How speech pathology can help communication for people living with Multiple System Atrophy (MSA)

From a speech pathology perspective, MSA can impact a person’s ability to communicate and swallow effectively. MSA affects the nervous system which is responsible for voluntary and involuntary movements. In turn, it can impact the muscles used for chewing, swallowing and talking. 

Communication is a vital part of every person’s life and more fundamentally, it is a human right. Speech, signs, gestures and communication devices are just some of the ways people connect with those around them. 

For people living with Multiple System Atrophy (MSA), communication can become increasingly difficult. Common features of communication in MSA include:  

• Dysfluencies (stuttering).
• Dysarthria (slurred speech).
• Dysphonia (hoarse voice, decreased breath support).
• Reduced precision in articulation.
• Changes in rate of speed (too fast or too slow).
• Cognitive communication difficulties. 
• Reduced movements of the arm impacting ability to engage in non-verbal communication e.g. waving, thumbs up etc.  

The nature and severity of communication difficulties vary from person to person. 

At MSWA, we conduct comprehensive communication assessments to identify the most effective ways to support every person’s communication. We welcome the involvement of family, carers and friends during these sessions, as it helps everyone learn strategies to stay connected and engaged. 

As MSA progresses, different modes of communication may be introduced. We will work with you to find what best supports your needs. This may include: 

• Low-tech supports such as alphabet boards or picture cards.
• High-tech supports such as speech-generating devices or eye-gaze technology. 

We offer a range of both low-tech and high-tech options and can support you to trial and learn how to use them effectively. 

In a busy world, we often forget to slow down and focus on communication. When speaking with loved ones who experience communication difficulties, here are some general tips that may help you engage in more meaningful conversations: 

• Time: Everyone benefits from extra time to process information. Try silently counting to ten before jumping in or asking another question, this can give your loved one the time they need to respond.
• Environment: Noisy or busy rooms can make it harder to process and respond to information. When talking, make sure you're close to your loved one and that they can see your face. In busy environments, we often rely on other modes of communication, like facial expressions and gestures, to help us understand the message.
• Visuals: Presenting information visually can support understanding. If someone doesn’t seem to grasp what you mean, try writing it down, pointing to the object or even showing an image.
• Check understanding: There’s nothing worse than pretending to understand. Make an effort to clarify any confusion and check for understanding if you’re unsure what the person has said. You might follow up with a yes or no question to help confirm the message. 

Speech pathologists support individuals experiencing difficulties with their eating, drinking and swallowing. MSA can affect an individual’s ability to safely and effectively eat and drink this may look like; 

• Coughing of choking on foods. 
• Increased movement in the arms and legs impacts someone’s ability to bring food to the mouth.
• Jaw muscle and lip muscle weakness or reduced range of movement impacting chewing and keeping food, drink and saliva in the mouth.
• Recurrent chest infections and/or aspiration pneumonia. 
• Turning away meals or drinks that were previously enjoyable.  

 
If you spot these signs in an individual living with MSA, they may benefit from a speech pathology review.   

We can support individuals to identify safe food and fluids to implement a mealtime support care plan or mealtime management plan. Mealtime support is best provided in collaboration with dietitians to ensure individual nutritional and hydration needs are met. Occupational therapists can support in identifying appropriate posture and equipment for mealtimes.  

If you or someone you know is living with MSA and experiencing changes to communication, voice or swallowing, don’t wait to seek support.  

We know your goals may be different, varied and ever-changing. Our team has knowledge of communication and swallowing difficulties due to neurological conditions, and we can provide:  

• Individualised communication and swallowing assessments.
• Implementation of Mealtime Support Care Plans or Mealtime Management Plans. 
• Individualised therapy, focusing on functional communication goals that are important to you. 
• Support to trial a range of low-tech and high-tech devices to support ongoing communication. 
• Support education of both communication and swallowing strategies for you, your family and support network. 

Supporting people living with MSA requires a person centered and multidisciplinary team approach, and we want to work with you, your family and therapy providers to ensure you are well supported to manage the ongoing and changing symptoms.  

At MSWA we have an integrated team of allied health professionals, physiotherapists, dietitians, occupational therapists, exercise physiologists, counsellors, nurses and many more to help you on your journey.