True or False:
1. Individuals with MS rarely experience changes to their vocal quality.
2. Everyone experiences having words stuck on the “tip of their tongue,” so there is no need to worry or tell my doctor.
3. Fatigue is a symptom of MS that can only affect my ability to walk and engage in physical activity.
If you answered “yes” to any of these questions then it is time for you to increase your speech and communication knowledge associated with MS.
Speech and Communication Disorders in MS
Research investigating physical and sensory disorders in individuals with MS is immense, while cognitive-communication deficits associated with MS have received little attention. The lack of research for communication disorders and MS is shocking given that between 45 percent and 65 percent of individuals living with MS experience difficulties with memory, attention, distractibility, problem-solving, word-finding and other cognitive functions as symptoms of the disease.
In addition, a variety of speech and voice disorders have been identified in individuals with MS. A research questionnaire investigating speech and communication skills associated with MS indicates that approximately 45 percent of respondents reported changes in speech clarity, while 33 percent reported impairments of voice and swallowing skills. Despite these overwhelming figures, only a small number of MS patients (2 percent) are appropriately referred for treatment. Understanding the different types of cognitive-communication, speech and voice difficulties associated with MS is the first step towards managing these symptoms effectively.
Word Finding
Aphasia, or the loss of words, until recently was not considered a clinical manifestation of MS because MS primarily affects the white matter of the brain and spinal cord, while aphasia is typically associated with diseases of the gray matter. However, a recent multicenter study investigating the prevalence of aphasia in MS found that nearly 40 percent of individuals with MS demonstrate markedly reduced word-finding skills. Aphasic disorders may be observed in two different situations in MS. The most common situation is experiencing difficulty generating the names of people, places, and things over the disease course while the second situation is experiencing acute aphasia during or following an exacerbation.
Quick Tip Give yourself a hint. Two types of useful cues to improve word finding skills are phonemic cues (generating the first letter of the missing word) and semantic cues (thinking of the category the word belongs within. i.e., foods, places, things in the kitchen, etc.)
Memory
Memory is a multifaceted, complex process that is localized in different structures in the brain. Memory deficits are due to ineffective encoding of information, inadequate storage of information, difficulty retrieving information, and the inability to suppress environmental distractions (background noise, competing talkers, etc.). Individuals living with MS may experience difficulty with episodic memory (memory concerning temporarily dated events), procedural memory (memory for how to do things) and semantic memory (memory for words and things).
Quick Tip Routines + Rituals = Success. Consistently use one method for keeping appointments, events, and errands organized in order to reduce your need to rely on working and short-term memory skills. Desk calendars, daily planners, smart phones such as iPhones and Droids, and web-based software such as Asana are options to keep you organized. It is important to minimize the amount of information you need to remember and instead have pertinent information available in one central location.
Cognitive and Physical Fatigue
Similar to the physical fatigue many individuals living with MS experience, cognitive fatigue can also be present. Research shows that persons with MS can easily experience fatigue when engaging in mentally challenging work and tasks that require focused attention. Once fatigued, individuals with MS tend to make errors in their written and verbal communication skills.
Quick Tip To combat cognitive fatigue, break down large projects and tasks into smaller, more manageable projects. Be sure to adequately space tasks apart and frequently take breaks.
Dysarthria
If you have MS, you may be aware of subtle changes to your speech. Do people ever ask you to repeat yourself? If so, you may be experiencing something called dysarthria. Dysarthria is a term used to describe a group of speech disturbances related to muscular control in the speech mechanism. It’s because of damage to the nervous system. There are many different types of dysarthria but for individuals with MS, the most often effected areas are speed, strength, range of motion, and accuracy of speech movements. Perceptually, your voice may sound weak, you may have reduced vocal volume, reduced breath support, reduced endurance and fatigue when communicating, reduced inflection in your voice, and/or slurring of speech sounds and syllables.
Quick Tip Try this exercise. Take a deep breath, open your mouth wide, and say “Ahh” for as long and loud as you can until you have no more air left in your lungs. On average, men should be able to sustain “Ahh” for 20 to 40 seconds, while women should be able to sustain “Ahh” for 15 to 35 seconds. This deceptively effective exercise increases breath support, improves control over expiratory intercostal muscles, and improves vocal volume and intelligibility (speech clarity).
Evaluation
If you or your loved one is experiencing any of the speech and/or cognitive communication disorders described above, consulting with a licensed speech language pathologist with experience treating neurological populations is a great way to investigate any concerns. Speech evaluations can slightly vary, however, the process typically consists of collecting a case history, assessing memory and word finding skills, taking measurements of your vocal volume, measuring the amount of air in your lungs, and determining the speed and accuracy of your speech musculature. Data collected is then compared to individuals of a similar age and gender in order to determine the degree of deficit.
Helpful Treatments
The exciting news is that there are several very effective treatments that can dramatically improve memory, aphasia, dysarthria, and voice disorders associated with MS. Speech and cognitive linguistic therapy typically involves attending a series of individual sessions either in person or via telehealth (a.k.a. Skype therapy). If you are unable to find a qualified SLP with experience treating individuals with MS in your area, or if it is too challenging to leave your home, consider utilizing telehealth as a treatment modality. Telehealth allows patients to have access to high-quality and specialized care regardless of location and/or proximity to MS treatment centers.
If you or a loved one is experiencing speech changes associated with MS, it may be frustrating. But remember, stay positive. Don’t let changes in your speech and communication withdraw you from the conversation. You are important and what you have to say is valuable.
Marissa A. Barrera, MS, MPhil, MSCS, CCC-SLP is the owner of New York Neurogenic Speech-Language Pathology and co-owner of the Aspire Center for Health and Wellness. She is a licensed speech-language pathologist, a multiple sclerosis certified specialist and professor of acquired motor speech and swallowing disorders. With private practices located in Midtown and the Upper West Side of New York City, Marissa and her clinical team feel privileged to provide therapeutic services to hundreds of MS patients each year. An avid supporter of telehealth (a.k.a. Skype therapy), Marissa provides therapy to patients all over the world via the internet. Apart from being a clinician, conducting research and teaching are two of her passions. She has written several research articles and gives lectures across most of North America. Marissa is proud to sit on the Clinical Advisory Council for the NYC chapter of the National MS Society and the Medical Advisory Board for MS Focus. In 2010 she was the recipient of the MS Rehabilitation Fellowship and in 2012 Marissa was invited to serve as distinguished faculty for Consortium of MS Centers. Call Marissa: 212.453.0036; Email: MBarrera@nyneuroslp.com. Visit: www.nyneuroslp.com
(Last reviewed 11/2012)