Symptom Management

Medical speech-language pathologists are vital members of the interdisciplinary healthcare team. SLPs collaborate with neurologists, occupational therapists, physical therapists, dietitians, social workers, nurses, and other allied health professionals in the care of persons with multiple sclerosis. This collaboration ensures a holistic, coordinated and patient-centered care for individuals with MS – a chronic, often progressive, autoimmune, neurodegenerative disease that affects the central nervous system. MS can affect many areas of function, including speech, swallowing, language, and cognition. These are areas within the SLP’s scope of clinical and research practice, making them a key professional in the care of persons with MS.  

Speech production disorder

Dysarthria, a motor speech disorder due to impaired movement of the muscles used for speech, is one of the most common speech-language impairments in MS. The presence of dysarthria can affect the overall communicative abilities of persons with MS, leading to social isolation and a decline in quality of life. Studies have reported dysarthria prevalence in persons with MS to be between 40–50 percent, depending on disease progression and the diagnostic criteria used.

The most prevalent type of dysarthria in persons with MS is mixed type, combining the features of both spastic and ataxic dysarthria. This is the result of the disease process affecting multiple areas of the central nervous system. Common dysarthria symptoms are slurred speech, scanning speech (abnormal prosody with long pauses between syllables or words), hypernasality, weak voice, reduced volume and difficulty with volume control, changes to voice quality (harsh, hoarse, strained, or breathy), and fatigue and worsening of speech clarity over time.

Swallowing disorder 

Dysphagia is the clinical term for difficulty swallowing. This is linked to brainstem involvement, cranial nerves, bulbar muscle, and cerebellar dysfunction. Dysphagia is a serious medical issue and can cause dehydration, malnutrition, and a life-threating condition called aspiration pneumonia. This is a specific type of pneumonia caused by food or liquid entering the lungs, instead of the stomach. It is the leading cause of death in some neurological conditions. Dysphagia is prevalent in persons with MS, with some studies reporting swallowing difficulty in up to 45-56 percent of individuals, and some estimates as high as 90 percent, depending on the disease progression and course. 

In individuals with MS, prevalent dysphagia symptoms include weakness or incoordination of the muscle in the oral and pharyngeal phases (e.g., tongue, lips, throat muscles), which causes prolonged and inefficient chewing and globus sensation (a feeling of something stuck in the throat). Mealtime fatigue can occur, which causes prolonged mealtimes and can lead to weight loss. In the pharyngeal (throat) phase, persons with MS may have difficulty initiating swallowing and managing liquids, which flow quickly compared to solid foods. This can lead to drooling, coughing, or choking during meals. In addition, numbness in the mouth or throat can interrupt the safety of swallowing, leaving vulnerability to aspiration pneumonia. 

Language disorder

Anomia, or word-finding difficulty, is less frequently reported in persons with MS compared to other deficits but is still notable. Despite its prevalence (about 30-40 percent), anomia is frequently underreported compared to motor symptoms. A study of 100 patients with relapsing-remitting MS found that 42 percent showed impairment in picture naming, with reduced accuracy and speed of picture naming. Aside from slowed and inaccurate naming skills, semantic level deficits, or impairment in the ability to retrieve word meanings, and semantic errors (i.e., substituting a word with a different one in the same semantic category, such as “blue” for “black”) were noted. Anomia can present challenges in verbal fluency for persons with MS, affecting the speed of word retrieval, particularly during episodes of exacerbation and fatigue. These word retrieval difficulties are often linked to underlying cognitive-communication deficits in MS.

Cognitive disorder

Cognitive deficits affect approximately 40–65 percent of persons with MS, leading to difficulties with memory, attention, processing speed, and executive function. These impairments can significantly affect communication. Individuals may struggle with their speed of understanding information and may report “brain fog.” Another common area of cognitive challenge is memory. Impairments in short term or working memory may present with challenges in your daily routine such as remembering a list of items at the grocery store. In the area of attention, persons with MS may have difficulty with sustaining attention or multitasking. Finally, areas of executive function, such as problem solving, organization, and decision making, may be challenging, particularly in situations of disease exacerbation and fatigue. 

The role of the speech-language pathologist

Persons with MS are at risk for a variety of communication, swallowing, and cognitive challenges throughout the disease progression. SLPs are there, every step of the way, to provide critical assessment, treatment, and education to help individuals maintain their best quality of life. SLPs use standardized and functional assessments to evaluate communication, swallowing, and cognition. Early assessment and treatment are essential, to closely track changes in function over time, which is important when applying for disability or workplace accommodations.

SLPs provide fundamental treatment to improve quality of life. These include: 

1. Speech treatment to address dysarthria, such as articulation, speech intelligibility training, breath support training, and/or voice therapy to improve loudness, vocal control, and speech intelligibility, such as Lee Silverman Voice Treatment. In severe cases, SLPs may recommend augmentative alternative communication systems to support functional communication skills. 
2.  Swallowing therapy to address dysphagia by using a combination of compensatory and therapeutic strategies to reduce the risk of aspiration and maintain overall nutrition and hydration. These treatments may include postural changes, diet modification, compensatory strategies, and exercises to strengthen the muscle of swallowing. Upon completion of an objective swallowing assessment, the SLP will customize therapy to your individualistic needs.
3. Language therapy is designed for persons experiencing word retrieval difficulties (anomia). Interventions, such word drills, picture naming, and semantic feature analysis enhance communication, improve quality of life, social participation, and emotional well-being. 
4. Cognitive-communication therapy, often done in collaboration with occupational therapists, is to address deficits in attention, memory, organization, problem solving, and other cognitive skills. In addition, the use of computerized applications can offer engaging strategies to further enhance cognitive skill retraining. 

Finally, SLPs serve as educators and counselors when working with neurological diseases, such as MS. They will provide training, resources, and support to persons with MS and their care partners.

If you or a loved one has MS and is need of an SLP, here are some suggested resources:

1. ASHA ProFind, a database created by the American Speech-Language-Hearing Association to help the public locate ASHA-certified SLPs in your area.
2. Your local hospital or searchable medical platforms, such as Healthgrades.
3. Your local university may have a speech-language pathology clinic
4. Local MS support groups or MS related websites.