unclear and they need to use other ways to communicate, either to clarify what they have said, or as an alternative to speech. Finding the most suitable way depends on your overall situation, not only how your speech is affected. Skills such as memory, reading and vision will be taken into account by a speech and language therapist as they help you to develop alternative ways to communicate with family and friends.

The speech and language therapist, MS specialist nurse, occupational therapist, physiotherapist, GP and neurologist are available to support and advise you on particular aspects of your condition.

Where can I find more information

Multiple Sclerosis Society
National MS Helpline
Freephone 0808 800 8000
www.mssociety.org.uk