The role of the speech therapist in the cognitive care of patients with multiple sclerosis
When talking about multiple sclerosis (MS), we often first think of physical symptoms: fatigue, walking difficulties, balance problems. However, another facet of the disease, more discreet but just as impactful, affects the majority of patients: cognitive disorders. Your brain, this remarkable information processing machine, can become slowed down, as if messages struggle to find their way. This is where a health professional, often underestimated in this field, plays a key role: the speech therapist. Far from being limited to speech or swallowing disorders, the speech therapist is a true coach for your brain. He or she helps you understand, navigate around, and retrain the cognitive functions that pose problems in your daily life.
1. Understanding cognitive disorders in multiple sclerosis
Before discussing solutions, it is essential to clearly identify the problem. Cognitive disorders in MS are not a form of dementia. They are the direct consequence of the lesions that the disease creates on the communication pathways of your central nervous system. Imagine your brain as a vast road network. MS creates slowdowns, detours, and even blockages on certain roads. Information then takes longer to arrive or gets lost along the way.
These cognitive difficulties primarily affect the speed of information processing, working memory, attention, and executive functions. Contrary to popular belief, these disorders are not related to age or general fatigue, but rather to the pathology itself. They can appear very early in the progression of the disease, sometimes even before the first physical symptoms.
The uniqueness of these cognitive disorders is their variability from person to person and even from day to day in the same person. This fluctuation can be confusing and a source of misunderstanding for those around. One day, you may perfectly follow a business meeting, and the next day, struggle to understand a simple conversation. This variability is normal in the context of MS.
The cognitive areas most frequently affected:
- Information processing speed: overall slowing of cognitive functioning
- Working memory: difficulty temporarily retaining new information
- Sustained and divided attention: concentration and multitasking problems
- Executive functions: planning, organization, problem-solving
If you are experiencing cognitive difficulties, do not hesitate to discuss it with your neurologist. A neuropsychological assessment may be prescribed to accurately evaluate your cognitive functions and guide you towards appropriate speech therapy support.
2. The concrete impact on daily life
These cognitive difficulties, although invisible, can have significant repercussions on your personal, social, and professional life. You might recognize yourself in some of these situations: you lose track of your thoughts in the middle of a sentence, you forget appointments despite your efforts, you feel overwhelmed by preparing a meal that requires managing multiple cooking processes simultaneously, or you have difficulty following the plot of a movie.
In a professional context, these disorders can manifest as difficulties in taking notes during meetings, managing multiple files simultaneously, meeting deadlines, or adapting to organizational changes. The resulting cognitive fatigue can be exhausting and may require more frequent breaks.
In the personal sphere, family and friendship relationships can be affected. Group conversations become tiring, outings in noisy environments exhausting, and managing the household more complex. This "cognitive fatigue" is draining and can lead to frustration, a feeling of incompetence, and gradual isolation.
"At first, I thought I was just tired. Then I realized that I was having trouble following my children's conversations at the table. It was as if my brain needed more time to process each piece of information. The speech therapist helped me understand that it was related to my MS and gave me tools to better manage these moments."
Use of a digital agenda with reminders, arranging family conversation times (calm environment, no television), and learning relaxation techniques to manage cognitive fatigue.
3. The speech therapy assessment: mapping your strengths and weaknesses
The first meeting with a speech therapist will not start with exercises, but with a thorough evaluation. This step, called cognitive assessment, is fundamental. Its goal is to create an accurate map of your cognitive functioning, much like a GPS that identifies smooth roads, construction zones, and alternative routes in your brain.
The assessment generally consists of two main parts. First, a detailed interview, called anamnesis. The speech therapist will ask you questions about your daily life, the difficulties you encounter, their frequency, their impact on your morale and quality of life. This is a crucial exchange moment where your feelings are at the heart of the process.
Next comes the standardized testing phase. This is not a school exam, but a series of fun and varied exercises (puzzles, memorizing lists of words, planning tasks, etc.) that allow for an objective evaluation of each cognitive function. These tests compare your performance to that of people of the same age and educational level, in order to identify what pertains to a specific difficulty related to MS.
The commonly used tests include:
- Sustained attention tests (maintaining concentration on a task)
- Working memory evaluations (mental manipulation of information)
- Processing speed tests (speed of executing simple tasks)
- Executive function evaluations (planning, mental flexibility)
- Verbal fluency tests (ability to generate words)
At the end of this assessment, the speech therapist will not simply give you a list of "scores". He or she will share with you a comprehensive analysis of your strengths and weaknesses. Above all, this evaluation will allow for setting concrete, personalized, and realistic care objectives. The goal is not to "cure" cognitive disorders, but to learn to live with them, to reduce them when possible, and to navigate around them intelligently.
To optimize your assessment, sleep well the night before, have a balanced breakfast, and come with a list of the difficulties you encounter daily. Don't hesitate to bring a relative who can share their observations.
4. Define personalized and realistic goals
A goal could be: “I want to be able to read an entire chapter of a book without losing track” or “I would like to participate in a family meal without feeling exhausted by the overlapping conversations.” It is from these life goals that the rehabilitation plan will be built. This approach centered on the real needs of the patient is what distinguishes quality speech therapy care.
Goals are always set in collaboration with you and can evolve over the sessions. They must be SMART: Specific, Measurable, Achievable, Realistic, and Time-bound. For example, rather than saying “improve my memory,” one would prefer “be able to remember a shopping list of 8 items without writing it down, within 2 months.”
The speech therapist also ensures to balance the goals across different areas of your life: personal, professional, social. These can be short-term goals (within 4-6 weeks) and longer-term goals (3-6 months). This progressive approach helps maintain motivation by celebrating small victories while keeping an overall vision.
Being able to take effective notes in meetings, manage your schedule without forgetting appointments, write a report without losing track of your ideas.
Follow a complex cooking recipe, watch a movie without getting bored, participate in group conversations.
Maintain satisfactory friendly relationships, participate in leisure activities, communicate effectively with loved ones.
5. The two pillars of care: rehabilitation and compensation
Once your functioning map is established and the destination set (your objectives), the work with the speech therapist can begin. It revolves around two complementary axes, like the two oars of a boat that allow you to move forward: rehabilitation and compensation. These two approaches do not oppose each other but complement each other to offer you maximum autonomy and quality of life.
Rehabilitation aims to directly stimulate weakened cognitive functions. The brain has an extraordinary capacity called neuroplasticity: it can reorganize itself and create new connections to compensate for damaged areas. The speech therapist acts like a sports coach who offers you targeted exercises to strengthen these new neural pathways.
Compensation, on the other hand, involves learning strategies to bypass obstacles. If rehabilitation is equivalent to repairing a road, compensation consists of learning to use effective detours. These two approaches are used simultaneously and adapted according to your progress and specific needs.
6. Rehabilitation: training your brain to create new pathways
These rehabilitation exercises are progressive and adapted to your abilities. They may include memory games, selective attention exercises, or problem-solving tasks. The goal is to challenge the brain intensively and repeatedly to encourage it to reconfigure. The sessions are designed to be stimulating but never discouraging, maintaining a level of difficulty suited to your current abilities.
It is with this in mind that digital tools have been developed to complement the work done in sessions. Our applications COCO THINKS and COCO MOVES are designed precisely for this purpose. They offer a wide variety of playful exercises that specifically target different cognitive functions. Used in collaboration with your speech therapist, they allow for continued training at home in an autonomous and motivating way.
Cognitive rehabilitation is based on scientifically validated principles: spaced repetition, gradual progression of difficulty, and multi-sensory stimulation. Each exercise is designed to specifically challenge a cognitive function while being varied enough to maintain interest and avoid automation.
Principles of cognitive rehabilitation:
- Intensity: regular and sustained sessions to stimulate neuroplasticity
- Specificity: targeted exercises on identified deficient functions
- Progression: gradual increase in task complexity
- Transfer: linking exercises to everyday life situations
- Motivation: maintaining engagement through variety and success
To maximize the effectiveness of rehabilitation, practice your exercises preferably in the morning when your brain is most rested, in a calm environment, and in short but regular sessions (15-20 minutes a day rather than a long weekly session).
7. Compensation: learning strategies to circumvent obstacles
When a cognitive function remains persistently deficient, it is pointless to persist. It is smarter and less tiring to learn to do things differently. The speech therapist is there to help you develop your own "toolbox" of strategies. These strategies are extremely concrete and aim to simplify your daily life by reducing the cognitive load necessary to accomplish your usual tasks.
For memory and planning, you might learn to systematically use a planner (paper or digital), create task lists for complex activities (shopping, preparing a trip), use alarms and reminders on your phone, or establish a morning and evening routine to not forget anything important.
For attention, strategies include learning to work in a calm and distraction-free environment, taking regular breaks to allow your brain to rest (the Pomodoro technique, for example), or training to focus on one thing at a time while avoiding multitasking, which particularly exhausts people with MS.
Do not hesitate to ask your interlocutor to repeat, to speak more slowly, or to rephrase their words in your own words to verify that you have understood correctly. Choosing calm moments for important conversations is also an effective strategy.
Use color codes to organize your belongings, prepare in advance what you will need the next day, break complex tasks into simple steps, and use timers to manage time.
The speech therapist helps you choose the strategies that best suit your personality and lifestyle, and supports you in making them true reflexes. The goal is for these strategies to integrate naturally into your daily life without giving you the impression of extra effort.
8. The speech therapist, an ally for you and your loved ones
The role of the speech therapist does not stop at the doors of their office. He or she is a valuable partner who can also intervene with your surroundings to facilitate understanding and communication. This psychoeducational dimension is crucial because cognitive disorders, being invisible, are often misunderstood by those around you.
Cognitive disorders are invisible, making them difficult for loved ones to understand. A forgetfulness can be interpreted as a lack of interest, a difficulty in following a conversation as voluntary distraction. The speech therapist can explain the nature of your difficulties to your family and friends. This psychoeducation is essential: it helps to alleviate guilt for everyone and replaces unspoken issues and misunderstandings with empathy and support.
Knowing that your slowness is not laziness but a symptom of the disease changes everything in a relationship. This understanding allows your loved ones to become true partners in your care, rather than worried spectators or sometimes annoyed by behaviors they do not understand.
The speech therapist can also give very practical advice to your entourage to make your life easier. For example, they can suggest speaking to you in a quiet place, looking at you when addressing you, avoiding asking you multiple questions at once, or giving you time to find your words without finishing your sentences for you. These small adjustments can considerably reduce your cognitive load and make social interactions much more enjoyable and less tiring.
9. Adapting the environment and communication
Beyond direct work with you, the speech therapist can advise on adjustments to your living and working environment. These modifications, often simple, can have a considerable impact on your quality of life. This may involve optimizing the lighting in your office, reducing sources of auditory distraction, or organizing your workspace to minimize the effort of searching and memorization.
In the professional environment, the speech therapist can collaborate with occupational medicine to propose job adjustments. These adaptations may include more frequent breaks, a quieter working environment, the possibility to work during the hours when you are most effective, or the use of technological tools to compensate for certain difficulties.
Communication with the medical team that follows you is also essential. The speech therapist can relay their observations to the neurologist, the primary care physician, and other healthcare professionals involved in your follow-up. This coordination allows for a global adjustment of your care and takes into account the evolution of your cognitive disorders in therapeutic decisions.
To improve communication with those around you, establish a simple code to signal when you need more time or when you feel cognitive fatigue. This will prevent misunderstandings and create a climate of kindness.
10. New technologies, partners in your rehabilitation
Today, speech therapy is enriched by new technologies. They do not replace the therapist, but they offer powerful tools to complement and enhance the work done in sessions. These technologies allow for advanced personalization of rehabilitation and precise tracking of progress.
One of the challenges of rehabilitation is maintaining motivation over the long term. Exercises can sometimes seem repetitive. The advantage of applications and software is their playful aspect (the "gamification"). Transforming a memory exercise into a game with points, levels, and rewards can make training much more engaging and encourage adherence to treatment.
Moreover, these tools offer great flexibility. You can train for a few minutes a day, wherever you are, from a tablet or smartphone. This regularity is one of the keys to the success of rehabilitation. The collected data also allows for precise tracking of your performance and can guide therapeutic adjustments.
Advantages of digital tools:
- Availability 24/7 for regular training
- Automatic adjustment of difficulty based on your performance
- Precise tracking of progress and report generation
- Variety of exercises to maintain motivation
- Ability to share data with your therapist
11. COCO THINKS and COCO MOVES: our solutions for tailored training
It is with this conviction that we developed our programs COCO THINKS and COCO MOVES. They are not just simple brain games. They are therapeutic tools designed in collaboration with health professionals to specifically meet the needs of people with neurological diseases such as multiple sclerosis.
An adapted and scalable program characterizes our applications: the difficulty of the exercises automatically adjusts to your performance. If you succeed, the level increases. If you are struggling, the game simplifies. This keeps you in a stimulating challenge zone but never discouraging. This dynamic adaptation is essential for people with MS, whose abilities can fluctuate.
Collaboration with your therapist is at the heart of our approach: COCO THINKS and COCO MOVES are designed to be used in tandem: by you, the patient, at home, and by your speech therapist in the office. The latter has access to a dashboard that shows your results, your progress, but also the areas where you struggle the most. This allows them to analyze your performance remotely and prepare the next session based on objective data.
Our applications detect performance variations and automatically adjust the difficulty. The exercises are also designed to be achievable even during periods of significant cognitive fatigue.
The collected data allows for tracking the evolution of your abilities over the long term and identifying moments when an adjustment in care may be necessary.
Support for your autonomy is also central: by allowing you to train regularly between sessions, these programs make you an active participant in your care. You no longer just endure your difficulties; you actively work to overcome them, which is extremely rewarding and beneficial for morale.
12. The importance of long-term monitoring and adaptation
Speech therapy management in MS is not a sprint; it is a marathon. Needs evolve with the disease, and monitoring must adapt accordingly. The speech therapist is not just there for occasional rehabilitation but can become a lasting partner in your care journey, intervening according to your needs and the evolution of your condition.
Follow-up assessments are essential for evaluating the effectiveness of the strategies implemented and adjusting them if necessary. These evaluations also allow for the early detection of new difficulties and prompt intervention. The frequency of these assessments depends on the evolution of your disease and your specific needs.
The approach must also adapt to the different phases of the disease. During flare-ups, the focus will be on maintaining achievements and providing support. During remission, rehabilitation work can be intensified. This flexibility is one of the strengths of speech therapy management.
13. Interdisciplinary collaboration and care coordination
The speech therapist rarely works alone in the context of MS. They are part of a multidisciplinary team that may include the neurologist, neuropsychologist, physiotherapist, occupational therapist, and other professionals according to your needs. This collaboration is essential for comprehensive and coherent care.
Communication between these professionals helps avoid redundancies and maximize the effectiveness of interventions. For example, the speech therapist's recommendations regarding organization can be reinforced by the occupational therapist in the arrangement of your home or workplace.
This integrated approach is particularly important in MS where physical and cognitive symptoms influence each other. Physical fatigue exacerbates cognitive disorders, and conversely, intense cognitive effort can increase general fatigue. Coordinated care takes these complex interactions into account.
Do not hesitate to inform each healthcare professional of the recommendations given by others. This cross-communication helps optimize your overall care and avoid contradictory advice.
Frequently asked questions about speech therapy and MS
It is advisable to consult a speech therapist as soon as you experience cognitive difficulties impacting your daily life. These disorders can appear very early in the progression of MS. Do not wait for the difficulties to become permanent. Early intervention is generally more effective.
The number of sessions varies according to your specific needs and goals. Generally, the first benefits are observed after 6 to 12 sessions. However, care may extend over several months, with a frequency that gradually decreases. Some people benefit from occasional follow-up over the long term.
Yes, speech therapy sessions prescribed by a doctor are covered by Health Insurance. As part of the MS, you can benefit from a Long-Term Condition (LTC) that allows for 100% coverage. Consult your neurologist to obtain a prescription.
Yes, tele-speech therapy has developed and can be an interesting option, especially in cases of mobility difficulties or significant fatigue. However, the initial assessment is usually done in person. Discuss with your speech therapist the modalities best suited to your situation.
Look for a speech therapist with experience in the neurological field and ideally trained in the cognitive disorders of MS. Don't hesitate to ask questions about their experience during the first contact. Your neurologist can also guide you to specialized professionals in your area.
Discover COCO THINKS and COCO MOVES for your cognitive rehabilitation
Complement your speech therapy with our applications specially designed for people with neurological disorders. Personalized training, professional follow-up, and exercises tailored to your needs.
Conclusion: Take back control of your daily life
If multiple sclerosis can sometimes give the impression of causing chaos in your mind, the speech therapist is there to help you bring order back. They do not have a magic wand, but expertise, tools, and a listening ear that can make a real difference in your quality of life. By precisely identifying your difficulties, teaching you workaround strategies, and stimulating your brain through targeted exercises, potentially supported by innovative digital tools like COCO THINKS and COCO MOVES, they give you the keys to become the pilot of your daily life again.
This speech therapy approach is part of a holistic approach to MS that recognizes the importance of cognitive disorders just as much as physical symptoms. It allows you to develop personalized strategies, tailored to your lifestyle and goals, to maintain your autonomy and quality of life for as long as possible.
Do not hesitate to talk about your cognitive disorders with your neurologist; they can guide you to this valuable ally in your care journey. Remember that asking for help is not a sign of weakness, but a proactive step to preserve your well-being and autonomy. With the right support and the right tools, you can learn to successfully navigate your daily life, despite the challenges that MS may present.
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