Language

We all rely on speaking and hearing speech throughout the day. This can be directly in person or through the TV or radio. It can be very disturbing to discover that your usually effortless communication has become less reliable. Sometimes you can't find a word you need at a particular moment, or some phrase is just on the tip of your tongue, but not coming out in conversation. 

These difficulties can feel very public, but its worth remembering that they will be much less obvious to those around you than they are to you. For most people with MS, it is unlikely that your words or phrases are lost forever. The difficulty lies with accessing them or using them appropriately. You will likely find that different words are hard at different times.

Although there are other factors that can affect your communication skills, such as fatigue or memory problems, your stores of words and their meanings are usually not significantly affected. This means that you can use some of these tricks below to help you speak and be understood.

• Everyone makes slips of the tongue and gets stuck for a word now and again. Be kind to yourself if this happens to you. The people around you will not necessarily notice or think that you have a problem.
• If a word is on the tip of your tongue, try not to tense up or panic. Stress will make it harder to get it out. Instead, either use another word or words to say what you need to, if possible. If it is a specific name or place where another word won't do, just say "I'll come back to that".
• If you are going to a family party or work meeting, where you expect to find people's names hard to remember, plan in advance. You could write the work people's names on the agenda or a piece of card and refer to it just before the meeting (or during, if necessary). Before a family party, run through who will be there with someone else and rehearse the difficult names in advance. Your partner may be able to greet people first, using their name, to give you a cue.
• If you have trouble following what someone is saying, do ask them to speak slowly and give you time to process what they are saying.
• If a person has a name that is easy to turn into a picture, you may find visualising them in a scene related to their name helps you remember. For example, Mr Smith could be imagined as a blacksmith hammering a horseshoe. This will link their face to the word "smith". This approach can take a bit of practice.
• If you need to speak to a group, for example at work or making a speech at a wedding, you will probably find it helpful to plan what you are going to say in advance and prepare prompt cards with bullet points. Even if you have been able to speak without notes in the past, it is an insurance policy to practice and prepare notes in advance. This will help you to avoid long pauses and "drying up".

There are many underlying reasons that can result in language difficulties. Your health professional will probably want to investigate exactly where the weaknesses are in your language, to develop effective management strategies with you. Your GP or MS nurse is the first port of call, but they may refer you to other health specialists.

A speech and language therapist will be able to help you if:

there are muscle or nerve impairments affecting your breathing, which makes clear or loud speaking difficult
you have weakness or poor co-ordination in the muscles of the mouth and throat, which may make your speech slurred or make it hard for people to understand your speech
you need a communication device of some kind

A psychologist will be able to help you if you find it hard to:

turn your thoughts into speech
follow conversations

An audiologist will be able to help you if:

you need a hearing test 
you are having trouble understanding what is said to you

If you talk to your family and friends about your difficulties with words it is likely that they will not have noticed that you are experiencing anything unusual. They may well seek to reassure you that they have the same problems. In some ways this could reassure you, because it shows that your slips have not been obvious.

However, if you feel that the slips and hitches in your speech are occurring more than they should, you could let your family and friends know. You could tell them exactly the kind of problems you are having, and give examples of when something was hard to say. 

If finding the right word has become a fairly frequent challenge for you at work, think about how you can prepare in advance or get support. You may wish to give presentations in a different way, for example. If your workmates understand what is happening, they are more able to help.