Managing speech problems

Speech therapy can help you find the methods that work best for you.

If muscle stiffness or spasms are causing your speech difficulties, there might be drug treatments to help relieve them. But in most cases, drug treatments won’t help. Instead, a speech and language therapist can help you find ways to compensate for problems. They'll help make communication and speech as easy as possible.

Things you can try with a speech and language therapist include:

• Exercises that strengthen or relax the muscles controlling the vocal cords. This can help with voice changes, like difficulties with volume and pitch, or a hoarse voice
• Practising different techniques to help you speak more clearly
• Looking at ways to help you communicate better. This is sometimes called 'functional communication therapy'. It puts the emphasis on communicating, rather than accuracy of the sounds. For example, you might look at how to phrase things in the shortest, most concise way. Or ways to simplify sounds, words or sentences. This makes sure you still get your message across
• Breath control exercises can help you make longer sentences in one breath, stress words and catch quick breaths between thoughts. Your speech and language therapist can also show you how to monitor your own breathing

Here are some simple things you can do that could make communication easier. Your speech and language therapist can work through these with you.

• When you need to communicate, don't try to compete with other noises, like TVs and radios. If you can, remove what’s making the noise, or move somewhere quieter
• Make sure you have someone's full attention before starting to tell them important information. Introduce the topic first, And be prepared to repeat things if necessary
• Whenever you can, try to communicate face to face. Your facial expression, gestures and body language can help the listener understand what you’re saying
• Try to speak slowly, with short sentences. And focus on speaking as clearly as you can
• If a conversation goes on for a long time, you might find your speech becomes less clear. If this happens, you might explain that you need a break before starting the conversation again
• If you have problems finding the right word, or remembering what you are trying to say, take your time and use notes if necessary. Try using alternative ways to describe things if you can’t find the right word
• Try to stay relaxed. Take regular pauses for breath when you’re speaking, and avoid rushing
• If you feel you can, try to laugh or smile about things. Both you and the person you’re talking to may feel less anxious about not understanding or being understood. And that can help the communication
• If you have difficulty making yourself heard on the phone, something as simple as raising the volume control might help. Specialist gadgets could also be helpful. Or you might prefer to send a text or email
• Good posture can sometimes make it easier to speak. Use pillows and foam supports for good posture when you’re sitting or lying down. A physiotherapist can help with posture
• Stress and anxiety can make speech difficulties worse. If this affects you, speak to your doctor, MS nurse or other health care professional. There may be treatments that can help. You might also find it helpful to connect with other people with MS who have speech difficulties. For example, on our online forum

As a friend, carer or family member, there’s lots you can do to help someone with MS speech difficulties. You might not remember to do these things every time. Open, honest communication is often what matters most.

• Most people who have MS speech difficulties have problems with the physical process of creating speech. Don't assume that someone has trouble thinking of words or understanding what you are saying
• When you’re speaking with someone who has speech difficulties, remember it can be frustrating and tiring for them to talk
• Be honest when you really haven’t understood something
• It might help if you ask ‘closed questions’ to clarify things and be sure you have understood. For example, if you ask “Do you mean ...?”, they can clarify with a yes or no
• Start with broader questions – like “Are you talking about something that happened this morning?” – before getting more specific
• Try to be patient, and don’t try to finish their sentences for them
• Not being able to find the right words or not being understood can make someone more anxious. This can then increase speech difficulties. Try to keep calm and understanding, and reassure them if necessary

If your speech is more severely affected, your speech and language therapist may suggest a communication aid.

There’s a range of gadgets available. They can help in different ways. For example:

• Voice amplifiers can increase the volume of your voice
• Communication devices can play pre-recorded messages when you press a button. They might store just one message or several you can choose from
• Devices, apps and software can translate written words into speech. For example, you might type a message into your phone and it reads it out loud for you. A textphone could give you the option of speaking when you feel able to, or typing when not

You might find useful apps by searching your usual app store for ‘AAP’. That stands for Augmentative and Alternative Communication. And the charity website Living Made Easy has more about apps, devices and other useful aids.

A speech and language therapist can suggest options and work with you to learn how to use them. Finding the right aid or device for you depends on your overall situation, not just how your speech is affected. Some other MS symptoms might affect what aids work well for you. For example, finding something that works with tremor in your hands, or eyesight problems.