Multiple Systems Atrophy (MSA)

MSA is a rare disorder of the nervous system where nerve cells in several areas of the brain deteriorate over time. Many symptoms are similar to those found in Parkinson’s disease, although in MSA, symptoms progress more rapidly. As well as affecting movement and balance, MSA affects autonomic functions such as breathing, bladder control and blood pressure.


Speech can become very unclear and voice changes can occur, for example, the voice can become weak sounding and quiet. Breathing can be noisy and people may sound like they ‘gasp’ when breathing.

Unclear speech is caused by muscle stiffness and incoordination of movement in the tongue, lips and jaw.

Speech therapists help by assessing speech and teaching strategies to improve intelligibility. Voice therapy can be helpful to increase speech volume. Therapists can also provide support material or equipment to enable efficient communication, even if speech has become very unclear. For example, making individualised pointing charts or books, or advising on electronic speech output devices.


Swallowing difficulties are common in MSA. These include:

  • Coughing or choking on food or drink
  • Wet voice quality when eating or drinking
  • A feeling of food sticking in the throat
  • Difficulty chewing food

Difficulties with eating or drinking can lead to weight loss, repeated chest infections (through small amounts of food and drink being aspirated into the lungs) and increased risk of choking. The following is some general advice:

  • Sit upright, facing forwards, chin level or down slightly
  • Avoid distractions, e.g. turn off the TV and try not to talk during a meal
  • Take small mouthfuls of food
  • Take your time, don’t rush
  • Chew carefully and finish each mouthful before you take the next
  • When drinking take single sips of fluids slowly, rather than gulping mouthfuls
  • Avoid mixing fluids and solids e.g. soup with bits in, cornflakes with milk
  • Avoid dry crumbly foods, moist foods may be easier
  • Sit upright for 20 minutes after eating and drinking

A Speech Therapist can help with these difficulties by providing a full assessment and advice on strategies, equipment, modified food and drink textures, and/or swallowing exercises. If swallowing deteriorates to the point where it is no longer safe, some people choose to have a gastrostomy, where nutrition and hydration is given by tube directly into the stomach through a small tube.

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