People with MS often have trouble with swallowing (dysphagia) and speech (dysarthria) due to the nerves in the brain and spinal cord that make these tasks happen becoming damaged. These difficulties are more common in those with advanced MS, but can occur at any stage. Speech and swallowing problems also vary in severity but treatments and techniques can help you improve speech and make swallowing easier.
It is important to discuss any concerns with your health professional as food or liquids in the lungs can cause pneumonia or abscesses, or a person may be at risk for malnutrition or dehydration if food is not reaching the stomach. A person can also inhale small amounts of food or liquids without being aware of it. This is called silent aspiration.
You may notice:
As each person’s experience will be different, individual management strategies are essential. It is better to seek assessment sooner rather than later, to ensure effective management. It is important to see a Speech and Language Therapist if any of the following occur:
Early intervention is vital as problems with swallowing can also result in weight loss, poor nutrition, dehydration and chest infections.
Difficulties with speech are fairly common with MS. Speech changes may begin with a slight slurring of speech, with a later weakening of the muscles of the mouth and throat. There are many areas in the brain, and brainstem, that control speech patters and when lesions appear and damage certain areas changes to speech patterns occur. Changes may stem from mild to severe making it difficult for people to speak and be understood. Not only can clarity of speech be impacted but also and non-verbal communication such as facial expressions. Additionally, you may have trouble ‘finding the right words’, as lesions on the brain affect the ways the brain finds words. A Speech and Language Therapist can help you focus on breathing techniques, learn energy conservation and find strategies to improve the volume and pace of your speech. Dysarthrias are commonly associated with other symptoms caused by lesions in the brainstem which may include tremor, head shaking or incoordination.
Common issues that occur:
Alternative communication methods
If speech becomes too difficult, other ways of communicating may be easier. There are many options available, such as: using pen and paper; pointing to pictures or written words; or using electronic communication devices. If communication technologies become necessary, a Speech and Language Therapist can discuss which technology is most appropriate and teach the best use of aids that can support or substitute speech. Your GP should be able to refer you for a review. Carers, family and friends should be taught about these technologies as well, as they will be communicating with you via the alternative system.
MS can damage the nerve fibres in the brain that control swallowing, or damage the nerves in the muscles that execute this function. As a result, chewing and readying food for swallowing may become difficult. Triggering a swallow and clearing food from the mouth may become harder and coughing may be weaker. Some food and fluid loss from between the lips may also occur. It is important that you, your carers and family members are alert to the possibility of swallowing problems, so that advice regarding management can be sought early. Modifications to the texture of your food and drink may increase food intake and safety. Other factors also play a part, such as posture and the eating environment. A Speech and Language Therapist will need to assess your situation before recommending specific management strategies.
Changing what you eat
For maximum enjoyment, try and vary your diet as much as possible. A dietician can match food preferences with adequate nutrition and the textures required for safe swallowing.
Changing how you eat
Changing the eating environment
Distractions during mealtimes can make managing problems more difficult, especially if you have to pay particular attention to a therapy technique.
Some suggestions that may make mealtimes easier are:
Swallowing difficulties may affect how you take any medications. It may be better to take tablets whole with pureed food or smoothies rather than water. Alternatively, check with a pharmacist if it is acceptable to cut or crush the tablets, or whether the medication comes in liquid form. Note: It is essential to discuss any changes to how you take your medications with your pharmacist.
You should be aware that:
Sometimes swallowing problems may mean eating becomes too difficult and alternative feeding methods (i.e. a tube) will be suggested. An Speech and Language Therapist can describe the various options in your case to help you and your support team make the best decision.
Associated Difficulties – Excessive Saliva
Some people may find they have more saliva in their mouths than they can manage. This is not the result of increased saliva production, but of lip, cheek and tongue weakness and less frequent swallowing. This can cause drooling.
The following strategies have been found to be useful:
Other potential remedies include:
Xerostomia (dry mouth)
Xerostomia is caused by a lack of saliva in the mouth. Saliva production commonly decreases as a result of dehydration, as a side effect of certain medications, or because the saliva glands are not functioning correctly. It is uncomfortable and can make chewing, swallowing and speaking difficult.
Some strategies for coping with a dry mouth include:
Xerostomia alters the acid balance in the mouth, and makes teeth susceptible to cavities. Thus, it is very important to stay vigilant about oral health – including checking for ulcers and tooth decay. If using a mouthwash, it is important to avoid those with alcohol as this can damage the lining of the mouth. Also, dry mouth can affect the lips and skin around the mouth. Lip balm can be used to prevent cracking, but should be nonpetroleum based to avoid skin reactions and dryness.
Because MS brings ongoing changes to functional abilities, regular monitoring and reviews are essential. Sometimes this will involve full reassessment, but may simply require informal discussions with you and those involved in your care. As with any other MS-related issues, managing speech and swallowing impairments works best when you, your family and carers, and other support services take a positive and collaborative approach.
For more information please view our MSNZ Information Series booklet: Multiple Sclerosis Speech and Swallowing