Communication and Swallowing

Communication & MS

Multiple sclerosis can cause problems with communication in up to 45% of people. Early assessment and accessing support is the best way to manage this symptom. Fortunately, there are treatments and techniques available that can help. 

What are the signs of MS-related communication changes?
  • Slurred, slow, or nasal speech
  • Reduced volume, poor pitch control, or fatigue after talking
  • Difficulty “finding words”
  • Needing more effort or noticing your speech slows down

These are signs of dysarthria (muscle weakness/coordination in speaking) or language impacts (“finding the words”).

Communication changes in MS happen when areas of the brain and nerves that control speech, voice, and language are affected. This can disrupt the coordination and function of the mouth and throat muscles used for speaking, or slow down the thinking process needed to find words and follow conversations. Fatigue can also have an impact on communication and speech.

  • Seek Speech and Language Therapy (SLT) as soon as you notice a problem.
  • Early intervention leads to better management.
  • The SLT works with your GP and may get input from neurologists or dietitians.
  • Voice and breathing exercises
  • Adjusting speaking pace and volume
  • Techniques to conserve energy
  • Use of alternative communication: writing, pointing, or electronic devices if needed
  • Education for carers/family in the use of technology

If speech or communication changes become more severe, there are still many ways to stay connected. Speech-language therapists can teach practical strategies and tools to make communication easier, from exercises to strengthen speech muscles, to technology that helps get your message across. 

While communication changes in MS can be challenging, there are many strategies available to help. With the right support and tools, you can continue to share your thoughts, feelings, and stories, and stay fully involved in conversations and daily life.

Early support makes a real difference, so if you notice changes talk to your health care team. 

MS and Swallowing

Swallowing difficulties are common among people with multiple sclerosis. It is estimated to affect approximately 30-40% of those diagnosed, and may be higher with increased age and disease duration.

Swallowing problems can come and go – sometimes appearing during MS relapses – or they may persist. These issues can affect your ability to enjoy food and drink, get enough nutrition, and may impact your overall health and wellbeing.

It’s important to know that help and practical solutions are available and should be sought early. Swallowing changes don’t mean you have to give up meals you love or miss out on social occasions. The right support can make eating and drinking safer and more comfortable, so you can focus on living well with MS.

What causes swallowing problems in MS?

Swallowing relies on precise coordination of muscles and nerves in your mouth and throat. MS can damage the nerves that control these muscles, making actions like chewing, moving food to the back of your mouth, or triggering a swallow more difficult. Sometimes, a weak cough makes it hard to clear food or drink that goes down the wrong way. These changes may be temporary or ongoing, and can arise at any point during your journey with MS.

Let your GP know straight away if you notice:

  • Coughing or choking while eating or drinking
  • Food, drink, or medication sticking in your throat
  • Food or fluid coming up into your nose
  • Sneezing, sniffing, or taking longer to finish meals
  • Difficulty managing saliva, or more drooling than usual
  • Other warning signs include reduced eating or drinking, weight loss, dehydration, or frequent chest infections. 

Start by telling your GP about any swallowing changes. You may be referred to a Speech and Language Therapist (SLT) who specialises in diagnosing and managing swallowing issues. SLTs can assess your symptoms, suggest tailored strategies, and work with you to improve safety and comfort. You might also see a dietician for nutritional advice, especially if you’re trying to maintain your weight or enjoy more variety in your meals.

  • Reduce distractions. Eat meals in a quiet, calm place and avoid talking with food in your mouth.
  • Sit upright. Always eat and drink while sitting in a stable, upright position.
  • Be alert. Try to eat when you’re fully awake, and consider smaller, more frequent meals if needed.
  • Take small bites and sips. Pause between mouthfuls to clear your mouth.
  • Choose easy foods. Soften food with sauces or gravies, and add extra moisture if needed.
  • Change textures. Try blended soups, mashed foods, or let cereal soak until soft.
  • Experiment with food and drink temperatures to see what feels best for you.

If tablets or capsules are hard to swallow, try taking them with pureed food or smoothies (if safe for your medication type). Always check with your pharmacist or GP before cutting, crushing, or changing how you take any medicines, as not all medicines can be altered safely. In some cases, your pharmacist may be able to provide a liquid version.

If swallowing becomes too hard, more specialised feeding options might be needed to keep you safe and well-nourished. A Speech and Language Therapist, dietician, and your healthcare team can talk you through your options, so you can make the choice that’s right for you and your whānau.

Swallowing should never feel painful, scary, or take away from the joy of eating. With the right help and adjustments, most people with MS can enjoy food and drink safely and comfortably. If you have concerns, talk to your GP, MS nurse, or SLT as soon as possible. Support is always available you’re not alone.

Eating delicious food can be a wonderful source of joy, and sticking to a healthy diet can help you live a longer, healthier and more energetic life.

Swallowing difficulties don’t have to interfere with this. Your Speech and Language Therapist can help you find ways to make eating easier,
so take some time to tell them what you want to be able to eat; they will try to find ways to make sure you can still enjoy your favourite foods and drinks.

If swallowing becomes more difficult, your SLT can suggest alternative options, including modified diets or other feeding methods when needed. Their goal is to keep eating enjoyable, safe, and nourishing.

If you experience changes, don’t delay — speak with your GP or MS nurse and ask to see a Speech and Language Therapist.

Further Info:

For further communication and swallowing support and advice:

Medical History & Neurological Examination:Medical History & Neurological Examination

The doctor collects a detailed history of symptoms, family background, and other relevant factors. A neurological exam assesses mental, emotional, and language functions, movement, coordination, balance, vision, and other senses. Keeping a record of symptoms and sharing them with your GP and neurologist is recommended for a comprehensive assessment

MRI scans are the most effective imaging tool for detecting MS plaques or lesions in the brain and spinal cord. They help identify both old and new areas of damage, but a diagnosis cannot be made based on MRI alone, as similar lesions can occur in other conditions or even in healthy individuals

These tests measure the nervous system’s electrical response to sensory stimulation (such as visual or auditory). They can reveal areas of slowed nerve conduction caused by demyelination, even when not detected in a standard exam

Analysis of cerebrospinal fluid can detect immune proteins and oligoclonal bands, which indicate inflammation in the central nervous system.

These findings support an MS diagnosis but are not exclusive to MS

While there’s no blood test for MS itself, blood tests are used to exclude other conditions that can mimic MS symptoms, such as infections or autoimmune diseases

Diagnostic Criteria

The internationally recognised McDonald Criteria (most recently revised in 2017) guide the diagnosis of MS.

To confirm MS, a doctor must find evidence of inflammatory damage in at least two separate areas of the central nervous system (CNS), occurring at different times, and rule out other possible diagnoses. The criteria allow for earlier diagnosis, even after a single clinical attack (Clinically Isolated Syndrome, or CIS), if MRI or other tests show additional evidence of disease.

Types of MS

MS can present in several forms, each with distinct patterns of symptoms and progression:

Clinically Isolated Syndrome

A first episode of neurological symptoms caused by inflammation or demyelination in the CNS, lasting at least 24 hours. CIS may or may not progress to MS, depending on MRI findings.

Relapsing Remitting MS

The most common type, marked by clearly defined relapses (attacks) followed by periods of full or partial recovery (remission). About 85% of people with MS are initially diagnosed with RRMS.

Secondary Progressive MS

Initially begins as RRMS, but over time, the disease transitions to a progressive course with or without occasional relapses, minor remissions, or plateaus.

Primary Progressive MS

Characterised by steadily worsening neurological function from the onset, without early relapses or remissions. About 10–15% of people with MS have PPMS.

Progressive Relapsing MS

A rare form featuring steady progression from the start, with occasional acute relapses.

Symptom Management