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How to Manage MS Speech Issues

By Kerry Weiss
Reviewed by Dana Cooper, M.D.
March 20, 2023

If you’ve found that you have trouble speaking clearly sometimes—especially when you’re feeling fatigued—you’re not alone. Speech issues may occur in up to 40% of people with MS, according to the National Multiple Sclerosis Society.

Here’s what to know about speech problems and MS, including how to regain confidence in your speech or adapt at times when speaking is more difficult.

Symptoms and Causes of MS Speech Issues

MS can impact speech in a variety of ways. Nerve damage related to MS can affect muscle control and hinder the ability to form words. Although rare, MS can also inhibit the brain’s ability to process language, leading to communication difficulties. Meanwhile, other MS symptoms like brain fog, fatigue, or spasticity can make speech more difficult, too.

A person experiencing MS speech difficulties may notice symptoms such as:

  • Abnormal rhythm of speech characterized by pauses between words or syllables (known as scanning speech)
  • Strained quality of speech (known as spastic dysarthria)
  • Slurred words
  • Low speech volume
  • Slowed rate of speech
  • Nasal speech
  • Hoarseness or raspy speech
  • Shaky voice (vocal tremor)

The speech symptoms a person may experience depends on which parts of their body and brain are affected by MS, says Brooke Hatfield, associate director of healthcare services in speech-language pathology for the American Speech-Language-Hearing Association (ASHA), in Rockville, Maryland.

“Think about how complicated the act of speech is,” Hatfield says. “It's moving from an idea in your head that becomes a series of muscle movements from all of the things that make speech—so your articulators in your face and your mouth, your tongue, but also your respiratory system that pushes air through your larynx up into your mouth and your nose. And we know that MS can affect muscles all along that process.”

Slurred speech, trouble pronouncing words, and other symptoms can be due to motor (muscle) weakness in those areas, says Kalina Sanders, M.D., a board-certified neurologist specializing in MS and spasticity management at Baptist Health in Jacksonville, Florida. “But then there is difficulty with production of language, so [people] sometimes have difficulties with finding the right word to say, or to be able to express their thoughts.”

Whether your speech issues are cognitive or motor-related, or both, there are strategies to help manage them.

Treating MS Speech Issues

If the difficulties you’re having with speech are related to underlying MS symptoms, like muscle stiffness or spasms, working with your doctor to adjust your treatment plan may help your speech issues.

However, most MS-related speech concerns are best addressed with the use of speech therapy, Sanders says. If speech services aren’t offered through your MS clinic, you can search for a certified speech-language pathologist (SLP) near you through ASHA’s ProFind tool or the National Multiple Sclerosis Society’s directory.

An SLP can work with you to relearn what likely once felt automatic. “Once we learned to talk, we never thought about it again. So, we didn’t think about the automatic process of speech,” Hatfield says. “Working with an SLP helps break it back down into its bits and pieces to be able to think about how someone can physically change their speech, how to strategize when to do it, and what the best tools are for them.”

Tips to Help with Speech

Getting evaluated by an SLP can help you come up with an individualized plan to address your speech concerns.

“There are three main components to [that plan],” Hatfield says. This includes practicing the physical aspect of speech production, working with your listeners, and energy conservation. When it all comes together, here’s what these components may look like:

  • Identify and practice exercises that can help strengthen (or relax) vocal cords and help with movements of the jaw, tongue, and lips.
  • Be open and honest with your loved ones about your speech difficulties so that they know to be patient listeners.
  • Make sure you have someone’s full attention before communicating with them.
  • Aim to communicate face to face as much as possible so your listener can pick up on nonverbal cues.
  • Turn off background noises like the TV and music or remove yourself from these distractions as much as possible when it’s your turn to speak.
  • Take your time—speak slowly and pause as needed when it’s your turn to talk.
  • Take breaks in conversation as needed.
  • Prepare notes to refer to if you have difficulty finding words.
  • Use shortcuts, like a text-to-talk app.

If your speech is severely affected, your SLP may recommend an augmentative and alternative communication (AAC) device. “These AAC systems are built for people who might have other difficulties with movement on top of their speech,” Hatfield says. An AAC may be a dedicated hand-held device or tablet for generating or amplifying speech, or it may be software that you can install on your own smartphone, computer, or tablet for the same purposes.

With the help of technological advances, these devices have come a long way. “They’re able to support things like message banking and voice banking, meaning if you know that your speech is going to change and you want to record a lot of things on days that you're feeling like your speech is good, you can pop it into these devices,” she explains. “So, instead of hearing a computerized voice, you can have your own voice being projected from the system.”

Seek Speech Therapy Early

A good rule of thumb: Don’t wait for speech issues to become a problem before seeking help.

“Often one of the first things that might change for somebody is that they just feel a little flatter with their speech, or it gets harder to kind of emphasize something in the same way,” Hatfield says. “I think often people will kind of notice a change in their speech and think, 'Well, it's not that bad,' or 'I'm getting by okay.’ But if you go ahead and you get help early, it's going to set up good strategies so that you know what to do if and when your speech does change [more significantly].”

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