Respiratory support for speech in multiple sclerosis

Abstract

The dysarthria of multiple sclerosis (MS) is known to worsen as the disease progresses (Darley, Brown & Goldstein, 1972). Thus, as an MS sufferer's activities of daily life and opportunities for activity are curtailed by increasing disability, the capacity of their respiratory system is also diminished both by disease and lack of demand on the system (Olgiati, Hofstetter & Bailey, 1988). It may be that disuse creates a discrepancy between the functional ability that is neurologically available and that which is characteristically used. It is this functional overlay that may be the target of speech therapy (Farmakides & Boone, 1969). Five patients with MS and dysarthria affecting intelligibility were involved in a multiple baseline therapy study to establish the efficacy of respiratory exercises in improving functional speech performance. Intervention effects were demonstrated by introducing the therapy to different patients at successive points in time. Speech therapy exercises targeted the respiratory system alone with no phonatory or articulatory components. Intelligibility was chosen as a global and objective repeat measure of functional speech performance and was established for each patient by use of the Yorkston‐Beukelman Assessment of the Intelligibility of Dysarthric Speech (Yorkston & Beukelman, 1981). Findings cautiously suggest that with certain patients respiratory exercises can improve speech performance as measured by intellligibility. Thus, a component of the dysarthria of MS may not be neuromotor dysfunction, but atrophy based on fatigue and disuse — and may be reversible. Conclusions on appropriate subject selection are made. The experience of the study with objective measures of intelligibility and the use of the multiple baseline across subject experimental format are also presented. A wider distribution in intelligibility scores generated by multiple listeners than that reported by Yorkston and Beukelman (1981) generated the necessity of a single listener for all tests. Wide variation in subjects' baseline speech performance despite stringent controls on factors known to affect intelligibility demonstrates the futility of single ‘before and after’ treatment measures with MS sufferers. Also, the limitations of the research format, especially the long basline phase for later subjects, are discussed.

Factors Associated With Treatment-Related Changes in Voice Volume in People With Multiple Sclerosis

“…31 Deconditioning prevents people with MS from efficiently using their residual capacities, 32 also affecting speech. 32,33 Conversely, conventional treatment is more tailored to a person's needs, but is less systematic and focuses on other voice aspects (such as prosody, articulation, posture, etc).…”