Speech and Swallowing - MS QLD

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January 2016

Speech

If people are asking you to repeat words; if it’s getting harder to carry on conversations because your speech is slurred, slow, or quiet; if you can’t talk fast enough to keep up with your thoughts — you may be experiencing a speech disorder. Up to 40% of people with MS may have speech problems at some time. Specialists believe they are caused by MS lesions (or damaged areas) in the part of the brain responsible for muscle control of the lips, tongue, soft palate, vocal cords, or diaphragm. Dysarthria is a speech disorder, which typically results in slurred or poorly articulated speech. There may also be reduced loudness, un-‐ natural emphasis, and slower rate of speech. Dysphonia is a voice disorder. It involves changes in vocal quality, such as harshness, hoarseness, breathiness, or a hyper-‐nasal sound. A person with MS may not notice his or her own speech problems. Many times a friend, family member or doctor may notice the changes first. When speech problems begin interfering with everyday communication, seek an evaluation with a Speech Pathologist (SP). During an evaluation, the Speech Pathologist will examine the oral muscles that are necessary for speech (your lips, tongue, and soft palate) and assess how you control their movement in terms of strength, speed, range, accuracy, timing, and coordination. Your teeth and hard palate will also be examined. The Speech pathologist will check your breath support and control, how precisely you pronounce words and how well you are understood by others. The SP may then offer strategies and exercises for specific problems. Some exercises can strengthen and improve function of the muscles involved in breath support and speech production. There are also techniques for slowing down, over-‐articulating, phrasing, and pausing to help make speech clearer and more understandable. Active listening and self-‐monitoring skills are also essential. Listening to yourself on a recorder can help you hear and learn to correct your speech. Some people practice new speaking skills in group therapy. Medications that relieve other MS symptoms can sometimes help dysphonia. There are also exercises to promote relaxation and improve breath support. People with more severe speech problems may benefit from voice amplification devices, electronic aids, or computer-‐assisted alternative communication systems.

FACT SHEET Speech and Swallowing


Swallowing

If you are having trouble getting your swallowing started, or frequently clearing your throat or coughing when you eat or drink, you may be experiencing a swallowing disorder. The same organs involved in speech are also needed for swallowing, so some people with MS will experience swallowing problems or dysphagia. These problems typically come and go, or are mild in MS. However, they can range from an occasional cough when eating or drinking to a much more serious situation in which an alternative eating strategy may be advised. 30% to 40% of people with MS experience difficulties with swallowing at some time. MS can cause dysphagia if there is damage to any part of the brain that controls swallowing, or damage to the connections between the brain and the spinal cord (the ‘brainstem’). Messages in the brainstem control the movements of the body, so damage to this area can lead to a combination of symptoms affecting muscles, including the muscles used in swallowing. Because of the role the brainstem plays in swallowing and mobility, people with MS who are more physically impaired are more likely to experience swallowing difficulties. Some people have swallowing difficulties during a relapse, which disappear as they recover. Let your doctor know if you are aware of one or more of these signs:

• problems chewing • food sticking in the throat • food or drink coming back up • sluggish movement of food going down • difficulty moving food back through the mouth • coughing and spluttering during and after eating • excessive saliva, which may cause dribbling

Symptoms may vary through the day. Heat, fatigue, stress and pain might all have an effect in making swallowing more difficult. Finding the causes of difficulties and factors that make problems worse can help find the best ways to manage your swallowing. Monitoring and managing these signs could help you avoid problems that are more serious, such as malnutrition, dehydration or aspiration. To evaluate a swallowing problem, a Speech Pathologist will observe the swallowing action while you are drinking and eating various textures and amounts. A “Modified Barium Swallow Study” may be performed. You will be asked to swallow various preparations containing barium while your mouth and throat are x-‐rayed and video-‐recorded.


The Speech Pathologist may suggest the safest food consistencies and specific eating techniques. The following food safety rules may help people with swallowing problems:

• Brush your teeth and tongue thoroughly twice a day (found to be the single most important factor for reducing aspiration pneumonia because it reduces bacteria in the mouth).

• Keep a good, upright posture when eating and remaining upright for at least 30 minutes after the meal. A physiotherapist can help with posture.

• Eat slowly -‐ Take one small bite or sip at a time. • Double swallows may be recommended: Swallow once to send the liquid or food down,

followed by a dry swallow to clear any residual or particles. • Clear your throat and swallow again. • Follow the Speech Pathologist’s individual recommendations for solids and liquids for you —

o Thin or thickened liquid such as water is preferable, to avoid dehydration. Thickeners may make liquids easier to swallow.

o Moist, soft foods are easier to swallow. Adding extra moisture to dry solids and cutting into small bites can be helpful

• Try alternating a bite of food with a sip of liquid. • If pureed foods are recommended, experiment with a kitchen blender. Some favourite dishes

can be pureed without losing their familiar flavour. Keep it appetizing. • If you feel yourself slowing down or fatiguing during a meal, take a break. • It may be better to plan smaller meals more frequently during the day, or have your main meal

at lunch time. • Eating in a relaxed atmosphere. Swallowing can sometimes be easier if you are relaxed. Being

relaxed might help you concentrate on your swallowing, or help the muscles involved to work to the best of their ability. Some find it best to eat in a quiet atmosphere, without radio, TV or conversation for distraction.

• Avoid speaking and eating • Do not rush a meal. • Chew well, making the food mix well with saliva.

A Dietitian may help plan your meals to ensure you are getting the right nutrition. Dry Mouth -‐ Some speech or swallowing difficulties might stem from dry mouth, which is a common side effect of some drugs used to treat other MS symptoms, especially bladder problems. Dry mouth may contribute to tooth decay and gum disease, as well as cause discomfort, and it should be discussed with your GP, dentist or speech pathologist. It is important to have regular check-‐ups with your dentist. The medication causing the problem may be adjusted or you may be advised to use mouthwashes, artificial saliva, or other approaches to protect your teeth and increase your comfort.


It is not uncommon to feel worried or anxious about swallowing difficulties. If you do notice changes, that does not mean they will inevitably get worse, and with proper care, problems can be managed effectively and safely. Left untreated, anxiety about swallowing can become a vicious circle – swallowing problems and anxiety can each make the other worse.

Useful Organisations

Speech Pathology Australia www.speechpathologyaustralia.org.au

Dietitians Australia www.daa.asn.au

Lifetec -‐ assistive technology for independence http://www.lifetec.org.au

References and Further Reading

MS Essentials 24 Swallowing Difficulties -‐ MS Society (UK) 2nd Ed. reviewed 2015

https://www.mssociety.org.uk/ms-‐resources

Speech and Swallowing: the Basic Facts -‐ the National Multiple Sclerosis Society (USA) 2014. U.S.A.

http://www.nationalmssociety.org/Symptoms-‐Diagnosis/MS-‐Symptoms

Swallowing -‐ Speech Pathology Australia http://www.speechpathologyaustralia.org.au/publications/fact-‐sheets

Copies of above articles are available from MS Queensland Infoline call 1800 177 591 or email [email protected]

Disclaimer – Information contained in this factsheet is intended to provide useful and accurate information of a general nature and MS Qld does not intend this to be a substitute for medical advice. Readers must seek their own medical

advice as may be appropriate.

Speech and Swallowing - MS QLD

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