Speech Difficulties

Speech is a highly complex process which depends on finely controlled and co-ordinated muscles. In Multiple Sclerosis, difficulties can vary from being scarcely perceptible to very severe.

What can affect the speech process?

 Speech patterns are controlled in several areas of the brain with the brainstem being particularly important. If lesions occur in this area, speech is going to be affected to a greater or lesser degree.

 Speech problems such as a weak voice are exacerbated by fatigue. Some MS patients report increased difficulties towards evening even if the day starts well and often become worse during periods of relapse.

Often when a person gets hungry and blood sugar levels become low, speech can be impaired.

What are the symptoms of Speech Problems?

• slurred, imprecise or slower speech
• low volume or weak voice due to respiration problems
• difficulty with resonance and pitch control
• the appearance of speaking through the nose
• abnormally long pauses between words or syllables of words – this is called ‘scanned speech’.
• dysarthia, in which the capability to understand, remember words and construct sentences is not lost but the ability to speak clearly becomes affected
• dysphasia, in which there is a lack of understanding of what is being said and an inability to recall the vocabulary and grammar necessary to build a sentence and the annoyance of losing a word mid-sentence.
• however without doubt, the most common problem is slurred speech which causes embarrassment in public. Slurred speech, together with impaired mobility, can sometimes lead to accusations of drunkenness or decreased intelligence. This lack of understanding can affect confidence, increase anxiety and lead to loss of self-esteem which may make the problem worse when a Person starts to hesitate or clam up for fear of sounding foolish.

People’s reactions to their own speech impairment can be quite devastating and a once confident speaker can withdraw into being a shy, hesitant person for fear of embarrassment. Others however take it in their stride and develop strategies to overcome this.

How can speech problems be managed?

Referral to a speech and language therapist is important, with most success achieved during periods of remission.

Strategies aim to help people cope with speech impairment by developing more control over their speech and ultimately making their speech more understandable. They include teaching:

• the importance of good posture
• how to make the relevant muscles as strong as possible
• how to make the relevant muscles as strong as possible
• how to articulate clearly, more slowly and take frequent pause
• show to exaggerate emphasis and intonation
• ‘speech conservation’ i.e. make the most important points first when energy levels are highest
• avoiding competing with background noise because trying to raise the voice can increase spasm and reduce articulation.
  

Personal experiences

“Apparently when I get tired I repeat the same word although I’m not aware of it. The frustration sometimes of trying to get the word out drives me nuts.”

“My voice remains permanently 'quiet' and it is extremely frustrating when in a group of people, or when requiring help, because no one seems to hear. My speech therapist suggested pushing down with both hands in order to raise the voice level and this does work sometimes. Both of these problems continue, along with fatigue, to be the most irritating form of my MS.”

“Often what comes out of my mouth is the opposite of what I intend saying. For example I will say ‘tomorrow’ instead of yesterday’. This totally confuses people and embarrasses me because I’m sure people must think I’m totally dotty.”

“Sometimes my voice will ‘crack’ mid conversation and the pitch may alter. Often my tone of voice will come out all wrong and inappropriate to a given situation e.g. I may sound aggressive without meaning to do so.”

“It’s not so much difficulty with talking, but the cognitive thing of not having the right word come to you or you build up a nice picture to make your point - then forget what your point was!”

“Mine goes slurry when tired or my blood sugars are low, also two small glasses of wine inside me and I've ‘gone’ speechwise, therefore I talk louder to try to make it sound clearer. My friends understand my difficulties but formal social events can be a nightmare.”

“During my last definite relapse I was slurring my speech. It sounded just as if I were very drunk. I remember giving a couple of people a lift home from Birmingham to Sheffield at the time and having really bad problems. The worst thing was that we had been in a hotel bar for several hours before setting off. I had only had half a bitter but I'm sure they thought I'd had much more.”

Further Information 

• Helpful Speech Products

© Multiple Sclerosis Resource Centre (MSRC)