Swallowing problems are not uncommon in MS, and they are often associated with speech problems. If you're experiencing swallowing or speech problems, it's because you have an area of damaged nerves that normally aid in performing these tasks. Lesions in the brain can cause several different types of changes in normal speech patterns. Some of the symptoms are as follows:

• Unexplained recurrent lung infections

• The feeling that food is being lodged in your throat

• Coughing or choking when eating

• Unexplained malnutrition or dehydration

• Weight loss

Your doctor will try to identify the location of your problem by doing a physical exam during which he'll pay particular attention to how your tongue and neck muscles are functioning. He may also order a test called a modified barium swallow where you drink or eat various consistencies of contrast and have a special imaging machine take pictures to trace the path of the contrast material. It is important to determine whether the swallowing problems are due to MS or other medical conditions.

Swallowing Problems

Swallowing difficulties can cause secondary problems including pneumonia and malnutrition. This happens when food or liquids are inhaled into the trachea instead of going down to the esophagus and into the stomach. In the lungs, the inhaled food or liquids can cause pneumonia or abscesses. Because an adequate amount of food is not reaching the stomach, dehydration or malnutrition can also occur.

A speech therapist usually treats swallowing problems. Changes in diet, positioning of the head when eating or drinking, and exercises may be recommended to improve swallowing. In the most severe cases, a feeding tube may be inserted right into the stomach to provide nutrients.

Here are a few of the tips that can help improve swallowing function:

• Try to swallow frequently, alternating between food and liquid. Swallow two to three times per bite.

• Drink plenty of fluids.

• Eat soft foods such as applesauce, mashed potatoes, Jell-O, and pudding. Puree foods in a blender.

• Crush pills and sprinkle them on a tablespoon of applesauce instead of swallowing them with water. Some pills should not be crushed, so be sure to check with your pharmacist first.

• Eat slowly. Make sure to cut your food up into small pieces.

Finding a good speech/language therapist is important when you're trying to handle swallowing problems. They can teach you swallowing exercises that improve muscle coordination during swallowing. They can also recommend modifications in the way you eat or the consistency of the foods you eat.

Speech Problems

Two common speech problems in MS are scanning and the slurring of words. Scanning produces speech in which the rhythm or cadence is disrupted with long pauses in between words or syllables. Slurring of words occurs because muscles in the tongue, lip, and mouth become weak. Some of the symptoms of speech problems include the following:

• Imprecise or slower speech

• Speaking in a low volume

• Difficulty with resonance and pitch control

• Long pauses between words or syllables of words

• Difficulty in understanding what is being said and an inability to recall grammar or vocabulary

A speech/language therapist or pathologist can help people with MS to improve speech patterns and enunciation. For those with severe speech problems, communication aids such as alphabet cards or hand-held communicators are useful.

Speech problems can run the gamut from very mild to severe. Troublesome speech problems can make it difficult to form words properly. It's important to note that, like any symptom in MS, speech problems can come and go, sometimes in the space of a few hours.