Myasthenia Gravis on Speech

Effects of Myasthenia Gravis on Speech, Voice and Swallowing

Effects of Myasthenia Gravis on Speech, Voice, and Swallowing

Just like how human beings communicate with each other to build relationships, to express their needs, and to complete their tasks, the structures in our bodies can also communicate with each other to perform their functions efficiently. If there is a disruption in the communication between two individuals, it may lead to bitter consequences. However, when there is a breakdown in the normal communication between the nerves and muscles, it results in Myasthenia Gravis.

Myasthenia Gravis (my-us-THEE-nee-uh GRAY-vis) is a disease affecting the peripheral nervous system which includes the nerves that control voluntary movement such as, picking up a piece of paper or smiling at someone. People with MG might wake up feeling fine, but get progressively weaker as the day goes on and sometimes might feel weaker with repetitive movements such as chopping vegetables or speaking.

In some cases, when certain muscles are affected patients can experience a Myasthenic Crisis, which is a life-threatening manifestation of this disease. By way of example, a decreased function of the muscles that control breathing.

Some of the common symptoms of Myasthenia Gravis

  • Eyelid drooping
  • Double Vision
  • Impaired speaking
  • Weakness in arms and legs
  • Difficulty changing facial expressions

changing facial expressions

This disease usually affects young women in their twenties and thirties or older men in their sixties and seventies. However, there is still a mystery behind the reason for this odd distribution of age of onset. Myasthenia Gravis is an autoimmune disease, which means that your immune system produces antibodies that attack and destroy many of your muscles, resulting in this weakness. Rarely, mothers with MG have children who are born with MG, however, if treated properly, they can recover within two to three months.

While there is no cure for MG yet, various types of treatments, alone or in combination can relieve the symptoms. A comprehensive treatment program is given by multidisciplinary teams comprising of Medical practitioners, physiotherapists, speech language pathologists, and counsellors.

The treatment comprises pharmacological management and behavioral management of symptoms. The program is created depending on the age of onset, the severity of the symptoms, and how fast the disease is progressing.

The human voice is generated by the lungs when the air is pushed through the vocal cord that vibrates symmetrically and creates a pleasing smooth voice. That pleasant sound from the voice box is then shaped into consonants and vowels with the help of the jaw, throat, tongue, and mouth muscles.

When this complex movement and coordination of muscles are affected, it may lead to speech, voice, or swallowing disorders. Myasthenia gravis can affect all the muscles responsible for speech and swallowing. While MG does not always affect these muscles, in some people, these symptoms can change throughout the day and they often get better after a period of rest.

Peripheral nervous system

 

Dysphonia

A diagnosis of Dysarthria or Dysphonia is very evident in persons with MG because they can perceive a change in voice. The symptoms can either be mild or intermittent. Once these symptoms persist for more than 2 weeks, it is always advised to visit an Ear, Nose, and Throat specialist (otolaryngologist) or a Speech Language Pathologist. An ENT specialist will make sure that the symptoms are due to Myasthenia Gravis and the Speech language pathologist will assess the type and the severity of the symptoms and provide appropriate treatment for the same.

Speech problems:
  • Vocal Fatigue: The voice wears out after speaking for a long time
  • Monotonous voice: Lack of ability to change vocal pitch
  • Speaking in short phrases Lack of breath support for speech
  • Dysphonia: Hoarse, weak, and strained voice
  • Slurring of speech (dysarthria): Muscle weakness tongue, lip, and jaw
  • Hypophonia: Low volume of voice
Swallowing
  • Difficulty chewing towards the end of a meal
  • Choking of food due to weak swallow
  • Increased meal timing
  • Risk of aspiration

Risk of aspiration

The treatment of speech and voice disorders is based on the severity of the disease and what muscle it affects. A speech language pathologist provides therapy to strengthen the muscles that are responsible for speech and also provides compensatory strategies. However, these exercises cannot be implemented during a myasthenic crisis. It has to be performed when the person is stable. The exercises are usually implemented when they are undergoing drug therapy.

One should only perform these exercises after being advised by their MG treatment provider.

  • Strengthening exercises must be done only at the peak of the drug therapy
  • Compensatory strategies – using gestures to communicate, communicators should use yes/no questions or communicate via mail or letter
  • Avoid talking when possible

Myasthenia Gravis is known as the “snowflake disease” as everyone’s experience is different. If diagnosed, make sure to arm yourself with as much knowledge as possible.  Living with this disease is frightening, but with the right treatment regimen and emotional support from loved ones, people can achieve a significant reduction of symptoms to lead a comfortable life.

 

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