Communication represents a distinct and significant part of human life. It connects people together, and allows individuals to share and express their thoughts, ideas, wants, and needs. There are diseases that exist in today’s world that unfortunately remove one’s ability to verbally interact and effectively communicate, and one of them includes multiple sclerosis. There are four discrete kinds of multiple sclerosis, which include relapsing-remitting, primary-progressive, secondary-Progressive, and progressive-relapsing. These do not differentiate in their symptoms necessarily, but rather the longevity and progression of the disease. This illness’ cause is unknown, but environmental factors are thought to be a reason it affects people. One frequently proven correlation includes multiple sclerosis and cigarettes. Studies have seen patients that smoke cigarettes develop this disease later on in life (Herna ́n et al., 2005). Multiple sclerosis affects over two million people across the world, with women being two times more likely to be affected than men. Its onset typically occurs around 20-50 years old. It ultimately is an autoimmune disorder that negatively affects the brain and spinal cord. The immune system targets and damages the myelin that covers nerve fibers, causing these fibers to scar. Due to this, the signals sent to and from the brain are impeded and distorted. The symptoms that are present in those with this illness include: fatigue, numbness, muscle weakness, dizziness, impaired cognition, inability to walk, spasticity, and speech and swallowing difficulties. These side effects are variable and are different in each patient. A cure has not yet been discovered for this disease; however, medications are given to manage and slow down the progression. Multiple sclerosis depicts an auto-immune disease that hinders an individual’s cognition, speech, language, and swallowing, which in turn can dampen their quality of life (Herna ́n et al., 2005).
Multiple sclerosis impacts many different aspects of a human’s life. These aspects include: vision, mobility issues, communication. While all of these consequences impede the individual from living a normal life, symptoms related to cognition, speech, and swallowing greatly affect their communication abilities. The concept of exchanging information is universal and a component of life that connects humans together. In order to communicate effectively, one’s cognition needs to function properly. Individuals with multiple sclerosis have been known to show cognitive deficits that hinder memory, executive functioning, and processing skills. A study was once conducted in 2005 to gain more knowledge regarding the alteration of cognition over time for patients with one of the types of this illness, specifically primary progressive multiple sclerosis. 147 people with this particular kind of multiple sclerosis participated in this study. 52 were males and 47 were females. The mean age was 48 years. Researchers for this study examined the subjects over a two-year time span. Each individual completed an entire neurological examination. Cognitive impairment and disability were assessed with the use of the Expanded Disability Status Scale (EDSS). In addition, the Brief Repeatable Battery (BRB) was administered, in which memory, verbal fluency, attention, and reasoning were all evaluated. The BRB includes a list task for memory, a number and shape matching assessment for attention, and attempts to elicit words from a specific category to examine executive functioning. The Verbal and Spatial Reasoning Test (VESPAR) was also given to the subjects, which involves evaluating verbal and spatial reasoning capabilities. These assessments and evaluations were completed after each year. After the testing was completed and the two years were complete, the researchers found a significant difference between the first and second year. There was a decline in cognitive function on all tests, with the BRB altering the most. Out of the subcategories, attention and working memory were impacted the most. Subjects displayed difficulty when trying to remember a small list of words and also focusing on tasks when instructed to (Camp et al., 2005). Even though the cognition declined throughout this study, other studies have noticed that cognition eventually stabilizes and does not continuously progress throughout the entire disease (Chiaravalloti & DeLuca, 2008). It is apparent that a lack of normal-functioning cognitive skills negatively impacts executive functioning and all other related tasks, but this illness has also been found to harm these affected individuals’ quality of life.
With diseases that greatly hinder a person’s physical capabilities, it can often be forgotten that these types of illnesses also negatively affect their mental and emotional health, which is ultimately just as important, and, in some cases, patients prefer their mental health be the main priority doctors focus on rather than their physical disabilities. A study conducted in 2002 aimed to discover the health-related quality of life in individuals with all four types of multiple sclerosis and its correlation with cognition and emotional health. The study included 209 people with multiple sclerosis. Everyone was provided and instructed to partake in the Functional Assessment of Multiple Sclerosis (FAMS), which involves 52 elements covering physical movement, symptoms, emotional health, happiness, fatigue, and social engagement. The Mini-Mental State Examination (MMSE) assessment was administered in order to evaluate cognition and the Hamilton Rating Scale for Depression (HRSD) for emotional health. All three examinations were administered by either a neurologist or sociologist in the subject’s home or clinic, whichever they preferred. Results showed that individuals who were more physically incompetent obtained higher scores on the FAMS assessment. Within these same individuals, cognition decreased and emotional instability increased. Ultimately, the lower the cognitive level and emotional health, the worse the health-related quality of life. Depression and anxiety represented the two most common consequences present in the subjects no matter the type or severity of multiple sclerosis; however, those whose illness was more chronic and progressive contained a higher level of depression and anxiety. This study helps prove that multiple sclerosis can not only decreases a person’s cognitive abilities, but also their quality of life (Benito-Leo ́n, Morales, & Rivera-Navarro, 2002). While a person’s quality of life is significant, it is not the only component that is affected through multiple sclerosis.
Communication requires proper-functioning cognitive skills because without this, speech and language are affected. Without competent speech and language, it is difficult for an individual to partake in conversational discourse, which also lowers their quality of life. A study executed in 2009 sought to examine patients with secondary progressive multiple sclerosis’ cognitive-linguistic skills and its relationship to intelligible speech. To begin, the researchers gathered 24 people, 16 females and 8 males, that were diagnosed with not only multiple sclerosis, but also dysarthria. The patients’ onset varied from two to 34 years. A control group was also created to compare the affected individuals to healthy peers. This group consisted of 24 individuals as well; however, it was not age-matched nor were any of these specific people diagnosed with any form of illness or neurological deficit. To asses these groups, the first test was the Arizona Battery for Communication Disorders (ABCD). This examined memory, expressive language, receptive language, and mental health. Next, the Assessment of Intelligibility of Dysarthric Speech (AIDS) was administered, which intended to look at the person’s severity of dysarthria and ability to produce intelligible sentences. The last examination included the Modified Barthel Activities of Daily Living Index (MBADLI), which consists of capability of executing daily activities, such as eating, practicing hygiene, and going to the restroom. All tests were administered in a low-noise, undisruptive setting and carried out by speech-language pathologists. Results displayed a strong correlation between cognitive-linguistic deficiency and dysarthria. With the help of the ABCD data, it was found that participants who produced more intelligible speech obtained higher scores on the cognitive-linguistic examinations. Compared to the control group, the experimental group performed poorly in all areas. This finding assists in proving the notion that the diminishing of skills is more global rather than specific lesions, and it includes both expressive and receptive language. Also, the patients with a higher severity level of multiple sclerosis had worse dysarthria, which ultimately created less intelligible speech. As for memory, individuals with multiple sclerosis struggled with recall, specifically when the recall was delayed. Language was also noticeably affected. The experimental group scored poorly on naming tasks particularly. These findings suggest that multiple sclerosis patients that have dysarthria are also having difficulty with cognitive-linguistic tasks; therefore, speech-language pathologists should incorporate activities and tasks in their sessions that encompass cognition, language, and speech to assist the client in becoming a more competent communicator (Mackenzie & Green, 2009).
As mentioned previously, communication brings humans together. It gives them a sense of belonging to society and overall improves their quality of life. A common symptom of multiple sclerosis includes dysarthria, which involves muscles weakness impeding speech. While it is a known fact that dysarthria is present in many individuals with multiple sclerosis, many do not know which type is more prevalent than others. One study completed in 2000 attempted to research the prevalence and features in multiple sclerosis patients. The researchers found 130 people with different types of multiple sclerosis who qualified for this study. The average duration for having the illness was 38 years and the average age was 67 years. For the control group, 15 people that did not contain any neurological deficits or other medical issues were used to compare to the experimental group. For the methods section of the study, every participant was recorded in a speech clinic and at home to obtain a variety of language samples. The recordings involved the subjects taking the clinical dysarthria examination and text-reading assessment. The dysarthria testing section includes the researchers examining 54 elements split up into sections, which are respiration patterns and efficiency, phonation, articulation, oral mobility, prosody, and speech intelligibility. For the reading section, the subjects were required to read a passage with 89 words, and all participants were recorded while doing so. After analyzing the tests, the researchers concluded that 51% of participants had some form of dysarthria, specifically 39% had mild-moderate dysarthria and 12% had severe dysarthria. It is thought that dysarthria being present in an individual with multiple sclerosis depends on their other symptoms caused by the illness (Hartelius, Runmarker, & Andersen, 2000). The number of subjects to have dysarthria was a high number compared to other studies but was still reliable (Feenaughty, Tjaden, Benedict, & Weinstock-Guttman, 2013). When observing the recordings of the participants, many different perceptual speech characteristics were noticed. These included imprecise production of consonants, rough voice, and prosody issues, particularly with stress. Glottal fries were also frequently observed during the recordings, which damages the vocal folds even more due to improper use. All six scores from the various sections of the dysarthria test were lower compared to the healthy controls. When searching for a prominent type of dysarthria, researchers concluded that normally ataxic and spastic types are the most common, but for some reason in this study, mixed was found to be the most common. This is thought to occur by chance since other studies have found ataxic dysarthria to be the most prevalent in multiple sclerosis. This study was helpful in proving that these individuals with multiple sclerosis do have dysarthria, and their speech is hindered because of it. It is important to know this in order for speech-language pathologists to be able to provide the best individualized treatment for their multiple sclerosis client (Hartelius et al., 2000).
Dysarthria exists in many forms. It can be present in the upper motor neurons, basal ganglia, or other anatomical locations. A certain kind of dysarthria, ataxic, has its location of damage in the cerebellum, and is also one of the more prevalent types found in multiple sclerosis patients. It impairs not only the cerebellum, but also connections headed to and leaving the structure. Because of this, many researchers have sought to discover characteristics of this particular speech disorder. Hartelius, Runmarker, Andersen, and Nord collaboratively conducted a study in 2000 to evaluate the speech features of ataxic dysarthria in patients with multiple sclerosis. This study contained 14 participants that were diagnosed with both multiple sclerosis and ataxic dysarthria. Nine of the subjects had a mild to moderate case of dysarthria, and five were classified as having moderate to severe. All of the individuals used for this study had a higher EDSS score meaning they had critical neurological damage and were physically impaired. Only one of the participants in the control group could walk. As for the control group, 15 healthy individuals that were similar in age and gender were chosen. To measure and observe different speech characteristics, all individuals were asked to read a large number of words and sentences that were created to elicit certain speech features. The sentences were designed to analyze syllable durations and interstress intervals. The sentences were, “…The visibility is relatively restricted at the curve,” and, “…The bus driver’s license was revoked” (Hartelius et al., 2000). The participants repeated them four times each. After thoroughly analyzing the data, the researchers found that the experimental group had an extended syllable duration in all positions compared to the control group. For interstress intervals, multiple sclerosis individuals also obtained a longer average of interval durations. These findings prove that longer pauses and slower speech are main features found in ataxic dysarthria in multiple sclerosis (Hartelius et al., 2000). Other studies have also found the same discovery plus more characteristics. Feenaughty and colleagues found that three main features exist in this form of dysarthria. They include: inaccurate articulation, additional prosody, and phonatory inadequacy. Ultimately, the speech sounds, especially consonants, are produced inefficiently, and sound unclear (Feenaughty, Tjaden, Benedict, & Weinstock-Guttman, 2013). Multiple sclerosis patients who have been diagnosed with ataxic dysarthria produce distinct speech characteristics that impair their intelligibility and make it more difficult for them to communicate.
Speech and articulation represent just one part of communication. Language is an entire area that exists and assists one in communicating with another person. Since language is located in the frontal and temporal lobes of the brain, and multiple sclerosis affects the brain and spinal cord, it is understandable as to why these skills can be negatively impacted. A study executed in 2011 aimed to investigate lexical retrieval approaches and how these alter over time because there had been little research over this particular topic. To further explain, lexical retrieval approaches represent a method where an individual chooses and obtains words from their mental dictionary, which is thought to be over 50,000 words. There are two primary strategies: switching and clustering. Switching is when someone uses their frontal lobe to change between categories for words, whereas clustering is the process for producing words within a word category. These two strategies will be evaluated during the study. As for participants, a group of 45 people that had been diagnosed with various forms of multiple sclerosis less than 10 years ago were chosen. These people were not allowed to have any other medical diagnoses or deficits. To begin the study, an interview was conducted with each person along with a neurological examination that was given every three months over a two-year time period. The EDSS and MS Functional Composite (MSFC) were also administered. All of these components evaluated personal language issues, auditory and reading comprehension, verbal fluency, and semantic and phonemic skills. After the data analysis was completed, researchers found low scores in semantics and verbal fluency early on. Scores for the switching strategy were lower after the two years, whereas cluster scores increased. This is not surprising since multiple sclerosis is known to impact the frontal lobe region of the brain the most compared to other locations. It is also thought this decrease in the switching strategy and increase in clustering suggests a method to compensate for their impairment and find a balance between the two methods. Ultimately, this specific study helps professionals within the field gain knowledge about lexical retrieval approaches and informs them that they arrive at an early point in multiple sclerosis. Experts should also be aware of this discovery in order to assist in rehabilitating and improving the patient’s language deficits (Sepulcre et al., 2011). While speech and language deficits do deter one from communicating effectively, there are other areas that are damaged due to multiple sclerosis that cause life more challenging.
Any illness, such as multiple sclerosis, greatly alters one’s life. These affected people are not able to function and live their life as they once previously could. When pertaining to the issues that speech-language pathologists attempt to treat and rehabilitate, talking is not the only feature. Another prominent element includes swallowing. When one is unable to safely and properly swallow, it is known as dysphagia. This disorder is often seen in diseases similar to multiple sclerosis, but is estimated to be found in 40% of these particular patients (Poorjavad, 2010). Ruoppolo. Grasso, De Vincentiis, and Paolucci decided to observe multiple sclerosis patients in 2010, and specifically focus on the percentage of individuals that had dysphagia and what their symptoms were. They collected 143 people with primary and secondary progressive multiple sclerosis. They were all required to endure a neurological evaluation and administered the EDSS. These two examinations were completed by a neurologist, and a swallow study was executed by a speech-language pathologist. During the swallow study, the professional examined their laryngeal elevation function, lip and tongue mobility, orofacial movement, diet, and bolus control. A fiber endoscopic evaluation of swallowing (FEES) was the official swallowing observation. All participants were rated on a scale of zero to three for severity purposes, with three being the most severe. Out of all the individuals that participated in this study, 34.3% had dysphagia. Less than 2.8% had severe dysphagia, 5.2% had moderate, and 26.3% showed slight dysphagia. For the moderate group of people, they had the most difficulty with bolus control, and they experienced heavy coughing when drinking liquids. Researchers found a correlation between brainstem damage and dysphagia. If the brainstem was greatly impaired, the more severe the dysphagia was. This shows how significant the brainstem is in swallowing. In regards to the characteristics of this disorder, the pharyngeal phase of swallowing was more damaged than the oral phase. Dehydration and malnutrition were also frequently observed in the individuals in the study. The speech-language pathologist involved in this study noticed the patients used compensatory strategies to help the swallow efficiently. These included changing their posture, lowering the size of bites, slowing down when eating, and altering the consistency of food. All of these methods were normally effective and helped prevent aspiration and pneumonia (Ruoppolo et al., 2010). Another study that researched the same topic found that some patients were diagnosed with permanent dysphagia (De Pauw, Dejaeger, D’hooghe, & Carton, 2002). Together these findings help prove that dysphagia prominent in multiple sclerosis patients and represents a significant issue that needs attention. Dysphagia is life-threatening and it is important to discover ways to assist patients in ways to compensate in order to eat and live the most normal, functioning life as possible.
Multiple sclerosis represents an illness that affects many individuals throughout the world. Areas of an individual that are impacted include cognition, speech, language, and swallowing. Due to this, the person’s quality of life can immensely decline. In regards to cognition, multiple sclerosis patients are not able to stay focused on a task for a long period of time nor are they capable of remembering multiple items at once. Speech is also affected because of this illness. Individuals are diagnosed with dysarthria, which leads to their speech sounding distorted and imprecise. When attempting to talk, it does not help that these individuals have been known to struggle with word retrieval, and have used strategies to aid them during this process. The most serious and life-threatening result of multiple sclerosis includes dysphagia. These certain people that have trouble swallowing have had to chew smaller portions of food, altered diets, slow down mastification, and use other strategies to assist them in eating food and drinking liquids. There is currently no treatment for multiple sclerosis, only medications to help manage the disease, but professionals, such as speech-language pathologists, help these individuals live a most normal and healthy life as possible.