Speech and voice changes with MS: What's happening and what helps

Speaking is a more coordinated act than most of us give it credit for. It draws on your breathing, your voice box (larynx) and a fine network of muscles in your lips, tongue and jaw, all working together in a split second. MS can affect the muscles used for speech and voice because it damages myelin, the protective coating around nerve fibres in the brain and spinal cord, which disrupts the signals travelling between your brain and these muscles. 

Because MS affects everyone differently, speech and voice changes can turn up early for some people and much later for others. They can also come and go depending on how active your MS is, so a voice that sounds strong one week might feel harder to control the next. 

MS speech and voice symptoms vary from person to person and can come and go depending on fatigue, heat and how active your MS is. This can include: 

• Difficulty controlling pitch and volume: Your voice may sound quieter or you may find it harder to vary your pitch to convey emotion or emphasis. 
• Hoarseness or a strained voice: Your voice may sound rough, hoarse or strained and may require more effort to produce. 
• Slurred or slow speech: muscle weakness or poor coordination, can make words harder to form clearly. 
• Voice fatigue: Your voice may become weaker as the day progresses, especially after extended periods of talking. 

Communication changes in MS are not limited to how your speech or voice sounds. You may need more time to find the right words, or find it harder and more tiring to follow long conversations in busy and noisy environments. These changes are often related to fatigue, which is one of the most common symptoms of MS. This means that your communication may be clearer and easier in the morning when your energy levels are highest and become more difficult later in the day as you become tired. Recognising this pattern can help you and the people around you schedule important conversations and calls for times when you have more energy. 
 
These changes can feel isolating, particularly when friends or family ask you to repeat yourself or assume you are unwell. However, you are not alone, and support is available. 

Yes. Speech therapy is one of the most effective ways to manage speech and voice changes and protect your ability to communicate confidently. At MSWA, our Speech Pathologists work one-on-one with people living with MS to understand their specific voice and communication goals, then build a tailored plan to help. 

This might include: 

At MSWA, our Speech Pathologists work one-on-one with people living with MS and other neurological conditions to understand their specific communication goals. An assessment usually starts with a conversation about how your voice and speech have changed, what situations feel most difficult and what matters most to you day to day. Your speech pathologist may assess you communication within a variety of tasks as reading tasks and within conversation to gain a better understanding of your specific difficulties. From there, they'll work with you to set goals and build a plan, whether that's a few simple strategies you can start using straight away or a longer program of regular therapy. 

Alongside professional support, there are simple things you can do at home to look after your voice: 

• Stay well-hydrated by drinking plenty of water throughout the day. 
• Position yourself close to and facing the person you are speaking with. 
• Where possible, reduce background noise. 
• Take your time when speaking. Slowing down and exaggerating your speech sounds slightly can help improve clarity by giving your speech muscles more time to work effectively. 
• Rest your voice when you're fatigued rather than pushing through. 
• Be open about changes in your communication. Letting others know when you're having a harder day can help them provide the support you need and make conversations easier. 

Many people wait until voice or speech changes become significant before reaching out for support, but earlier intervention often leads to better outcomes. It's worth speaking to a speech pathologist if you notice: 

• Your voice sounds consistently quieter, hoarser or more strained. 
• People are asking you to repeat yourself more often. 
• Talking feels tiring or effortful, even in short conversations. 
• You're finding it harder to be heard in groups or over the phone. 
• You're avoiding conversations or social situations because of how your voice or speech sounds. 

At MSWA, we understand that voice and speech changes can affect far more than communication, they can impact confidence, relationships and independence. Our experienced Speech Pathologists take the time to understand your goals and build a plan around what matters most to you, whether that's being heard clearly on the phone, enjoying family gatherings or feeling confident speaking up at work. 

Support is available in your home, at MSWA Services Centre or via telehealth, so you can access help in a way that suits you. Get in touch with MSWA's Speech Pathology team today to find out how we can help you stay clear, confident and connected.