Approximately 75-90% of individuals with Parkinson disease (PD) have speech and voice disorders at some time in the course of their disease. The most common perceptual speech characteristics include reduced loudness, monopitch, hoarseness, a breathy voice quality and/or imprecise articulation. The exact cause of these speech symptoms is not clearly understood, but they may be related to the rigidity of movement, slowness of movement and reduced amplitude of movement of individuals with PD. In addition, people with PD may not be aware that they are getting softer in their speech and more difficult to understand.

These voice and speech symptoms can have a significantly negative impact on quality of life. The presence of speech and voice disorders can effect communication at work, with family or with friends. Seeking an evaluation with a speech-language pathologist experienced with PD as early as possible is important so you can begin an effective treatment program. You will need a prescription from your physician for this.

If individuals are having any difficulty with swallowing they should let their physician know immediately and request a referral for a swallowing evaluation with a speech-language pathologist. The reason prompt action is important is that swallowing problems have the potential to lead to more serious medical problems such as pneumonia.

At a minimum a swallow evaluation will include a clinical examination of the muscles and function of chewing and swallowing. It can also include a modified barium swallow study that is done in a hospital and allows the evaluation of the anatomy and physiology of swallow, assessment of whether food or liquid goes down the wrong way and evaluation of the effectiveness of treatment strategies. The needs of the individual determine whether a modified barium swallow is needed in addition to a clinical examination.

People who have PD frequently report the problems you describe with excessive saliva and drooling. There has been controversy about whether the root cause of this problem is more saliva than usual or less frequent and less effective swallowing or a combination of both. Speech-language pathologists can assess and treat swallowing disorders. The best course of action would be to consult with your physician to describe your problem and request a swallow evaluation with a speech-language pathologist.

PD medication is critical in the management of PD symptoms so taking pills is very important. Difficulty swallowing pills is a type of swallowing disorder. Some people report there are times in the day when swallowing is easier than others and sometimes swallowing gets more difficult over the course of the disease. I suggest you call your physician to describe your symptoms and request a swallow evaluation with a speech-language pathologist who is experienced in treating people with PD. You need to swallow well to keep your medication levels consistent.

Fortunately, there is an effective treatment that can help improve voice and speech by training increased loudness. The LSVT® has been documented to increase loudness and improve intelligibility in individuals with PD. If you would like to learn more about speech and voice disorders in PD or the LSVT®, please contact the LSVT Foundation at 888-606-5788 or email www.lsvt.org for information. The LSVT foundation maintains a list of LSVT® certified speech clinicians in your area.

Shortness of breath is a condition that you very appropriately had evaluated by your physician. I suggest you continue to be in touch with your doctor so that he/she can monitor that situation.

It is common for individuals with PD to notice reduced volume and decreased breath support for speech. Many individuals complain that they can’t talk as loudly as they used to or they feel they are running out of breath while they are talking. Fortunately, behavioral speech therapy can address these changes in communication function. The LSVT® targets increased vocal fold adduction, which can have an impact on loudness and the amount of air available for speaking.

Although there are voice, speech, and swallowing disorders that are typical of people with PD, the typical picture doesn’t always apply to an individual. Therefore, it is much easier to describe treatment approaches in general than it is to determine which treatment approaches are appropriate for a specific individual. It is important that any treatment approach address the underlying cause of voice, speech or swallow problems.

I would recommend that you get a prescription from you physician for an evaluation with a speech-language pathologist who works with PD and is trained in the LSVT®. That person will be able to assess voice, speech and swallowing disorders and make treatment recommendations. If getting to a facility is difficult for treatment then a home program could be worked out. However, the initial evaluation in person is a critical step in choosing the correct treatment approach for you.