Speech therapy for muscular dystrophy
Reviewed by Speech therapy for muscular dystrophy can serve as part of multidisciplinary care when the condition affects speech, communication, or swallowing. In some types of muscular dystrophy, weakness of the facial and oral muscles controlling the tongue, lips, soft palate, and cheeks, as well as respiratory muscles such as the diaphragm, results in impaired speech quality (dysarthria) and voice quality (dysphonia).
Speech therapy and assistive communication technology can help individuals communicate more effectively as they navigate progressive symptom changes, supporting participation in school, work, and daily life. These interventions also evaluate and manage chewing and swallowing problems in muscular dystrophy, which is vital for protecting the airway, preventing choking, and maintaining good nutrition over time. A speech therapist forms a crucial part of a patient’s neuromuscular care team if muscular dystrophy affects communication or swallowing.
This article outlines what to expect from speech therapy, why it can help, and how it works.
How muscular dystrophy affects communication
Muscular dystrophy affects communication by weakening the physical structures necessary for producing spoken language. For some children with Duchenne muscular dystrophy, speech delays serve as early signs of the disease.
Managing muscular dystrophy speech problems involves addressing how the condition alters speech in the following ways:
- Speech clarity and pronunciation: Duchenne muscular dystrophy, myotonic dystrophy (DM1), oculopharyngeal muscular dystrophy, and limb-girdle muscular dystrophy type 1A can lead to weakness in the muscles around the mouth and voice box, as well as respiratory support muscles. The connection between dysarthria and muscular dystrophy often manifests as slurred speech or indistinct pronunciation of consonants and vowels.
- Voice and resonance: Facioscapulohumeral muscular dystrophy and DM1 can cause weakness in the soft palate and tongue, preventing full closure of the nasal passage during speech. As air escapes through the nose, the voice takes on an overly nasal tone (hypernasality). Laryngeal muscle weakness can also lead to a quiet, hoarse, or monotone vocal quality.
- Breath support: Weakness in the diaphragm and respiratory muscles can reduce breath support for speech, resulting in shorter phrases, a whispery voice (breathiness), and vocal fading at the end of sentences.
- Language and developmental differences: In certain types, such as Duchenne, the absence of dystrophin in the central nervous system can cause early neurodevelopmental delays. These include speech delays, language processing deficits, and expressive language challenges, even before physical weakness appears.
When speech therapy may be helpful
A neuromuscular care team or physician may recommend an evaluation if changes in speech, swallowing, or feeding impact an individual’s daily life or indicate underlying safety risks. Doctors can refer patients to a speech-language pathologist for a comprehensive evaluation and personalized treatment plan.
Signs that a referral may be necessary include:
- reduced speech clarity or slurred speech
- a voice becoming noticeably quieter, breathy, monotone, whispery, or nasal-sounding
- speaking in short phrases due to reduced breath support
- taking significantly longer to chew and swallow food, or food getting stuck in the mouth
- in children, developmental speech delays or difficulty finding words to speak
Signs that an urgent referral is needed include the following:
- coughing or choking during mealtimes
- a gurgling or “wet” quality to the voice after eating
- weight loss, dehydration, or malnutrition
- recurring chest infections caused by food, liquid, or saliva entering the lungs (aspiration pneumonia)
What happens in a speech therapy assessment
During a speech therapy assessment, a speech-language pathologist examines the muscles used for speech, assesses language and communication skills, and measures how safely a patient can chew and swallow.
Depending on a patient’s age and specific presentation, a speech therapist may test the following areas:
- Structural-functional and oral mechanism examination: This evaluates the symmetry, strength, structural integrity, and range of motion of the lips and oral structures.
- Motor speech and acoustic or perceptual assessment: The therapist measures how easy a patient’s speech is to understand, how clearly they pronounce words, how their voice sounds, and their overall speech rhythm.
- Respiration and phonation assessment: The therapist evaluates vocal volume, pitch variation, breathiness or whisperiness, and breath coordination across phrases.
- Language and communication assessment: In children, a speech therapist might ask about delayed speech development and assess difficulties with expressing and understanding language, processing sounds, remembering the words they want to say, or retaining short-term memory for others’ speech.
Therapists may also screen for swallowing difficulties (dysphagia). They will evaluate whether patients need extra time to chew, whether food or liquid leaks from the mouth or gets stuck in the throat, whether coughing or choking occurs during meals, or whether the voice sounds wet or gurgly after eating.
How speech therapy can help
Speech therapists utilize several approaches to address muscular dystrophy speech problems.
- Muscular dystrophy speech therapy exercises to improve muscle strength: Speech therapists guide patients through exercises that target tongue, lip, and jaw placement during speech. This helps improve control and word clarity.
- Pacing and intent: Specialized speech programs (such as LSVT LOUD® or SPEAK OUT!®) teach individuals how to speak with intentional, conscious effort to boost vocal volume and speech clarity. Therapists may use practical tools such as pacing boards to guide speaking speed, metronomes to build a steady speech rhythm, and hand-tapping techniques to trigger natural breathing pauses.
- Vocal cord and palate exercises: Targeted muscular dystrophy speech therapy exercises can also shape vocal quality. For example, patients with a weak, breathy voice might benefit from throat-closing exercises to help the vocal cords close more tightly. Those with strained, tight voices might learn relaxation exercises and receive vocal cord massages. Specialized air-pressure exercises using a continuous positive airway pressure (CPAP) machine, guided by a therapist, may help strengthen the roof of the mouth to improve vocal tone.
- Breathing and rhythm exercises: Therapists may provide handheld devices for patients to breathe into and out of to build lung strength. They can also teach individuals how to “chunk” speech into shorter phrases to conserve air, find natural breath pauses, and practice raising or lowering vocal tone to emphasize certain words.
When communication aids are useful
When speech becomes difficult for others to understand or requires too much physical effort, other communication strategies, such as augmentative and alternative communication (AAC), can help.
Augmentative communication supplements speech when clear communication becomes difficult, while alternative communication replaces it entirely if a patient becomes nonverbal. Other approaches include hand signs, gestures, and fingerspelling.
Several communication devices for muscular dystrophy are available as part of an AAC strategy. Individuals with enough hand strength can utilize low-tech options such as:
- writing with a pen and paper
- writing on a Boogie Board, which has an LCD screen for writing and erasing words
- typing on a computer or touchscreen tablet
- using photographs or physical objects to communicate ideas
Mid- and high-tech options include:
- using a computer, tablet, or smartphone through communication apps, text-to-speech functions, and drawing or writing tools
- single-message devices that play a prerecorded message to convey a quick idea, such as “more, please” or “I need a break”
- recordable or digitized devices that play multiple messages using buttons or interchangeable paper displays
- speech-generating devices, or purpose-built hardware that enables text-to-speech communication and may support eye-gaze tracking cameras, head-tracking mice, and adaptive switches for limited hand mobility
How to prepare for a speech therapy appointment
Preparing for an initial speech therapy appointment helps make the most of the visit. Being aware of how symptoms present, what triggers them, and what a patient or family wants from a session supports a productive initial consultation.
Patients and caregivers should note:
- specific times of day that trigger speech changes
- continuous talking that triggers speech changes
- speech changes that occur alongside physical fatigue
- settings (such as noisy family dinners or the classroom) that cause the most frustration with communication or fatigue
- specific goals, such as contributing more in the classroom, feeling less tired after talking, or finding an AAC system that works well
If a patient currently uses assistive technology to communicate, they should bring it to the appointment.
After the initial consultation, the best way to prepare is to practice the muscular dystrophy speech therapy exercises set by the speech therapist, get used to any new assistive devices, and note any particular challenges or roadblocks encountered during use.
Tracking progress or symptom changes helps the speech therapist adjust care plans and exercises as needs evolve. A written or digital journal may support this, and the therapist can advise on how best to log these changes.
Muscular Dystrophy News is strictly a news and information website about the disease. It does not provide medical advice, diagnosis, or treatment. This content is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. Never disregard professional medical advice or delay in seeking it because of something you have read on this website.
