Communication difficulties with MS

Around 40-50% of people with MS will find that communication is affected at some point. These symptoms may or may not be there all of the time. As with other areas affected by MS you may find communication becomes more affected during a relapse and then improves again. You may find that it is only affected when you are fatigued.  The symptoms that you experience will depend on which part of the nervous system is affected but may include:

  • Slurring of speech
  • Changes to the speed of speech
  • Speech which sounds like it comes down the nose
  • Changes to the voice such as changes to vocal quality or the pitch of the voice
  • Difficulties with breath support for speech
  • Fatigue

Although less common MS can also affect language such as problems with

  • Word finding
  • Processing of the words becoming slower
  • Losing track of what has been said or what you want to say

What can I do if my Speech is affected?

  • Reduce background noise to make it easier to be heard
  • Make sure that you are facing the person you are talking to and that you have their attention before you start to speak
  • Use shorter sentences
  • Take time to pause for breath
  • Slow down the speed of your speech
  • Have rest periods if you find that your speech fatigues

What can I do if my language is affected?

  • Try to remain calm as stress will often make it harder to find the word
  • Try to use other words to explain what you want to say
  • Plan ahead- for example if you are going out to a party you may want to note down people’s names before you go
  • Reduce background noise and distractions as this may impact on processing of what is said
  • If you can’t find a word you could try the following.
  • think of other words which are associated with the one you want
  • Go through the alphabet to see if this helps activate the word
  • Describe the word to someone e.g. what group does it belong to, where do you find it, what does it look like, what does it do

Speech and Language Therapy Services for MS in Herefordshire

Speech and Language Therapy can provide:

  • assessment of communication difficulties
  • strategies to enable better communication
  • Exercises to help to improve the clarity of speech
  • Advice regarding word finding
  • AAC assessment and support with referral on to specialist services as required.
  • Swallowing assessment, treatment and advice

The Speech and Language Therapy Department mainly see people in clinic in Hereford but can provide home visits where people are not mobile enough to attend. If you are registered with a GP surgery in Herefordshire you can be referred to Speech and Language Therapy for a communication assessment through your GP, Consultant or MS nurse. You can also make a self-referral for communication assessment/treatment.

If you would like to make a self-referral please complete a referral form following the link below and send it to either salt.hereford@nhs.net or post it to Speech and Language Therapy, Vaughan Building, Ruckhall Lane, Belmont, Hereford, HR2 9RP.

https://www.wyevalley.nhs.uk/visitors-and-patients/county-hospital-(acute)/a-z-departments/speech-and-language-therapy/referral-form-and-criteria.aspx

Links for further information

MS society

https://www.mssociety.org.uk/about-ms/signs-and-symptoms/speech/managing-speech-problems

MS Trust

https://mstrust.org.uk/a-z/speech-problems

Swallowing

As well as working with people on their communication Speech and Language Therapists also assess and manage people’s swallowing.  This involves a discussion regarding your swallow, an examination of how the nerves are functioning and trials of different textures of food and drink.  Advice can then be provided on how to optimise your swallowing.   This may include advice about food and drink textures, postures to use or alternative strategies.  Where appropriate swallowing exercises to improve the swallow can be provided. 

Sometimes you will be sent for further assessment using videofluoroscopy.  During a videofluoroscopy you will be given food and drink containing a small amount of barium which will show up on a video x-ray.  This will give more detailed information about how the swallow is functioning and what can be done to make it safer for you to eat and drink.  Herefordshire patients have to travel to Gloucester Royal Hospital for this assessment.

The Speech and Language Therapy Department mainly see people in clinic but can provide home visits where people are not mobile enough to attend. If you are registered with a GP surgery in Herefordshire you can be referred to Speech and Language Therapy for a swallowing assessment through your GP, Consultant or MS nurse.  Please contact the department on 01432 363975 or email at salt.hereford@nhs.net if you have any queries about referral.

At least a third of people with MS probably experience some changes in their swallowing at some time (MS Society). These difficulties are often due to damage to the nerves which control the muscles for eating and drinking including the tongue, lips, jaw, throat and larynx or the sensory nerves which feedback what is happening.  Sometimes there are also changes to the thinking processes involved for swallowing such as concentration.

Difficulties that people may experience with eating and drinking can include:

  • Taking longer to eat a meal due to effort to swallow or fatigue
  • A sensation of food and/or drink sticking in the throat
  • Chewing becoming more effortful
  • Food and drink going “the wrong way”
  • An increase in coughing and throat clearing when eating/drinking
  • Problems with keeping food and drink in the mouth
  • Dribbling
  • Problems clearing food from the mouth
  • Numbness in the mouth and/or throat
  • Food/drink coming back up
  • Weight loss

In some cases these symptoms can be mild. Mild symptoms can impact on people differently ranging from mild discomfort to feelings of embarrassment or anxiousness.  Where people experience more severe swallowing symptoms there can be weight loss or an increased risk of chest infections (aspiration pneumonia) which will need to be managed by the Speech and Language Therapist and Dietician.

Tips for managing swallowing

Below are some ideas of strategies which may help but please also request a referral to the Speech and Language Therapy team for assessment of your swallowing:

  • Reduce distractions
  • Don’t rush when eating and drinking. Cut the food up and take your time
  • Alternate food with a sip of drink if there is a sensation of food sticking in the throat
  • If you find that you fatigue when eating have smaller more frequent meals and eat at a time of day when you are less fatigued
  • Note down foods which cause you difficulties and try to find alternatives which are easier to swallow
  • Make sure that you are sat up well in a supportive chair for mealtimes.
  • Don’t try to speak whilst you are eating
  • Make sure you clean your teeth and mouth regularly to reduce bacteria
  • Ask your GP or MS nurse for a referral to Speech and Language Therapy to provide assessment, advice and treatment for your swallowing

Links for further information

IDDSI - Patient Handouts If you have been advised to have certain textures of food by the Speech and Language Therapist then follow this link for further information

Swallowing | Multiple Sclerosis Society UK (mssociety.org.uk)

Swallowing | MS Trust