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Speak More Clearly and Swallow More Safely


You Can...Speak More Clearly and Swallow More Safely

 MS can affect both speech and swallowing. Difficulty with speech (dysarthria) may occur in up to 40% of people with MS. Difficulty with swallowing (dysphagia) may also occur in MS, although less frequently.

But the good news is that, with some help, you CAN learn to speak more clearly and swallow more safely.

Your speech language pathologist

A speech language pathologist (SLP) can evaluate specific speech and swallowing symptoms and recommend treatment.

For speech symptoms, an SLP examines how you use your lips, tongue and soft palate. He or she will also assess your breath support and control, how you pronounce words, and how well others can understand you.

For swallowing symptoms, an SLP will assess you while drinking and eating. You may be asked to do a modified barium swallow. In this radiology procedure, you swallow barium in a variety of liquid consistencies and amounts, as well as mixed with foods, while the movements of your mouth and throat are X-rayed and videorecorded. Based on the results, an SLP can recommend specific diet and swallow strategies. Other specialists on the swallowing team may include a dietitian, dentist, occupational therapist, nurse and doctor.

Common speech symptoms

Speech problems can interfere with how easily you can be heard and understood by others. Some common problems caused by MS include: 

  • Reduced volume caused by weakened breath support and control
  • Imprecise articulation caused by weakness, slowness or incoordination of the lips, tongue and soft palate
  • Slow rate of speech, with irregular pauses affecting flow of speech, caused by difficulty timing respiration with articulation
  • A harsh, hoarse or hypernasal voice quality caused by neuromuscular involvement of the soft palate or vocal folds

Speak more clearly

Try the following:

  • Fill your lungs fully. Use your diaphragm.
  • Speak louder. Use extra effort to push out. (In some situations, a voice amplifier may be recommended.)Slow down. Allow extra time for lip and tongue movements.
  • Exaggerate articulation. Make precise contacts with your lips and tongue to reduce slurring.
  • Sit up straight. To allow for better breath support and control.
  • Pause strategically. Pause every few words to allow for better breath support, loudness and articulation.
  • Evaluate yourself. Watch your listener and correct your speech if he or she seems to have trouble understanding you.


If needed, your SLP may recommend special equipment such as:

  • Voice amplifiers (with headset microphone) when speaking loudly enough is too difficult on your own
  • Speech generating devices (although a rare need) that speak for you when speech is profoundly unintelligible.

Common swallowing symptoms

These problems are typically mild or transient. But when chronic, they can lead to dehydration or poor nutrition. In severe cases, food or liquids can enter the lungs, which can lead to “aspiration” pneumonia. Common issues include:

  • Delay in triggering the swallow: “I can't get my swallow started.”
  • Residue left in the throat due to weakness: “It feels like there is still something stuck in my throat.”
  • Inadequate airway protection (with possible aspiration) due to weakness or timing problems: “It goes down the wrong tube and I cough.”

Swallow more safely

With the advice of your SLP, try following these tips:

  • Take care of your mouth. Brush your teeth and tongue twice daily to reduce bacteria and the risk of pneumonia, should aspiration occur. (Regularly visit the dentist also.)
  • Sit upright at a full 90-degree (or right angle) position when eating or drinking.
  • Take small sips and bites to safely control the amount of food you’re ingesting.
  • Take follow-up dry swallows to clear any residue left in the throat.
  • Cough or clear your throat and swallow again to protect your airway.

Author: Pamela H. Miller, MA, CCC-SLP, Denver VA Medical Center, Can Do Multiple Sclerosis Program Staff