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Speech and language therapy and MS - beyond the glottal-stop

Steven Bloch, Speech and Language Therapist and lecturer at University College London

Open Door - May 2004 pages 6-7

Scene: A barber's shop in Brighton (circa 1991)

Barber: 'aving a day off today then
Steven: Yes - just thought I'd catch up with a few things
Barber: Looks set to be a good weekend
Steven: Yes - I hope so (pause in talking whilst barber looks for scissors)
Barber: So what line of business you in then?
Steven: Ermm I'm a speech therapist
Barber: COR BLIMEY (in an appalling fake cockney accent) you'll have to teach me to speak proper won't ya! D'ya 'ear that, Stan? This bloke's a speech therapist. Mind ya effing everyone!
Steven: (reddens) Ha ha

A good few years ago I graduated as a speech and language therapist. I was incredibly proud, not only for the fact that I had qualified in what I took to be a very demanding subject but also because I was now recognised as a professional. The curious thing was that whilst I believed most of my colleagues in the NHS knew who I was and what I was able to do, many of those outside of the profession had only a vague idea of my role. I felt frustrated. I was worried that to be defined as a 'speech and language therapist' would reduce my life to bad jokes about stammers and fake-cockney calls for elocution lessons.

Of course it did not take me too long to realise that very few of us really understand what others do on a day to day basis. We may think we know what a nurse, a teacher or business manager does, but in actual fact this is most often based upon general knowledge. Upon reflection I can now happily ask how on earth anyone could ever know what a speech and language therapist does unless they've had some direct experience?

The purpose of this article is to provide an introduction to speech and language therapy for people with an interest in multiple sclerosis. It is not a 'how to do therapy' guide but rather something that might encourage a few readers to seek out more information if they are interested.

What is speech and language therapy?

Speech and language therapy involves a partnership between a person who is experiencing some form of communication problem and a trained professional therapist. In recent years therapists have also taken an increasing role in working with people who have swallowing difficulties. Whilst mainly focussing upon an individual with a particular need, many therapists also like to involve family and friends wherever possible.

Despite the name, these therapists are not just interested in speech and language but rather in all aspects of communication: how we express ourselves, how we get our message across and how others communicate with us.

There is not one way of doing 'therapy' - it all depends upon the needs of the person and any problems they are experiencing. The important point is that therapy is a shared activity between the person with a communication problem and their therapist

Why might someone with MS want to see a speech and language therapist? Some people with MS can experience very mild difficulties with their speech muscles - leading to occasional slurring or reduced loudness in speech when they are particularly tired. Sometimes their voice may sound a little croaky or hoarse. These problems are all related to the underlying nature of MS itself - a problem/delay in the transmission of information along the body's system of nerves. There may be nothing wrong with the vocal cords or the tongue itself but rather in the pathways along which messages from the brain are sent.

Other people may have problems in remembering specific words or in concentrating on things involving words - for example reading a long article in a newspaper or trying to complete a crossword.

The experience of these problems varies from person to person. For some, even quite a mild difficulty can be very upsetting. For others, speech may not be so important and they are less concerned about it than, say, their walking. The effects of a communication difficulty may only be noticeable in a noisy street or pub, or they may be felt every time someone is speaking.

Given that many of the muscles involved in speech are also used for swallowing it is not too surprising to learn than eating and drinking can also cause occasional problems as well. Problems with swallowing may be due to a number of reasons and can be looked at in detail by a GP and speech & language therapist.

What can be done to help?

Speech and language therapists are specialists in communication and swallowing. Their first role is to find out what problems (if any) a person is experiencing and how they feel about the situation. The therapist may also want to see exactly how someone's speech/swallowing is working. All of the findings are explained and then ideas for help are discussed.

Therapy often works through a person understanding how their communication/swallowing works and what they can do to make things better. We all have skills and strengths and it is the role of the therapist to help people use their own skills to make the most of their speech/swallowing abilities. This may take only one session to do or a series of sessions with a follow up appointment to monitor progress.

Some people expect to be given exercises to work on their tongue movements or breathing. Such exercises are used sometimes but they may not always be appropriate. Often more benefit may be gained from a detailed look at specific problems and then working on specific solutions.

Mary was a lady I worked with a few years ago who had particular problems talking on the telephone to her sister in New Zealand. It turned out that Mary's voice was a little quiet but that the bigger problem was her sister's hearing! She did not want to have a hearing aid but she did agree to have a telephone that amplified the voice of incoming calls. I made a few calls to BT and found some very helpful suppliers of specialist telephones in NZ. It was through considering the practical problems that we resolved the difficulty rather than seeing Mary as the 'problem'.

In addition, speech and language therapists are often very sociable creatures and like to work not only with family members and friends but also other professionals. For some people with MS, a large number of professional contacts may be built up over the years. One useful role the therapist may play is to ensure that useful ways of communicating are shared amongst all these professionals so that the person with MS is understood as often as possible. It's not just the person with MS who might be having difficulties with communication but also those around him/her.

Where to go for more information

If someone has a concern about their communication or swallowing then they can see a speech and language therapist for advice and help. This may take place at a hospital, a day centre or at home depending upon local services. Speech and language therapists are employed throughout the NHS and referrals are usually made through a GP. Most therapy services can also be contacted directly for advice and local contact details can be obtained from health and social care professionals, GP surgeries and hospitals. The Royal College of Speech and Language Therapists also has a website with useful information at www.rcslt.org or telephone: 020 7378 1200.

Education continues

At the end of 2003 I was at a Christmas party and met a charming lady who turned out to be a solicitor. 'And what do you do Steven?' she asked. I told her. 'Ohhhh you must teach me how to speak properly!' she replied.

Clearly the need for information continues but I think we're moving in the right direction.

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