Speech therapy
Videos, information and references on speech therapy and tips for managing symptoms of dysarthria and dysphagia caused by ataxias.
Information and tips
Difficulty speaking and swallowing
Many types of ataxia affect the cerebellum and other structures of the central nervous system, such as the brainstem. These changes can impair the coordination of the muscles responsible for speech and swallowing. Over time, symptoms of dysarthria may appear — speech difficulties that include slurred speech, voice changes, and trouble clearly articulating words. Problems with swallowing, known as dysphagia, may also occur, causing choking, weight loss, and significantly increasing the risk of aspiration pneumonia.
If you have these symptoms, or care for someone who does, seek the help of a speech-language pathologist.
Portuguese video with English subtitles.
Ataxic Dysarthria
Impaired word articulation is the main feature of ataxic dysarthria.
Therefore, speech therapy aims to reduce these difficulties and improve speech intelligibility. The areas of focus include posture, control of pitch and muscle tone, muscle strength, breathing coordination, phonation, resonance, articulation, and training of stressed syllables.
The exercises involve working with the diaphragm, abdominal muscles, breathing patterns (inhalation and exhalation), coordination of muscle movements, and adjustments to speech rate, among others.
Dysphagia caused by ataxia
As ataxia progresses, the patient may begin to show symptoms of dysphagia, such as coughing when swallowing, choking, difficulty swallowing, and a sensation of food being stuck in the throat. As soon as any of these signs appear, it is recommended to consult a speech-language pathologist.
The problem is that, without being able to cough and swallow normally, the person is at greater risk of choking on food (solids, liquids, or both). This can lead to serious complications, such as aspiration pneumonia, or even death if the airway cannot be cleared.
Treatment
The speech-language pathologist performs the diagnosis and provides individualized treatment for each patient, aiming to restore the functional ability to swallow and thus reduce the risks of dehydration, malnutrition, and consequent weight loss.
The treatment seeks to reestablish safe eating, giving the patient back the ability to enjoy food.
Dr. Susan Perlman (an ataxia specialist) explained in a webinar that coordinating the numerous muscles used to speak, breathe, and eat simultaneously is complex, and over time, this coordination can become more difficult for those with ataxia. Since we can't hold our breath, those with ataxia should educate themselves to avoid talking while eating (it's not "being silent during lunch," it's avoiding talking while chewing and swallowing food).
People with ataxia who have choked on food are advised to do the following to reduce the risks while eating:
- Break solid foods into small pieces. However, avoid foods that are very small or easily inhaled, such as sesame seeds.
- Avoid dry and brittle foods, such as biscuits and nuts.
- Avoid foods that are difficult to break or cut with your teeth, such as steaks and apples.
- Stay mentally focused while eating, paying attention to the act of swallowing, without talking or doing other activities while chewing.
- To drink liquids, use a cup with a straw.
- Avoid consuming thin liquids. Try to drink thicker liquids, or add thickeners (sold in pharmacies or made at home with powdered gelatin).
- Avoid eating and drinking while lying down.
- In more severe cases, when sleeping it is advisable to raise the head of the bed a little (keep your head a little higher) to avoid choking on saliva (ataxia can produce excess saliva in certain cases).
If you experience symptoms of dysphagia, you should see a speech therapist for therapy (special exercises to help you swallow without choking). There are also medications like Pyridostigmine that can help in certain cases (which must be properly prescribed). Monitoring by a qualified professional is important to avoid dehydration or malnutrition due to eating difficulties, as well as to reduce the risk of aspiration pneumonia, which occurs when food debris falls into the lungs, which can be fatal.
Learn more about the risks of aspiration related to ataxia - the article "Snapshot: What is Aspiration?" from the NAF (National Ataxia Foundation) written by Hannah Rowe, PhD, CCC-SLP, and edited by Celeste Suart, PhD. The text is in English, but you can translate the page into several languages using the Translate button.
NAF (National Ataxia Foundation) YouTube Webinars on Speech-Language Pathology
The videos are in English, but you can activate subtitles and enable translation into other languages.
Link to NAF YouTube channel
Assistive Technology & Strategies to Mitigate Speech & Swallowing Impairments in Ataxia (AAC 2025)
Caitlin Cloud, MA, CCC-SLP
Document in English from the NAF (National Ataxia Foundation) with tips to mitigate speech problems (dysarthria) and swallowing difficulties (dysphagia) caused by ataxias.
Assistive Technology & Strategies to Mitigate Speech & Swallowing Impairments in Ataxia (AAC 2024)
Dr. Allison Hilger, PhD, CCC-SLP