Multiple Sclerosis Centers of Excellence
Swallowing, Speaking, and Thinking
Joanna Close, MS, CCC-SLP
Individuals with MS experience a wide variety of symptoms, which may impact swallowing, speech, or cognition. Speech-language pathologists, often called SLPs, can evaluate and provide treatment options should difficulties in these areas become problematic.
Swallowing difficulty, called dysphagia, can be characterized by fatigue during meals, difficulty chewing or swallowing, coughing and choking on foods and liquids, sensations of something “stuck” in the throat, increase in reflux (sometimes called heartburn or gastroesophageal reflux disease), or unexplained chest infections. If there are concerns about swallowing, a speech-language pathologist may evaluate swallow function and provide additional strategies such as dietary texture changes, postural movements, or possibly exercises to help support safe and efficient swallowing. In rare cases, alternative means of nutrition may be considered. General safe and comfortable swallow strategies include:
- Reducing distractions during mealtimes,
- Eating smaller meals more frequently throughout the day,
- Sitting as upright as possible while eating and for 2+ hours after,
- Small bites and sips at a slowed rate,
- Alternating bites of food with sips of liquid, and
- Keeping foods soft and moist, using sauces.
Just as the muscles involved in swallowing can be impacted by MS, the muscles involved in speaking can, too. Speech difficulties, called dysarthria, are relatively common for people with MS, with about 40-50% of individuals reporting changes in their communication. Speech difficulties might include slurred-sounding speech, increased fatigue with conversation, or reduced vocal loudness. This is often mild and may not impact overall intelligibility or successful communication, but can be of concern to the individual. Some general strategies to support effective communication include:
- Breath support and diaphragmatic or “belly” breathing,
- Increased speaking loudness,
- Reduced speech rate, and
- Exaggerated articulation of each sound.
In more severe case of MS, speech supplementation or speech-generating devices might be necessary. When dysarthria interferes with safety, functional communication of daily needs/desires, or general quality of life, both low-tech and high-tech devices may be useful. Low-tech devices include alphabet and eye gaze boards, pictures, notebooks, or whiteboards, bells and buzzers, and simple yes/no systems. High-tech alternatives include voice amplifiers, text-to-speech devices, and applications (“apps”) that can be found on smartphones and tablets. Some apps to assist with communication include Proloquo2Go, LAMP, Speak for Yourself, and SmallTalk.
If recommended, there are more complex, computer-based devices available, called speech-generating devices. These devices have a variety of modes of access dependent upon physical abilities that may include via joystick, mouse, or eye gaze technology. Tobii, Dynavox, GoTalk, and Tango might be familiar brand names. It is important to work with a knowledgeable professional to determine the best-suited complex, computer-based device, as indicated.
Cognition is a fancy word to refer to thinking processes, such as attention, memory and learning, or executive functions (think planning, organizing, goal setting, and time management). Some individuals with MS report changes in cognition which may include:
- Increased reliance on organizational systems such as day planners, smartphones, or alarms,
- More difficulty making decisions,
- Reduced ease of remembering names, places, conversations, or recent events,
- More difficulty “multitasking,” tuning out distractions, or focusing for a long period of time,
- Problems with word-finding, and
- Slowed information processing.
Typically, these changes do not impact an individual’s overall ability to function independently, but may require more support and strategies including use of sticky notes, maps or GPS devices, day planners or smartphones, or requests for repetition or for written information. General recommendations to support cognition include:
- Focus on one task at a time,
- Reduce distractions,
- Write it down,
- Actively listen; request slower speed, repetition, and clarification as needed,
- Use calendars, day planners, computers/tablets, or smartphones to keep track of appointments, and for planning/prioritization,
- Use word-finding strategies: describe the word, think of the first letter or sound of the word, use a similar word, or use gestures,
- Keep your mind active and engaged with work, games, social activities, reading, playing music, or physical exercise, and
- Eat well, get enough sleep, and practice basic healthy habits.
If an individual with MS experiences difficulty or concern about issues related to speaking, eating and drinking, or thinking, consider a visit to a speech-language pathologist who may assist you with providing more information, strategies, or possibly therapy to support cognitive, communication, and swallowing issues.