SALT Our speech and language therapists assess and manage EDS issues such as dysphagia, dysarthria and dysphonia. Sometimes, we are the first port of call. A person with myasthenia will be referred to us due to difficulties with speech. This will either be from a dysarthrtric or a dysphonic perspective. Many of those with myasthenia do not realise that we treat dysphagia too. In LEMS speech and swallowing difficulties are rare but in myasthenia gravis swallowing difficulties can lead to aspiration pneumonia or choking. There are two immediate and practical considerations: These clients may have complications taking medication and some tradition exercises are contraindicated. Dysarthria and Dysphonia Dysphonia can be present as a result of respiratory or laryngeal weakness. Dysarthria can occur due to weakness or difficulty in coordinating the speech muscles. Typical features of myasthenic speech: Poor breath support (quieter voice). Weakness or poor laryngeal movement (breathy voice and slow, quiet speech). Weak palatal closure (nasal speech). Weak articulation and movement of lips, tongue and jaw (garbled/slurred laboured speech). Weak facial muscle movement (sneer / lip pouting). Caution: Traditional exercises that assist with dysarthria / dysphonia are contraindicated in myasthenia due to weakness caused by fatigue. Aids: Voice amplifiers for low volume. Communication books or picture symbol boards to aid speech difficulties. Dysphagia We recommend that clients with myasthenia: Eat when they are strongest i.e. after taking meds. Eat little and often so as not to tire themselves. Eat a modified diet (soft or pureed food). In some situations drinks can pass upwards and come out through the nose when palate doesn’t close so the right consistency is vital. Compensatory techniques can help some clients.