Voice production is a complicated process involving coordination between the relevant muscle groups, which in normal life (without Multiple Sclerosis or other condition af fecting voice production) we tend to take for granted. Speech problems are normally assessed by speech therapists – they need to know just where the problem lies for management:

• Breathing: You may not be able to exhale in a slow and measured enough way needed for good speech production.
• Phonation: You may not be able to speak loudly enough or with sufficient clarity or tone of voice.
• Resonance: This additional quality of sound may be hampered by your palate not working properly.
• Articulation: Your vocal movements may not be sufficiently precise to articulate sounds properly.
• Phrasing and continuity: You may have difficulty in putting all the sounds together to produce sentences with appropriate pauses and so on.

Sometimes speech may be ‘scanning’, which means that each syllable is pronounced as if it is a separate word. Occasionally speech may be
‘explosive/staccato’, where a syllable is forced out in a loud manner. Both these problems arise when Multiple Sclerosis affects the ‘cerebellum’, the part of the brain that deals with coordination.
Each of these areas can be af fected by particular combinations of defective muscle control.
If you can manage your level of fatigue well, and reduce or shorten the effects of exacerbations or attacks of MS, you may find that you have fewer problems with your speech. However, this will not always be the case and, of course, if the Multiple Sclerosis progresses, it is more likely that problems with speech will arise at some point.
As far as the sound and tone of your voice is concerned, these change in any case as we grow older, which is why it is generally quite easy to recognize the voice of a child as different from that of an older person. In MS different aspects of voice production may change more quickly as the disease af fects the various muscles of the face, mouth and throat in different ways. Because of the damage to muscle control, your voice may be more difficult to control – it may sound high or low quite suddenly, or your speech may not sound very smooth, or perhaps you may lose your voice in mid-sentence. These problems are mainly caused by the varying, and sometimes sudden, changes in the way that your nervous system is transmitting messages to this sophisticated and normally coordinated system of voice production. There is little that can be done for the neurological difficulty itself. It is mainly a question of being aware of the problems that you have, as well as pacing your speech, and exercising the muscles to try and retain their maximum use for as long as possible.