Don't DIS my speech: How a Speech Therapist can help Part 2

Speaking your mind! 

*In South Africa to dis something is to show disrespect

Approximately 100 muscles of the chest, neck, jaw, tongue and lips are needed to work in a synchronised manner in order to produce one sentence (1). Being able to communicate is an essential part of human existence. Speech is a main source of communication, however thankfully not the only method.

When in crisis, the muscles activating speech are also affected. While I might  sound like I'm drunk or that I'm trying to talk while playing the game chubby bunny, I am actually trying my best to get my message across.

The first time I had speech difficulties was when I was trying to help my younger sister with her  math homework. She thought I was making fun of her as my voice changed to a nasal squeaking/strangled duck sound. In the moment I couldn't even explain, all I could do was wait until my muscles were slightly rested and then explain what had happened.

The second time, I was doing a case presentation in an exam. My lecturer assumed that my speech issues were linked to anxiety. While I cannot deny that anxiety aggravates MG,  symptoms are however often misdiagnosed and MG warriors are first assumed to have psychiatric issues such as social phobia or anxiety. It is essential that you seek appropriate treatment and assistance. Many times speech will improve with correct medication from your Neurologist.

There are two main areas of difficulty that have been identified in terms of speaking:

Dysarthria: Unintelligible speech due to muscle weakness

Dysphonia: This refers to when one’s voice is affected. The main characteristic of MG speech is hypernasal speech and is often the main complaint (2). 

Stephanie Wainwright has once again offered her advice on this topic:
It is helpful to have your speech therapist on speed dial for moments like this as particular symptoms require particular compensatory techniques. The most common compensations for slurry speech that I regularly recommend are the following:

1.       Over-articulate
       Think “how-now-brown-cow” and the Queens English… this helps to improve enunciation.

2.       Slow down and take many pauses
      Pausing for breathing breaks automatically  slows your speech down which automatically makes it more intelligible.

3.       Use alternative methods of communication: 
       We live in a day and age where we have amazing technology at our fingertips, literally! Use your smartphone to record important voice messages that you can then use when you aren’t able to speak. You can also download apps that can help you communicate during these times. One I use regularly in therapy with my stroke patients is called Type and Speak. It allows you to type a message and then it plays it aloud, you can then choose to save the message which is helpful for later use.

4.       Stand up straight
      This allows you to breathe better. Sound is created by the air being forced out of your lungs, so the clearer your breathing, the clearer your speech. Look straight ahead, so your jaw is flat instead of lowered which compresses your throat.
When talking to someone roughly the same height as you, maintaining eye contact is a good way to ensure your chin stays raised.
At the end of the day, you need to figure out what works for you. As therapists, we are here to guide you along that road.

Often the lack of speech creeps up on you and therefore it is helpful to ensure that you have all your necessary emergency contact information on hand. I chatted with my friend Kristen Bent, who is a medic about what can help in emergency situations. She mentioned that it is useful to have as many information cues as possible.

-    ICE contact on cellphone: ICE=In Case of Emergency. 
Store at least two contacts in your phone book under this name. Remember since your cell phone is password protected, this information may not be easily reached. If you have an iPhone, all your medical information can be stored under the health app by creating an emergency card. This makes it easy for medics to retrieve your important medical information from your lock screen in an emergency situation.

- In wallet contacts:
You can make this yourself. Laminate a short list of information and keep it in your car and wallet. Information should include your personal details, medical aid and plan, medications and doctor's contact details.

- Emergency Bracelets: Medi alert Bracelets/tags, iceID 

- Free Emergency Apps: mySOS , AA South Africa, For Discovery Health Members

Final thoughts:
Be prepared, be aware and offer support and understanding to those who need it.


Stephanie Wainwright :

1) Simonyan K, Horwitz B (April 2011). "Laryngeal motor cortex and control of speech in humans". Neuroscientist 17 (2): 197–208. doi:10.1177/1073858410386727. PMC 3077440. PMID 21362688.

2) Dysphonia as the primary complaint in a case of myasthenia gravis: diagnosis and speech therapy


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