Speech therapy for Multiple Sclerosis

Overview
More than 40 percent of people with multiple sclerosis (MS) experience problems with speech at some point. Speech problems may take the form of dysarthria or dysphonia. Dysarthria, or speech disorder, could involve slowed, quiet or slurring speech, poor articulation or unusual speech patterns. In dysphonia, or voice disorder, the voice may change and become hoarse, harsh, breathy or nasal due to issues with the nerves and muscles associated with speaking. All of these changes can cause difficulties in communication.

More than 30 percent of those with MS experience dysphagia, or swallowing problems, at some time. Although difficulty in swallowing is usually mild or passing in most people with MS, in others, it can become severe and lead to poor nutrition, dehydration, or inhaling food particles, which may even cause aspiration pneumonia.

Speech-language pathologists, or speech therapists as they are more commonly known, can diagnose and treat these problems with education, exercises and assistive devices.

What does it involve?
Depending on what state you live in and what type of insurance you have, you may require a referral from your doctor in order to see a speech therapist. At your first appointment, the speech therapist will interview you about the speech or swallowing problems you are experiencing and perform a physical exam of your tongue, mouth and throat muscles. If you are having difficulties swallowing, they may perform a barium swallow. In this exam, you will be asked to swallow liquid or material of different consistencies, all containing a contrast additive. As you chew and swallow, the therapist will film the process using a fluoroscope, which is similar to an x-ray machine that takes moving pictures. This test helps the speech therapist pinpoint the cause of the problem you are having.

Depending on your specific speech or swallowing issues, the speech therapist may teach you voice exercises to improve projection or mouth exercises to strengthen muscles associated with speech and swallowing. They may recommend different posture while eating, or changes in diet such as adding more liquid to foods to make them easier to swallow. The speech therapist may coach you on slowing down while talking or eating, articulating more clearly, or on controlling your breathing. You may also learn energy conservation strategies such as keeping conversations short. The therapist can also help you learn how to use other strategies or assistive devices to better communicate.

Intended Outcomes
The goals of speech therapy are to communicate and interact with others effectively, to eat and drink safely, and to improve your quality of life.

Results
There has been little clinical research proving the effectiveness of speech therapy on MS-related speech or swallowing problems. However, many studies have established that rehabilitative therapies in general improve quality of life, sense of well-being, mood and delaying or preventing deterioration.

Constraints
Most types of insurance will only pay for a limited number of physical therapy appointments. The National MS Society or the American Speech-Language-Hearing Association may be able to provide financial assistance if you need it.

Depending on where you live and your level of disability, it may be hard to travel to speech therapy appointments.