“The one thing I would recommend for people with Parkinson’s disease is to not forget the effects it has on your voice and swallowing. Everyone with PD needs to see a speech therapist early on in their disease.”
—LAURA S., PWP
About 75 percent of people with Parkinson’s experience changes in their speech or voice during the course of their disease.39 Though we don’t know exactly what causes these changes, researchers think they may be related to the rigidity, slowness, and reduced range of movement in people with PD.
Below are some of the typical problems people with PD may have with speech (although they may not be aware of them).
• Slurred words (often)
• Soft and quiet voice (so quiet you sometimes can’t even hear it)
• Sudden pauses or long breaks in the middle of a sentence while trying to remember a word or thought
• Monotone voice
• Hurried way of speaking that sometimes seems like a stutter
• Slow speech patterns, with repeated sounds and stops
If you are noticing these symptoms or feeling like your communication skills are suffering, you may benefit from seeing a speech-language pathologist. These specialists teach effective techniques for working within limitations and conserving energy while doing so. A speech-language pathologist may also teach you nonverbal communication skills that you can use as needed.
Because a speech disorder can be a severely limiting and stress-inducing symptom of PD, having a resource to consult about it can be enormously helpful. Talk to your doctor to determine whether a speech-language pathologist referral is right for you. Two popular programs that are seeing some great results are Lee Silverman Voice Therapy (LSVT) LOUD and Parkinson Voice Project’s SPEAK OUT!
Following are some speech therapy techniques you may wish to try.
• Pick a quiet area when you are talking with others. Trying to make yourself heard over loud peripheral sounds can be tiring and stressful.
• Speak slowly.
• Prioritize face-to-face conversation. Looking at the other person while you are talking can help increase understanding and reduce miscommunication.
• Try using short phrases only. Limiting your speech to only one or two syllables per breath will help prevent fatigue.
• Over-articulate your speech by making your vowels longer and exaggerating the consonants.
• Choose a comfortable posture and position so you don’t have to worry about pain or fatigue when having extended or stressful conversations.
• Use the exercises recommended by your speech-language pathologist and be careful not to overexert yourself. Exercises meant to strengthen weakening muscles may do more harm than good if done improperly.
• Plan a period of rest for your voice before a long conversation or phone call. Keep in mind that fatigue affects your ability to speak and that you may need to adapt your speech techniques as the day progresses.
• Use an amplifier if you are struggling to be heard because of a low or soft voice.
If people have difficulty understanding you, these ideas may help.
• If you are able to write without too much trouble, carry a pen and notebook with you so you can write down what you are trying to say during periods of miscommunication or fatigue.
• If writing is difficult, use an alphabet board. You can point to the first letter of the word you are trying to say, or you can fully spell out words if they are not being understood.
• Pick a topic before starting a discussion.
• Use telegraphic speech. Leave out words you don’t need to communicate what you’re trying to say.
• Use facial expressions and gestures to communicate.
Below are some devices available to help people with PD communicate more clearly.
Palatal lift. A palatal lift is a prothesis that looks like a retainer. The lift stops air from escaping from the nose during speech.
Amplifier. Personal amplifiers do just that—they amplify the voice. Because you don’t have to work as hard to produce vocal volume, you will experience less fatigue with speech.
Electronic speech enhancers. There are several types of communication devices available for purchase, including computers with voice synthesizers.
Prepare now so that you can communicate in an emergency.
• Make sure you set up a system in advance to communicate emergencies. You can use something as advanced as an intercom system or as simple as a baby monitor to alert people around you of an emergency.
• If you are unable to speak, use bells and buzzers to alert your caregiver. Set up a plan. For example, ringing a bell may mean “I’d like some company,” while an air horn means there’s an emergency.
• Keep a mobile phone with preprogrammed emergency contact numbers with you at all times so you can automatically dial for help when necessary.
• Invest in a LifeCall button if you live alone or spend time without a caregiver in the home.
One easy and fun way you can help retrain your weakened vocal cords is to sing! Consider trying a Parkinson’s singing group, or if there isn’t one near you, why not start a group of your own?