How does Parkinson Disease affect speech?
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.

Are swallowing problems associated with Parkinson Disease?
Swallowing disorders are common in individuals with PD. Swallowing problems can occur at various stages in PD and may change throughout the course of the disease getting worse as symptoms progress. Difficulties with swallowing can often co-occur with changes in speech and voice. Symptoms can include coughing, choking, difficulty taking pills, drooling, taking a long time to eat meals, weight loss, pneumonia and/or dehydration.

What should I do if I notice problems with swallowing?
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.

I have been diagnosed with PD and have problems with excessive saliva and drooling. What can I do about that?

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.

I have had PD for 6 years. Recently I've noticed difficulty swallowing my pills. What can I do?
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.

I notice when I look in the mirror that the muscles of my face don't move as much as they used to, and my face is not as expressive as it used to be. Could this be a result of my Parkinson's disease?
Yes it can. It is very common for individuals with Parkinson's disease to have what is called a “flat facial expression”. Individuals who have a flat facial expression may look disinterested or unhappy, even though this is not truly how they feel. Just as the Parkinson's disease may make it more difficult for you to move the muscles of your body, it can also make it more difficult for you to move the muscles of your face, or express emotion on your face. Other people that you communicate with may not be aware of how Parkinson's disease can affect your facial expression. Thus, it is important to educate those around you and let them know that even though you may look disinterested or upset, you really are not. It is important for others to know that this is a result of the Parkinson's disease, and is not an indication of how you actually feel.

I have recently developed difficulty with voice and speech and have to repeat a lot. Is there any treatment for this?
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 check the website at www.lsvt.org for information. The LSVT foundation maintains a list of LSVT® certified speech clinicians in your area. My wife is always asking me to repeat myself. She says I don't talk loud enough and I think she is losing her hearing. I feel like I'm speaking with extra effort already.

What can we do?
One of the symptoms that accompanies changes in voice and speech in PD is that the person with PD has difficulty monitoring how loud they are speaking. This is not the result of a change in hearing, rather it is a result of changes in the sensory system where a softer voice sounds louder to the person with PD than it does to the listener. Often the person with PD will state that it takes much more effort to speak at a level sufficient for others to understand them. The LSVT® includes sensory training as a component of the therapy. Only clinicians certified in LSVT® can administer the therapy. To locate a clinician in your area contact the LSVT Foundation at 888-606-5788 or go the website at www.lsvt.org.

I have had PD for the last 5 years. In the last few months I have had shortness of breath. I have seen my family doctor and have been cleared of heart and lung problems. It also seems that my voice volume has decreased. Do you have any suggestions about this combination of symptoms?

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.

What exercises can I do at home to improve speech or swallowing disorders?

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.

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