Speech problems of some kind are quite common for people with MS.

Speech problems with MS can come and go through the day. They sometimes last only a few minutes at a time. They might only appear during a relapse and fade away afterwards. Some people find their speech problems get worse when they’re tired.

For many people with multiple sclerosis, any changes in their speech are mild and don’t stop them from being understood. For other people, speech difficulties might be longer-lasting and make it harder to communicate.

There are practical ways that could help you manage these changes. A speech and language therapist can help find what works for you.

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How do we speak?

Speaking is a complicated process. It involves different parts of your body acting together – all controlled by your brain.

First of all, your brain has to work out the language for what you want to say. Then it sends messages to the all the muscles that control how we speak. That tells the muscles how to form the right words and sentences. All of this happens in a tiny fraction of a second, so we‘re not usually aware it’s taking place.

When you’re talking, your brain continues to send messages to these different muscles. This creates the accent, volume, tone and precision of our words.

There are lots of parts of the body involved in speech, including:

  • Your lungs - These push air upwards through your windpipe and voice box and out through your nose and mouth
  • Your diaphragm - This is a large sheet of muscle that stretches right across the bottom of your rib cage. Your diaphragm helps to control how much breath you use, and how forcefully it’s pushed out
  • Your voice box (‘larynx’) - This contains two small bands of muscle tissue, called your vocal cords. When you speak, you push air through a gap between the vocal cords, making them vibrate. This creates sound. The pitch of the sound (high or low) changes depending on how tight the vocal cords are pulled
  • Your throat, mouth and nasal cavity - These all work together to control how the air the passes through after your vocal cords. This adjusts the tone of the sound
  • Your lips, tongue, jaw and palate - Together, their movements create the particular vowel and consonant sounds we make. They also affect the tone of sounds produced

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Common MS speech problems

Not everyone with MS has speech problems. But if you do, common MS speech problems and voice changes include:

  • Slow or slurred speech
  • Not being able to control the volume or pitch of your voice
  • Sounding “nasally” – like you’re speaking through your nose
  • Having long pauses between words or syllables
  • Hoarseness – a hoarse voice means your voice sounds breathy, raspy or strained
  • Sounding monotonous (not being able to emphasise different words or change the pitch or tone)
  • Not being able to control your breathing when you speak

As well as changes in how you speak and sound, you may have problems with other aspects of communicating. For example, not being able to remember words, or finding it hard to follow conversations.

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What causes speech problems in MS?

There are a few different ways MS can cause speech problems.

MS can affect parts of your brain that control the muscles involved in speech. When these muscles are affected, the speech problem is called dysarthria. Some people find that medications they take for MS can contribute to dysarthria.

MS can also affect the messages in the brain that control your voice box. This can change the sound of your voice. It’s known as dysphonia.

MS can cause problems with memory and thinking, which can affect communication too. You may have trouble understanding or using language. It can also affect the thought processes involved in communicating. These are sometimes called cognitive communication difficulties. More rarely, MS can cause specific changes called dysphasia or aphasia.

Find out more about the causes of speech problems with MS

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Coping with social situations

For most of us, speaking is a major way of communicating with other people. If you have speech problems this could affect how you feel about yourself and how you relate to others.

Speech difficulties can sometimes make social situations awkward or uncomfortable. People might not understand why your words sound slurred or why you’re speaking louder than usual. For example, some people with MS find they need to explain that they are not drunk if they sometimes slur their words.

If you find it hard to explain, it can make you feel like you want to avoid these social situations. We don’t always want to explain everything to everyone.

We’ve got a free ‘I have MS’ card which fits in a wallet or on a keyring. It might help to raise the issue if you need to. You could also try thinking of a simple way to explain your speech difficulties. Then rehearse it until you become comfortable with saying it.

Order your free ‘I have MS’ card

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Treatments for speech problems

There are lots of ways to manage speech problems. Speech and language therapists can help. Your doctor or nurse can refer you.

Speech therapy can involve exercises to help improve your speech and voice, and to control your breathing. A bit like physiotherapy for the voice.

Your speech and language therapist can also help you find easier ways to communicate. That can include finding ways to simplify sounds, words or sentences, or using alternatives like text or email when you need to.

There are simple things you can do yourself to make speaking easier. For instance, communicating face-to-face can be easier than over the phone. And letting people know if you need to take a break.

Communication aids include devices and gadgets that can help if you’re more severely affected.

If you’re at work, you can ask for ‘reasonable adjustments’ to help you do your job. You might find it useful to point your employer, as well as family, friends and carers, to our information. But let them know they should still learn from you about how you’re affected, when you want to explain. Your MS might be different to someone else’s.

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