Symtom Awareness

Speech and Voice Problems
Studies indicate that 41 to 44 percent of the MS population experiences some type of speech or voice dysfunction, and 23 percent perceives that they have an expressive communication disorder. Anyone experiencing changes in speech or voice should know why this is happening and what can be done to treat these symptoms.
Speech and voice disorders fall under two classifications: “dysarthria” refers to motor speech disorders, and “dysphonia” relates to disorders with the voice. Dysphonia often occurs with dysarthria, as many of the muscles, structures, and nerve pathways for speech are also shared for voice production.

Normal speech requires the controlled movements of parts of the mouth to properly form words. These include the lips and tongue, mandible (jaw), and soft palate (upper back portion of the mouth). Additionally, the vocal cords and the diaphragm (the muscle that controls breathing and pushes air out of the lungs) need to function adequately.

With MS, damage to the myelin and axons in the areas of the brain that control the muscles of the mouth, soft palate, and diaphragm can affect an individual’s speech. Symptoms such as spasticity, tremor, weakness, and slowness in the muscles of these areas can make speaking more difficult. These symptoms may affect how well an individual articulates and how well he or she is understood by the listener, along with the rate and natural flow of one’s speech. These are all symptoms of dysarthria.
“Scanning speech” refers to a form of dysarthria that causes one to talk in a monotone manner, slurring words, while putting excessive and equal stress on each word. Approximately 14 percent of individuals with MS experience scanning speech, a disorder seldom seen in other conditions.

Dysphonia may be caused by myelin and nerve damage as well. It affects the quality of one’s voice, the amount of nasal sound (or resonance), and the ability to control pitch, loudness, and emphasis on different words and syllables.

Fatigue can also strongly impact speech and voice problems in MS. This affects how much strength one has to form the words, control the air needed to produce sound, and use the vocal cords for a clear voice.

When an individual experiences or exhibits difficulties with speech and communication, he or she should be referred to a speech-language pathologist. This specialist can formally evaluate the symptoms and recommend a treatment program, involving the patient, care partner, referring physician and nurse, and possibly a team of medical professionals.

A variety of treatments are available for speech and voice difficulties in individuals with MS. Medication may be prescribed to treat the underlying symptoms, such as spasticity, tremor, weakness, or fatigue. Specific exercises, drills, relaxation techniques, proper positioning, and practice strategies can help individuals to compensate for a deficit and enhance their communication skills.

Various devices may also be beneficial, and these may include: a pacing board to develop better timing and articulation; a tape recorder, Voice lite®, and speech lab computer software to aid with monitoring and self-correction; and a delayed auditory feedback (DAF) unit to help slow down speech. A small number of individuals may have a need for a palatal lift prosthesis to elevate a weak soft palate, a voice amplifier to increase volume for someone with severely reduced loudness, or other devices that help to communicate without the use of one’s voice.

All of the treatments mentioned are examples of what may be useful for an individual with MS who is experiencing speech and voice difficulties. Verbal communication is an important part of one’s life and relationships. If someone is facing challenges in this area, he or she should seek help to avoid unnecessary hardships, discover solutions, and enjoy a better quality of life.
Information for this article was summarized from Multiple Sclerosis – Diagnosis, Medical Management, and Rehabilitation, edited by Jack S. Burks, MD, and Kenneth P. Johnson, MD, Demos Medical Publishing, New York, 2000. The chapter on “Dysarthria” was written by Pamela Miller Sorensen, MA, CCC-SLP, a speech-language pathologist, who also reviewed this article for MSAA.