AAC and MS, Part 2: Bigger-Picture Considerations

Welcome back to our two-part series on AAC intervention for people with multiple sclerosis as MS Awareness Month 2018 draws to a close. Again, we thank speech-language pathologists Katie Seaver and Alex Burnham for sharing their expertise.

Part 1 focused on the role of AAC in mediating speech impairment that individuals with MS often experience, highlighting touch-access options including traditional AAC devices and popular mobile technologies with AAC apps. Now for a peek at factors unique to MS that may set a course for the pursuit of communication solutions.

Spoken communication presents challenges for an estimated one-third of individuals with MS. Dysphonia, a sound production disorder that manifests as hoarseness and reduces speech volume, is common and may be addressed with voice amplification. So is dysarthria, a condition affecting muscles as well as processes involved in production of speech that causes unintelligibility. This is typically where AAC comes in. 

The nature of MS and its effect on speech are less predictable than with some neuromuscular conditions.

Earlier this decade, the National MS Society’s Clinical Bulletin reported that the need for AAC devices among individuals with MS is relatively rare. However, the report also noted that AAC intervention is vital when the ability to communicate daily needs, personal safety and overall well-being are at stake. When AAC technology is recommended, three words closely govern the next steps: Wait and see.

The nature of MS and its effect on speech are less predictable than with some neuromuscular conditions. “The progression of dysarthria in advanced MS remains idiosyncratic,” Burnham said. “It’s really hard to know from the day of diagnosis what track they’ll be on.” 

Success with eye gaze devices for people with MS depends on a number of variables. Some patients experience neck paralysis, which helps keep their head still while shifting their gaze during communication, Mr. Burnham said. Good candidates for eye-controlled technology, he said, also have intact or aided vision, minimal nystagmus (repetitive, uncontrolled eye movements) and no ptosis or inability to shut their eyelids.

One’s memory and thought processes are key considerations for eye access, Mrs. Seaver said. “Some (people) require longer training sessions, but that's OK as long as some level of new learning is possible. They have to be able to problem solve on their own."

Whether troubleshooting, socializing or expressing everyday needs to caregivers, individuals may complement their device use using with tools such as eye gaze boards, unaided AAC strategies like pointing or their remaining verbal abilities.