Myasthenia gravis (MG) can affect the head and neck muscles that people use to speak. If you live with speech issues from MG, you might benefit from speech therapy.

MG is an autoimmune disease involving the neuromuscular function.

When a person lives with MG, their immune system mistakenly targets healthy cells that allow nerves to send messages to muscles. As this connection is interrupted, muscles are less responsive to voluntary control and become weaker.

This muscle weakness can affect many aspects of daily living, such as speech and swallowing.

When you speak, you use the muscles of your:

  • lungs
  • vocal cords
  • throat
  • lips
  • jaw
  • palate
  • tongue

If MG weakens any of these areas, it can affect the way your voice sounds.

Some of the MG effects on speech include:

  • slurred speech (dysarthria)
  • an overly nasal tone
  • poor breath support
  • vocal fatigue
  • pitch control issues
  • limited pitch changes (monotone)

You may not experience these effects when you first speak after a period of rest. However, as your voice gets tired, MG signs can become more apparent.

How does myasthenia gravis affect communication?

The effects MG has on the mechanics of speech can affect your ability to communicate.

Factors like volume, pace, and intonation are examples of how a person uses their voice to express the emotions behind their words. MG muscle fatigue can interfere with the way you convey your intentions and lead to misunderstandings.

MG may also change your ability to control your facial expressions. You might accidentally show a “poker face” or an awkward, unusual, or poorly timed expression.

Communication challenges can lead to issues like:

  • social isolation
  • anxiety
  • stress
  • depression
  • reduced sleep

These are some of the factors that may also worsen MG symptoms.

Speech therapists help people with MG in several ways.

These include:

  • teaching strengthening exercises
  • suggesting environmental adaptations
  • explaining vocal hygiene
  • teaching compensatory strategies
  • emphasizing vocal rest
  • providing training on the use of augmentative alternative communication (AAC) devices for use during vocal rest

Strengthening exercises are reserved for use in specific situations, such as:

  • while your medication is at its peak
  • during times of MG stability
  • during MG remission

MG muscle weakness isn’t the kind you strengthen with repetitions, like athletes in a gym.

Too much work can cause fatigue, which may increase your chance of a myasthenic crisis. This is a medical emergency that affects about 10% of people with MG, during which your breathing muscles weaken so much that you require the support of a ventilator.

So, it’s recommended that you avoid strengthening exercises during exacerbations or myasthenic crises.

A speech-language pathologist can also formally diagnose dysarthria or any other speech issues (such as dysphonia).

In addition to teaching you skills to speak with greater clarity and ease, a speech-language pathologist can also help if you have problems swallowing (dysphagia).

How do speech therapists treat dysphagia?

Dysphagia means swallowing difficulties. Speech-language pathologists can help you learn to manage dysphagia.

Treatments include:

  • swallowing exercises
  • advice about modifying food consistency
  • strategies like posture adjustments to help you swallow
  • education about dysphagia

When are swallowing exercises contraindicated for myasthenia gravis?

Swallowing exercises are not recommended during a myasthenic crisis, symptom exacerbation, or immediately before eating.

When a person with MG is stable or in remission, they can perform swallowing exercises during peak drug therapy.

You might benefit from speech therapy if your MG symptoms interfere with your:

  • speech sounds
  • communication
  • swallowing

The implications of these issues can be significant. Your ability to communicate has important social and occupational effects, and functional swallowing allows you to eat nutritious food and reduces your chances of choking.

It might be time to try speech therapy if you experience:

  • a reluctance to answer questions or participate in conversations
  • unwanted social isolation
  • occupational limitations
  • unintended weight loss not from another illness

The duration of speech therapy for MG is based on your specific needs and symptom severity. A speech-language pathologist can help you set up a treatment schedule.

If you’re experiencing a symptom flare, your speech therapist may recommend taking a break from your therapy, since MG symptoms usually improve with rest.

If you’re interested in learning more about speech therapy for myasthenia gravis, speaking with your doctor about a referral is a good first step.

Keeping a log of your symptoms can help your doctor assess how you’re doing. Making note of your activities before symptoms occur may also be helpful.

Bringing a list of questions to your appointment can help you get the information that you need, and your detailed summary of symptoms can help your doctor make an appropriate referral or treatment suggestions.

MG causes weakness in voluntary muscles in your body, including the ones in your head and neck.

Speech therapy is an important treatment for many people living with MG. A speech therapist can help you improve your ability to communicate, as well as manage issues with swallowing.