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You deserve freedom of speech!

Do you find your friends and family finishing sentences for you, asking you to repeat words or simply losing interest in conversation? A tongue-twister called dysarthria may be the culprit affecting your speech if you have MS, according to Kathleen R. Helfrich-Miller, Ph.D., CCC, a Pittsburgh speech-language pathologist.

Dysarthria is actually a broad term referring to speech impediments that result from poor coordination or weakness of muscles in the tongue, lips or palate. The symptoms may include: slurred speech, vocal harshness, lowered volume, change in tone and speech rhythm, inappropriate stress and a reduced rate of speaking. For people with MS, the severity of the problems and the ease of correcting them depend on the extent of neurological damage.

However, it is reassuring to note that only about 10% of people with MS suffer with significant dysarthria and of these only 2% struggle with unintelligible speech.

Moreover, MS speech problems usually affect only the quality of speech, not the knowledge of speech. Dr. Miller says it is rare to see problems such as aphasia -- a disorder in which articulating ideas becomes difficult. "That kind of speech problem is much more common in stroke patients than in people with MS," she says.

The third piece of reassuring news is that from the mildest to the severest problem, there is usually something that can be done to improve communication.

Among those who have excellent potential for correcting speech problems are individuals with relapsing/remitting MS, according to Dr. Miller and other authorities, in good part because the symptoms experienced in a relapse are often treated successfully together. A typical case involves a woman from Missouri who had had a mild case of relapsing/remitting MS for nearly 20 years and then experienced her first harsh attack in 1976. "I had severe fatigue, numbness and slurred speech, among other symptoms," she recalls. "My doctor put me in the hospital and treated me with ACTH injections. They worked, reducing my speech problems along with everything else.

"My latest relapse was just a few months ago. I had double vision, memory loss and I was stuttering. This time I was given steroid pills that helped me get better faster. Now I'm fine again."

For mild cases where general medication is not indicated, "often simple exercises and improved posture can help," Dr. Miller says.

A 40-year-old Pittsburgh woman who had an exacerbation experienced difficulty in maintaining normal speech in speaking and in pronouncing some words, among other symptoms. Several days of speech therapy and repetitive pronunciation exercises put her back on the track to normal speech.

"The therapist slowed my speech down and had me repeat sounds like 'sha-shi-pa.' Also the therapist taught me how to hold myself erect and breathe deeply. It all really helped."

"In another instance, a 35-year-old woman diagnosed at the age of 25 had already had some 10 years of on-and-off speech therapy before I saw her for the first time," Dr. Miller reports. "Her symptoms included weakness in the tongue and lips and a rapid rate of speech. We slowed the rate down and improved posture, and used strengthening exercises as well. When we discharged her from regular therapy, she still had some slurring in her speech, but she was able to communicate.

"This woman responded typically to her problem by trying to speed up her speech, which only makes things worse." Dr. Miller and all authorities stress that "just slowing down can do wonders to improve how well you speak and how easily you are understood by others. This is the first, crucial step to take."

Although some must work much harder than others, no one should just put up with speech problems, thinking nothing can be done. Therapy should be tried.

Just how good are the results? Because of the wide variations in how MS affects different individuals, Dr. Miller says it's impossible to make blanket promises or predictions.

"Some people after a little help can speak fairly normally," she says, "while others who work long and hard do not make much headway. But while not everyone can speak perfectly, I can say that nearly all of those I have examined have been able to improve their ability to communicate." One of Dr. Miller's patients is a 54-year-old man diagnosed 23 years ago with relapsing/remitting MS. Symptoms include severe spasticity and moderate to severe dysarthria, as well as swallowing problems.

"For the swallowing problems we put him on a pureed diet and gave him a special cup that did not require tipping the head far back. In normal sitting posture, the act of swallowing automatically closes off the trachea, or airway. But when the head is tipped back, closing off the airway relies more on manipulation of the tongue. As for dietary changes, in most cases, pureed food isn't necessary. Simply chopping some of the more difficult foods is all that is necessary.

"For his speech, we started him on oral motor exercises and articulation drills, and prescribed a supplementary speech synthesizer to help him communicate while speech therapy was under way. The device was later discontinued."

After a year of the drills, plus work on improving his posture, this man's speech had become intelligible.

No matter how mild or how severe the problem may be, the first step, says Dr. Miller, is proper testing to try to pinpoint the problem.

"I start by testing a person's speech," she says. Included is an oral motor exam, which evaluates the functioning of the tongue, lips, and other facial muscles often slowed down by MS.

"Once a determination has been made as to extent of dysfunction, and its source, I begin to work on a corrective plan. Therapy usually starts with various, basic exercises -- drills to improve the speed, volume, rhythm and articulation of speech.

"Often when people realize they're having difficulty, their first reaction is to try to speed up to a normal pace. The trouble is that as speed goes up, the quality and intelligibility of speech frequently go down. I slow people down at first, and speech quality usually improves almost immediately."

Another part of the slowing down process is controlling prosody, or the phrasing of speech. Speech often is improved by grouping fewer words together, Dr. Miller says. "At the same time, I work to improve inflection.

"Frequently when people work hard to get the words out, they neglect the melody of speech. When you speak in a monotone, it's often harder to be understood."

Poor posture can further weaken already weak muscles. So Dr. Miller says she works on strengthening the head and neck muscles, getting better control of the shoulders, and improving posture -- often by anchoring the hips when sitting in a wheelchair. Deep breathing exercises also can help make speech clearer.

Those who are more severely affected and have poor breath control and weak speech can fatigue easily when talking. Authorities in the field, therefore, begin treatment with the determination of a comfortable number of syllables per breath cycle. A patient may be taught to pause between phrases for two to three seconds to relax the muscles used in breathing and speaking.

When there is nerve damage, exercises can't always do the trick. "When that happens," Dr. Miller says, "compensatory methods sometimes work, such as using the blade instead of the tip of the tongue to make a certain sound."

Communication also can be aided by enhancing the speaking environment. Direct eye contact, closer positioning of speaker and listener, and reduction of background noise interference all help.

"If after a reasonable time -- about three to six months -- there hasn't been a significant improvement by using any of the methods discussed, I consider alternative methods of establishing communication -- voice or speech synthesizers.

"Usually a course of speech therapy lasts six months to a year," Dr. Miller continues. She explains that turning to a speech aid does not mean therapy has failed or is finished -- often the two avenues to better communication are followed at the same time: The voice synthesizer makes communication easier while therapy continues. The device may be discontinued later when speech has improved.

"Basically, I feel a speech aid is desirable if individuals cannot communicate with their caretakers or others whom they see daily. It is also wise and recommended to check with your physician to see if he or she feels a device is indicated."

It is not always necessary to purchase a synthesizer for temporary use, as a number of therapy centers maintain a pool of the devices. Dr. Miller says that while the cheapest models may be adequate for limited periods during therapy, patients should consider higher quality devices if they are purchasing them for possible permanent use.

A Raleigh, North Carolina man still struggles with slurred speech, although he says his speech used to be much worse. Exercises and other therapy he underwent four years ago did not help very much, and today the former engineer is working on a speech synthesizer that talks for him. "I can communicate," he says. "That's the important thing."

Dr. Miller comments that a key feature of the Handy Speech Communication Aide, a laptop, computer-based relatively inexpensive system she developed with her partner, an electrical engineer, is that it can be operated by a single muscle movement, such as an eyeblink or the twitch of a finger.

This is one of many devices on the market designed to facilitate communication. (See box below.)

"The technology is now here to help," Dr. Miller stresses. Although the majority of people with speech problems as a result of MS do not need communication devices, they are a god-send to those wo do. There is hope and help from the mildest to the severest cases -- that is the most important message I can convey."
COPYRIGHT 1991 National Multiple Sclerosis Society
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Copyright 1991, Gale Group. All rights reserved. Gale Group is a Thomson Corporation Company.

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Title Annotation:dysarthria victims; includes related articles on oral exercises to aid speech problems, speech communication devices
Author:Frames, Robin
Publication:Inside MS
Date:Mar 22, 1991
Previous Article:A crash course in being a mom ... with MS.
Next Article:Disability Express.

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