Swallowing and speech disorders usually play a subordinate role in the perception of patients. However, problems with swallowing occur in up to 40% and with speech in around 75% of all MS patients during the course of the disease. This episode is about how you can recognize that there is a problem and, above all, what you can do about it. After all, eating and drinking as well as socializing with other people are among the absolute basic needs. A speech therapist can help you to learn how to swallow or speak again. You can find out more in the article.
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When do swallowing and speech disorders occur?
Speech and swallowing disorders often only tend to play a role at a later stage. A slight change in speech is initially not very noticeable. It is only when communication is severely affected that social life suffers and the pressure to act increases. Mild to severe speech problems occur in up to 75% of all MS patients.
Swallowing disorders are perhaps more likely to cause distress, as frequent swallowing is at least unpleasant and sometimes even dangerous. However, with a frequency of 30 to 40%, it is less widespread. Here too, the figure refers to all degrees of severity from mild to severe.
Both symptoms can, but do not have to, be present together. There is also a connection with movement disorders.
How do swallowing and speech disorders manifest themselves in multiple sclerosis?
Speech disorders
In speech disorders, the muscles and organs required for speech no longer function properly. The spectrum ranges from minimal to completely unintelligible. The term dysarthria is used when paralysis or impaired coordination of the speech muscles makes it difficult to produce sounds.
If breathing, resonance and voice production are also affected, the technical term is dysarthrophonia. In any case, communication is made more difficult, which usually leads to fewer contacts.
Specific symptoms:
- voice that is too soft or loud, or too high or too low
- a rough, hoarse or squeezed voice
- slurred, washed-out pronunciation
- Speaking too slowly or too quickly
- a monotonous speech melody, choppy speech, inappropriate pauses in speech
- Pitch fluctuations and jumps
- Breathing disorders (shortness of breath, speaking while inhaling or at the end of exhalation, uneven breathing, etc.)
Good to know:
Vocabulary and speech comprehension are not affected by a speech disorder.
Swallowing disorders
In the case of a neurogenic swallowing disorder, also known as dysphagia, the otherwise quite automatic program no longer works so that eating and drinking can become a torture. Typical signs are:
- frequent swallowing
- Increased salivation
- the urge to cough
- a muffled voice
- watery, running eyes
- increased mucus production
- fever
- Malnutrition and loss of fluids
- possible social isolation, as food can also escape from the mouth or nose when swallowed
In many patients, food particles enter the respiratory tract. Half of all patients cough, the other half do not. This is because this protective reflex can also be impaired.
What triggers lead to swallowing and speech disorders?
Around 50 pairs of muscles and 5 cranial nerves are involved in the swallowing process. The five important nerves involved are the trigeminal, facial, glossopharyngeal, vagus and hypoglossal nerves. Depending on where the MS lesions occur, they no longer function properly or their otherwise completely unconscious coordination. Since we swallow about once a minute, that makes around 1,000 swallows a day. It’s really stupid when it no longer works properly.
Individual muscles or their interaction can also be impaired in speech disorders.
Important:
Medication for spasticity can worsen speech disorders. Perhaps it makes sense to try a lower dose and test whether speech becomes clearer again.
What tests are carried out to make the diagnosis?
In the case of swallowing difficulties, the organs involved in the swallowing process are examined in addition to general observations. It is checked whether there is sufficient sensitivity and how the swallowing attempt proceeds. If necessary, special endoscopes are used to check whether saliva, food or nourishment has accidentally entered the airways.
The precise diagnosis of speech disorders includes checking reflexes, lip movements, breathing, the jaw, soft palate, voice, tongue and general intelligibility. In addition, the progression is crucial: is there an improvement, does everything stay the same or does it even get worse?
Effects of MS-related swallowing and speech disorders
Speech disorders make it difficult to communicate with other people and can lead to isolation.
In the case of swallowing disorders, there is a risk of malnutrition, dehydration and pneumonia.
The quality of life decreases significantly in both cases. My tip is therefore. As soon as you or those around you notice any changes, you should seek professional help.
Specifically, difficulty swallowing can lead to frequent coughing and choking during eating and drinking. Food may also flow into your nose. Salivation may be increased. A frequent “gurgling” voice after eating or a foreign body sensation when swallowing can also be triggered by a neurogenic swallowing disorder.
Silent aspiration is a major risk. Food or drinks enter the airways and in 50% of those affected this happens silently, i.e. without coughing fits. Pneumonia can be the result, as can fever.
What can you do yourself to treat swallowing and speech disorders?
Seek professional help from a speech therapist at an early stage to avoid negative effects on your health and social life. The clear aim is to make your speech more understandable so that you can communicate with others easier again. If your breathing is affected, it will also be trained.
In the case of swallowing problems, the aim is to improve the actual swallowing process so that you can take in enough food and liquids regularly. The aim is to prevent choking.
Use the techniques and exercises you learn in your private life too. And also have all your other MS symptoms such as fatigue, tremor or spasticity treated. Multiple sclerosis is a complex disease that requires equally comprehensive treatment.
Specific tips for swallowing difficulties
Sit upright with your head held high.
Eat few sweet foods and dairy products, as they stimulate salivation.
Take your time when eating, drinking and speaking. Short breaks, good chewing and small bites are healthier and lead to fewer problems.
Use thickening agents. They can help you to drink liquids without choking.
Pay attention to consistency, it is a crucial factor. Avoid foods that are dry, small, grainy, chewy, irritating or spicy. They increase the risk of swallowing difficulties.
Avoid herbs, fibers and garnishes and mixed foods.
A fine, homogeneous, non-sticky porridge is ideal, as is soft food.
When drinking, keep your head close to your chest instead of bending it backwards.
Remain seated for at least 20 minutes after eating and then perform thorough oral hygiene. So that no small pieces of food can be swallowed later.
How can speech therapy help you with MS-related swallowing and speech disorders?
Speech disorders
In the case of speech disorders, behavioral change is the top priority. You will train your speaking speed, voice pitch and posture, as well as your pronunciation. You will also be taught to use short sentences.
Initially, the aim is to make you aware of your deficits so that you can then work on them in a targeted manner. This involves training the mobility of your speech organs, i.e. your tongue, lips and lower jaw and their movements.
Did you know that around 100 muscles are active when you speak? All these muscles can be strengthened and mobilized. Breathing plays a special role here, because without enough air, speech simply doesn’t work.
Group therapy may appeal to you. There you can exchange ideas with like-minded people and, above all, learn to argue and discuss. Regardless of whether you take on a certain role, lead the communication temporarily or process your illness, in the end you will be practising the exchange with others and that is very good.
If your problem is particularly advanced, the speech therapist will practise non-verbal communication with you, i.e. facial expressions and gestures. There are also technical support options, such as written communication aids, speech amplifiers or speech computers or various apps. Of course, aids can only benefit you if you accept them and see them as support.
Swallowing disorders
The specific swallowing therapy depends on the exact cause. For example, you can use exercises for your tongue and lips or consciously stimulate your swallowing reflex. An upright sitting position and head posture as well as very conscious, sometimes repeated swallowing and rasping can also be helpful.
There are also voice, speech and breathing exercises that not only help with speaking, but also promote better swallowing.
Note
Nowadays, there are a variety of treatment options to slow down or stop MS so that such severe symptoms become less and less likely. But of course there are also MS patients who have been living with the diagnosis for a very long time and have not received access to treatment or have only received it very late or have deliberately decided against it. For these people, it is good that there is a wide range of support available.
Is there medication for swallowing and speech disorders in multiple sclerosis?
If there is a very severe speech disorder and speech therapy does not lead to the desired improvement, Fampridin can be tried.
If saliva production is too high, an injection of botulinum toxin into the salivary glands may help.
As always, talk to your neurologist. They can advise you on which option is suitable and worth a try.
What other options are available?
If speech therapy alone is not enough to improve severe swallowing disorders, electrical stimulation of the throat muscles can be tried. And in particularly severe cases of malnutrition or if food keeps getting into the lungs, a gastric tube can provide permanent or temporary relief.
What is the best prevention against swallowing and speech disorders in MS?
That you have an effective disease-modifying therapy and combine it with a healthy lifestyle. There are treatment options for all types of MS. Regardless of whether you have mild, active or even highly active MS, whether you are in a relapsing or progressive stage.
Seek advice. Preferably from a doctor who specializes in multiple sclerosis. And be aware that you can choose a suitable therapy for any life situation and to suit your job or leisure activities. Injections, tablets, infusions – there are almost always several options to choose from. And remember, side effects are not nice, but progressive MS usually means much more serious and sometimes irreversible effects.
So reduce risk factors yourself by avoiding tobacco use and consuming little alcohol. Eat a balanced diet and exercise regularly, preferably in the fresh air. Then you have already made a very positive contribution.
Food for thought
If you occasionally have slight problems with swallowing or speaking that you didn’t have before, then simply get it checked by a specialist, be it your neurologist or a speech therapist. It is almost always the case that early intervention leads to a better prognosis.
Question for you
Have you ever had problems with swallowing or speaking? And was there possibly a connection to multiple sclerosis?
Maybe you are interested in the other articles about MS symptoms:
- Finding Joy Again. Navigating MS-Related Sexual Dysfunction
- Overcoming MS Sleep Challenges for Restful Nights and Brighter Days.
- Depression and MS. How to find your way back to emotional balance
- Living Fully with MS. Managing Bladder and Bowel Disorders
- MS Symptom Pain. How to regain your quality of life
- Spasticity in MS – far more than normal muscle cramps
- Movement restrictions in MS – how to maintain your strength, balance and mobility in the best possible way
- Clearing the Fog – Understanding Vision Problems in Multiple Sclerosis
- Cognitive disorders in MS – when the mind goes on strike
See you soon and try to make the best out of your life,
Nele
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