How to Manage Speech Problems Caused by MS

Speech problems in MS occur when the brain’s ability to send messages to the muscles used in speaking is disrupted. These symptoms may come and go or become more persistent over time, especially as the disease progresses and causes more lasting nerve damage.

Not being able to communicate effectively is not only frustrating, but it can also contribute to isolation and even depression in people with MS. The good news is, research shows that speech therapy is an effective tool in managing many of the most common speech difficulties. 

Speech-language pathologists not only help with speech impairments caused by MS, but the techniques used in therapy have also been shown to enhance lung volumes and respiratory muscle strength.

Learn more about the different ways MS can impact speech, and get expert advice on how to treat MS-related speech problems.

Types of Speech Problems Typically Caused by MS
Changes in speech depend on what part of the brain is affected, and like other MS symptoms, difficulties can range from mild to severe.

The type of speech changes in MS can vary from person to person but typically fall into a few key categories.

Dysarthria
The most common is dysarthria, a motor speech disorder caused by weakness or poor coordination of the muscles used for speaking. This can make speech sound slurred, slow, or effortful, and can affect the way you control your breathing, voice volume, and pitch.

There are three main types of dysarthria seen in MS:

Spastic dysarthria often results in tight, strained-sounding speech due to stiff muscles.
Ataxic dysarthria may make speech sound uneven or jerky because of poor coordination.
Mixed dysarthria combines features of both and is frequently seen in MS as multiple areas of the brain are affected.

Anomia and Aphasia
Some people with MS may have trouble “finding” words that they want to say, which is called anomia, or “tip of the tongue” phenomenon. Anomia is not usually a result of destruction in the brain’s language regions, but is instead due to a combination of stress, poor sleep, distraction, and psychological problems like depression or anxiety.

Aphasia is more severe and is a result of a destructive process in the brains’ language regions, like the lesions from multiple sclerosis, which interrupt the communication between the neurons. This can affect how the brain attaches meaning to words, resulting in a receptive aphasia, in which the person does not understand language well. Or the lesions can affect how the brain gets language out, resulting in expressive aphasia, meaning the person is unable to get meaningful words out, verbally or in writing.

Ataxia, Dystonia, and Other Causes

Speech difficulties can also occur as a result of other MS symptoms, including ataxia, which is poor muscle control that causes involuntary movements, and dystonia, when muscles contract involuntarily. Muscle spasms, muscle stiffness, cognitive changes, and tremors can also contribute. 

This can manifest as issues with voice control, such as hoarseness, or difficulty projecting, as well as rate of speaking — either too slowly or too quickly.

Early Signs and Symptoms of Speech Problems

Early signs of speech issues can include reduced vocal intensity or spoken volume; slurred, slowed, disfluent speech; nasal-sounding voice quality; scanning speech (speech that is slow, deliberate with noticeable pauses); and dysarthria, says Nidhi Mahendra, PhD, a professor of head and neck surgery and the division chief of speech language pathology at Duke University School of Medicine in Durham, North Carolina.

Many people with speech dysfunction also have difficulty with swallowing, called dysphagia.

Causes of and Contributors to MS Speech Problems

In MS, your immune system mistakenly begins to attack the insulating layer of the neurons, called the myelin sheath.

“The myelin sheath is what allows our neurons to communicate very quickly and rapidly, which is essential for reflexes, quick movement, and rapid muscle coordination, which you need for speech and swallowing,” says Dr. Mahendra.

The myelin normally prevents any leaking or weakening of nerve signals racing between neurons, and when it breaks down, many problems result, she says. 

“When myelin is damaged, these signals to the muscles used for speaking can be slowed down or disrupted, making it harder for the brain to coordinate the movements needed for clear speech,” says Danielle Brown, a speech-language pathologist at the Mellen Center for MS at Cleveland Clinic in Ohio.

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