Managing Speech, Language, and Cognitive Challenges

The Effect of MS on Speech

Difficulty with speaking clearly (dysarthria) and other multiple sclerosis speech challenges may occur in up to 40% of people with MS. Problems may interfere with how easily a person’s speech can be heard and understood. They are typically mild to moderate or worsened intermittently by MS-related fatigue. Changes in voice quality (dysphonia) may also occur, resulting in hoarseness, breathiness, and/or reduced loudness. 

Common speech and voice problems for those with MS may include: 

• Reduced loudness due to poor breath support/control.
• Imprecise articulation due to weakness, slowness, or incoordination of the lips, tongue, and soft palate. This may affect overall speech intelligibility.
• The flow of speech may be slow, have irregular pauses, or have excess and equal emphasis due to poor timing of respiration and articulation.
• Voice quality may be hoarse, harsh, breathy, or hypernasal if there is neuromuscular impairment of the vocal cords or soft palate. 

A speech-language pathologist (SLP) can evaluate specific multiple sclerosis speech/voice problems and provide treatment. When voice changes are noted, referral to an otolaryngologist (ENT) for a scope exam is recommended to assess the vocal cords. Primary therapy goals are to improve intelligibility and naturalness of speech with communication partners and to use proper voice techniques with less vocal strain. 

The following strategies can be used to speak more clearly: 

• Fill Your Lungs Fully: Use your diaphragm.  

• Speak Louder: With conscious effort. 

• Slow Down: Allow extra time for your lip and tongue movements. 

• Exaggerate Articulation: Make precise contact with your lips and tongue to reduce slurring. 

• Pause Strategically: Every few words, to allow for better breath support, loudness, and articulation. 

• Actively Self-Evaluate: Watch for feedback from the listener, and correct your speech if it appears not to be understood. 

• At times, specialized equipment may be recommended, such as: 

• • Voice amplifier (with headset microphone) when adequately increasing loudness is too difficult
  • Speech-generating devices (although a rare need in MS) when severe dysarthria and unintelligible speech 

Cognitive and Linguistic Challenges With MS

Cognitive/communication challenges affect approximately 50-66% of those with MS. Impairment can range from mild to severe, but most cognitive changes in MS fall within the range of mild to moderate. However, even subtle changes in cognition can have a significant impact on daily functioning.

In fact, cognitive and fatigue issues cause people with MS to leave the workforce more than mobility issues. The most common cognitive-linguistic complaints associated with MS are problems with forgetfulness, finding the right words, and feelings of being overwhelmed or paralyzed by indecision and too much information.

Fortunately, compensatory strategies can enhance and maximize cognitive function. Visual or verbal associations can assist with learning new information. Gestures, synonyms, and initial letter cues are useful tools for word retrieval. External aids such as smartphones and calendars can ease planning, organization, and memory challenges.

However, it is important to remember that if language or cognitive challenges have a significant impact on your safety or ability to function in work or daily life, a consult with a speech/language pathologist, occupational therapist, or neuropsychologist is advisable to address individual needs in greater depth.