Close to half of people with multiple sclerosis (MS) experience swallowing difficulties and speech issues. Swallowing issues may also be referred to as dysphagia. Identifying the issue and seeking early treatment is key.
With the right advice and support, swallowing and speech issues can be minimised or managed effectively to maintain a healthy and active lifestyle.
For people with MS, swallowing issues can be an uncomfortable and distressing symptom. For some, these changes come and go, or may happen only during a relapse. For others, this is an ongoing issue.
Swallowing issues can lead to:
These problems can affect the safety of your eating and drinking, your enjoyment of mealtimes and even self-esteem. Managing these signs and seeking help from your health professional can help you avoid developing more severe problems.
Dysarthria is the medical term applied to speech issues as a result of muscle weakness. In MS, this could result in changes in voice quality, a monotone voice, a nasal sounding voice, imprecise articulation, a slow rate of speech, variable loudness of speech or vocal tremor.
Chewing and swallowing involves the coordination of various muscles in the mouth and throat, including those which protect your windpipe when food and drink pass through your throat. Muscles can be weakened, or the coordination of their movements disrupted by damage to the nerves caused by MS. This can also affect the way you sense the presence of food and drink in your mouth and throat.
If the muscles are weak, chewing can involve a lot of effort and food may lodge in your throat. You may need to swallow several times to clear one mouthful away. If the muscle movements are slow or lack coordination, fluid or food particles might enter the windpipe (rather than your stomach), causing coughing.
If MS has weakened the coughing muscles, it may be more difficult to eject particles and they may enter your lungs (called aspiration, or ‘silent aspiration’ when something is inhaled without being aware), or cause choking. Reduced sensation in the mouth means that saliva is not swallowed away as frequently, which can result in dribble escaping from the lips.
Stress and other MS symptoms such as heat and fatigue may lead to swallowing issues. Mild or occasional difficulties can be present early on in MS and occur during relapses. Significant symptoms are more likely if you have progressive MS.
Fundamentally, it is weakness or lack of co-ordination of the muscles used in speech. In MS, the loss of myelin on nerves results in neurological damage. If certain areas of the brain are affected that contribute to speech function, there may be issues with speech formation and patterns leading to the symptoms mentioned above.
If you’re experiencing swallowing issues, talk to your neurologist, MS Nurse or GP. They can provide advice according to your individual situation and may refer you to a specialist.
Swallowing issues or dysphagia is diagnosed by examination of the tongue and swallowing muscles, sometimes with a special imaging procedure called a modified barium swallow. This involves drinking or eating samples of different consistencies, such as thin or thick liquids or solids. A video-fluoroscope films the swallowing to pinpoint the location and issue and assist with potential treatments.
Depending on the severity of your symptoms, your health professional can help you develop a management or treatment plan.
In MS, most speech issues are mild and manageable, but it is important to seek help early to ensure the right diagnosis is made and treatment initiated if needed. Speaking to your neurologist and MS care team is the first step, who may refer you to an occupational therapist, physiotherapist or speech therapist, depending on the specific issues identified.
There are various techniques you, your family or carers can learn, to both help with swallowing and manage changes effectively:
There are different forms of dysarthria which can affect speech. In order to ensure the best outcomes, the specific type of dysarthria needs to be identified. If you have been referred to a specific therapist, an assessment is usually made to determine the exact issues and guide management. Simple management strategies to improve general communication include maintaining eye contact with the listener, using gestures and facial expressions, preferring a quieter environment to reduce background noise, and in some cases, using technology. Tiredness and fatigue can also affect speech and thus managing these symptoms is also important.
Your health professional may refer you to a speech pathologist who can assess your swallowing difficulties. They can advise on posture and/or head position, food and drink consistencies, eating environment and possible exercises to strengthen the muscles involved in swallowing. You may also work with a physiotherapist, to help you achieve the posture that makes swallowing easiest and as comfortable as possible and even a dietitian, to advise on ways to maintain your nutrient intake or the need to alter food and drink consistencies.
If swallowing problems are more severe, there are options your healthcare team may consider, to ensure you maintain adequate nutrition, hydration and avoid complications. This includes specialised feeding procedures.
Many people with swallowing issues can also have speech disorders, which can be treated by speech pathologists.
Improving speech fluency and naturalness is the goal of therapy. Speech requires a complex series of interactions between different body areas, such as the lungs, diaphragm, vocal cords, lips and tongue, so issues in any of these areas may contribute to dysarthria. Once the type of dysarthria is identified, targeted therapies can be prescribed by therapists to treat specific speech issues, and these are usually quite effective. Strategies could include breath support and control to improve loudness, reducing the rate of speech, using pauses when speaking, overemphasis of articulation and active self-monitoring and self-correction of speech. There have been advances in understanding speech issues in MS in recent years and it is an important topic of ongoing research internationally.
There is support available to help you manage your MS.
Your neurologist, MS Nurse or GP should be the first contact for any new and/or persistent swallowing concerns, so they can perform a detailed assessment and tailor a management plan or referrals if needed.
Contact your state or territory MS organisation to access services such as MS nurses, peer support and other resources.
The following support services may be able to provide wellbeing and lifestyle advice: