Communicating With Parkinson’s Patients

Problems With Speech And Voice

If you experience problems with your speech and voice you may find your speech sounds slurred or unclear, or that you speak more quickly than before. You may also find you have to slow down to make yourself understood. It can also become harder to control how quickly you speak.

Your voice can also change. It may sound:

• unsteady and flat

• difficulty putting enough power into your movements

Speech and language therapists are healthcare professionals who can provide assessment and advice on all aspects of communication, from facial expression and body language to speech and communication aids.

Clinical guidelines recommend that your GP, specialist or Parkinsons nurse should consider referring you to a speech and language therapist with experience of Parkinsons when youre in the early stages of the condition.

This is important because you may not notice changes to your speech and communication if they are subtle. But a speech and language therapist can uncover any issues, help you manage them and stop them becoming worse.

You may find it helpful to have regular check-ups. This will allow your speech and language therapist to monitor whether there are any changes with your speech. If there are, they can recommend specific exercises or programmes to help you.

Another recommendation in the guidelines is that youre given equipment to help you communicate if you need it .

Medication such as levodopa may help improve how loudly and clearly you speak.

What Alternative Communication Devices And Tips Can Help With My Voice And Speech Problems

If you have difficulty speaking, are frustrated and stressed by your inability to communicate or tire from the efforts to speak, consider the following devices and methods to be better understood:

• Amplification: This could be a portable personal amplifier or a telephone amplifier that can be used to increase vocal loudness in soft-spoken people. The amplifier also decreases voice fatigue.
• TTY telephone relay system: This is a telephone equipped with a keyboard so speech can be typed and read by a relay operator to the listener. Either the whole message can be typed or just the words that are not understood.
• Low-technology devices: Paper-based books and boards, alphabet boards and typing devices are examples of low technology assistive methods.
• High-technology electronic speech enhancers, communication devices: Computers with voice synthesizers and speech generating devices are available. Talk to a speech-language pathologist about the available high technology devices best suitable for your needs.

How Is Parkinson Disease Diagnosed

Parkinson disease can be hard to diagnose. No single test can identify it. Parkinson can be easily mistaken for another health condition. A healthcare provider will usually take a medical history, including a family history to find out if anyone else in your family has Parkinson’s disease. He or she will also do a neurological exam. Sometimes, an MRI or CT scan, or some other imaging scan of the brain can identify other problems or rule out other diseases.

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For Family Friends And Carers

Communication difficulties also affect family, friends and carers. Problems can be frustrating to deal with and misunderstandings may arise. The following suggestions may help when communicating with someone who has Parkinsons:

• Be patient and give them plenty of time to collect their thoughts and communicate. Dont walk away while they do this.
• Dont interrupt and finish their sentences for them.
• Talk normally, without shouting or sounding stressed or impatient.
• Make sure you are both in the same room and can see each other.
• Listen carefully and turn off any distractions such as the radio or television.
• If you dont understand something, ask them to repeat it louder and slower. Dont pretend that you have understood if you havent.
• Encourage them to engage in a conversation but without putting them under pressure.
• Reassure them if they have difficulty communicating. A simple squeeze of the hand can be very calming and encouraging.

Communication Devices And Technology

Some people with Parkinsons find that they have difficulties with communication, including their speech and writing. But technology can make this easier.

Being able to use a computer and the internet can open up lots of opportunities for you. You can:

• handle day-to-day correspondence through email, video calling or using speech-to-text software, which can be useful if you have problems writing by hand
• keep in touch with your friends and family, and share experiences with other people affected by Parkinsons through online communities and social media

A smartphone is a mobile phone that can do many of the same things a computer does, such as access the internet and emails.

Tablets are very slim, lightweight computers. Many people with Parkinsons tell us that tablets, such as the Apple iPad, are easier to use than desktop or laptop computers because they have touchscreens, rather than a keyboard and mouse.

Smartphones and tablets come with apps, which are pieces of software that can be used to perform a variety of tasks you may find useful, including:

• Voice activation most smartphones and tablets either have built-in features to enable voice control, or you can install an app to do the same job. You can use voice activation to help you:
• search the internet
• dictate text messages and emails
• open apps
• record notes as reminders or to send as messages

Video calling lets you see and hear the person you are talking to during a call.

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Do Swallowing Problems In People With Parkinsons Disease Also Affect Speech

Swallowing problems are a common problem in people with Parkinsons disease. They can occur at any stage of the disease, can change throughout the disease course and often get worse as symptoms progress. Let your healthcare provider and/or speech-language pathologist know as you notice you are having swallowing problems. Symptoms of swallowing problems include drooling, choking, coughing, difficulty taking pills, taking a long time to eat, weight loss and dehydration. The most serious complication of a swallowing problem–and the reason why you should see your provider right away– is aspiration. Aspiration is when food or liquid goes into your windpipe , then passes down into your lungs, which can lead to aspiration pneumonia.

Although swallowing problems may not directly affect your speech, swallowing problems and voice and speech problems often occur at the same time.

A note from Cleveland Clinic

Voice and speech difficulties are common problems in people with Parkinsons disease, especially as the disease worsens. These problems affect your ability to communicate in the work setting and with family and friends which affects the quality of your life. Fortunately a speech-language pathologist can develop an effective treatment program to help improve your ability to communicate.

Support Groups And Parkinsons

A support group is not a substitute for the support of family and friends but can provide an opportunity to:

• make new friends and enjoy the social opportunities support groups offer
• extend your support team which can make it easier to get the help you need, when you need it
• provide support for your carer and close family
• minimise feelings of isolation and having to cope with Parkinsons alone
• learn about clinical trials and opportunities to participate in them .

If youre unsure, it may be useful to attend one or two meetings before you commit to joining a group. Talk to members to find out more about what the group offers and any aspects that are of particular interest to you. Remember that almost everyone is apprehensive about going first time, but if after several meetings you dont feel comfortable then see if there is another local group as no two groups are the same.

The Parkinsons association in your country may be able to provide contact details for local groups. Your care team may also have suggestions or you could look in your local library, local newspaper, or on the Internet.

If there isnt a group in your area then you might want to consider setting one up. Your national Parkinsons association may be able to provide helpful information on starting a new group.

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What Are The Complications Of Parkinson Disease

Parkinson disease causes physical symptoms at first. Problems with cognitive function, including forgetfulness and trouble with concentration, may arise later. As the disease gets worse with time, many people develop dementia. This can cause profound memory loss and makes it hard to maintain relationships.

Parkinson disease dementia can cause problems with:

• Speaking and communicating with others
• Problem solving
• Forgetfulness
• Paying attention

If you have Parkinson disease and dementia, in time, you likely won’t be able to live by yourself. Dementia affects your ability to care of yourself, even if you can still physically do daily tasks.

Experts don’t understand how or why dementia often occurs with Parkinson disease. Its clear, though, that dementia and problems with cognitive function are linked to changes in the brain that cause problems with movement. As with Parkinson disease, dementia occurs when nerve cells degenerate, leading to chemical changes in the brain. Parkinson disease dementia may be treated with medicines also used to treat Alzheimer’s disease, another type of dementia.

If I Have Speech And Voice Problems How Can I Maintain And Improve My Communication

Some tips to improve communication include:

• Choose a quiet, low-noise space. Turn off televisions, radios and other devices that create noise.
• Speak slowly.
• Make sure your listener can see your face. Look at the person while you are talking. A well-lit room improves face-to-face conversation, increasing the ability to be understood.
• Use short phrases. Say one or two words or syllables per breath.
• Plan periods of vocal rest before planned conversations or phone calls. Know that fatigue significantly affects your ability to speak. Techniques that work in the morning might not work later in the day.
• Keep your throat hydrated. Drink plenty of water. Dont drink caffeinated or alcoholic beverages. Use a humidifier if the air in your home is dry.
• Keep an upright posture, straight chin, slightly lifted neck to improve airflow from lungs to your vocal cords.
• If you are soft spoken and your voice has become low, consider using an amplifier.

If some people have difficulty understanding you, these additional strategies might help:

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Apda In Your Community

APDALiving with Parkinson’sLets talk about Augmentative and Alternative Communication and Parkinsons disease

Many people with Parkinsons disease find that their speech and communication skills are impacted as their disease progresses. Low voice volume, imprecise speech, lack of inflection, rapid speech and other issues can become problems for some people living with PD. There are steps you can take early on that will help strengthen and preserve your voice, so it is important to educate yourself.

What The Healthcare Team Needs To Know

• A full list of all medications not only anti-parkinsonian medications. Use this medication form or keep a list electronically, so it is easy to update.
• New symptoms or side effects
• Improvements or worsening symptoms or side effects
• Things that seem to either relieve or trigger symptoms or side effects
• Difficulties in taking medications e.g., are swallowing problems affecting medication intake?
• How the person with Parkinsons is doing with other medical conditions e.g., diabetes, hypertension, COPD, etc.
• Any hospitalizations or ER visits since the last visit
• Change in the caregiver plan e.g., are there new caregivers at home? Did you hire help since your last visit? What is the aide helping with?

If you have a recording device, such as a smartphone or digital camera, use it to film your loved ones on and off states. This can help the health care providers see what on and off means for the person with Parkinsons, and adjust treatment and care recommendations accordingly.

Ask for written information about the medical situation from the healthcare team, so you can review it later and make sure you understand everything. You can share the document with other family members, friends and caregivers.

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How Can Listeners Help People Who Have Difficulty Speaking And Communicating

Here are some ways friends and family of people with Parkinsons disease can ease speaking and communication difficulties:

• Talk to the person with Parkinsons disease face-to-face only, and look at the person as he or she is speaking.
• Ask questions that require a simple “yes” or “no” answer.
• Repeat the part of the sentence that you understood.
• Ask the person to repeat what he or she said, to speak more slowly or spell out the words you did not understand.

What Emergency Type Devices Should A Person With Parkinsons Disease With Speech And Voice Problems Have At Hand

To preparing for emergencies:

• Use an intercom system or baby monitor to alert others that there is an emergency.
• Use bells or buzzers if you are not able to speak. Use “codes” that signify urgency. For example, a tinkling bell might mean, “I’d like company,” while an air horn might mean there’s an emergency.
• Carry a cell phone that is equipped with pre-programmed numbers. Preprogram all of your telephones so they can automatically dial the necessary emergency number.
• Sign up for a “Life Call” button service if you spend time alone. Pressing a button on a device usually worn on the wrist or around neck signals a service company that alerts loved ones and/or your local emergency service.

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What Are The Symptoms Of Parkinson Disease

Parkinson disease symptoms usually start out mild, and then progressively get much worse. The first signs are often so subtle that many people don’t seek medical attention at first. These are common symptoms of Parkinson disease:

• Tremors that affect the face and jaw, legs, arms, and hands
• Slow, stiff walking

How To Best Communicate

Parkinsons disease can interfere with your ability to communicate for reasons that have nothing to do with education or intelligence. Muscle rigidity in your throat and chest can cause your voice to become difficult to hear. Internal tremors, stiff face and throat muscles, as well as some medications, can cause slurring of words.

Certainly, your voice and body language are a big part of your life. And anything that impacts your ability to communicate with others can have a significant effect on your relationships. Early on, you might not experience rigidity in your muscles, but most people seem to develop this symptom as the disease advances. This is referred to as masking because your facial expression appears to be locked in place, as if you were wearing a mask.

As time goes on, Parkinsons will affect your ability to control your body movements. As a result, you run the risk of being misunderstood or worse yet, being labeled impatient, anxious or even drunk. To avoid these misunderstandings, it is important to discuss these issues with the people you encounter. Let them know about the ways Parkinsons disease affects your body and your ability to communicate. This is an investment that can be made at every stage of the disease.

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Go To All The Medical Appointments

Whether the appointment is at your house or at a medical facility, be present at every appointment with your loved one. You are there to be supportive and take notes, but also to ask questions and share information. Your ability to communicate with the healthcare providers can influence the quality of care your loved one receives. Be honest and ask direct questions. If something is wrong, the provider should say so, but it helps to ask. If you have doubts, get a second opinion. Even the experts do not always agree about the best treatment.

Fill out the Medical Appointment worksheet before the visit to make sure you are prepared.

Remember, the health care providers see many patients in a day and only see your loved one with PD for a brief time in the office. You are with him or her all the time. Therefore, it is important that you prepare for each visit and know all about your loved ones medical conditions , including medications and other treatments, so you can make the most of your time with the provider. Go to each appointment with a written list of questions that you want to cover as well as problems or improvements that have arisen since the last visit.

What Is Parkinson Disease

Parkinson disease is a movement disorder. It can cause the muscles to tighten and become rigid This makes it hard to walk and do other daily activities. People with Parkinsons disease also have tremors and may develop cognitive problems, including memory loss and dementia.

Parkinson disease is most common in people who are older than 50. The average age at which it occurs is 60. But some younger people may also get Parkinson disease. When it affects someone younger than age 50, it’s called early-onset Parkinson disease. You may be more likely to get early-onset Parkinson disease if someone in your family has it. The older you are, the greater your risk of developing Parkinson disease. It’s also much more common in men than in women.

Parkinson disease is a chronic and progressive disease. It doesn’t go away and continues to get worse over time.

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Q: When Should A Person With Pd Who Has A Communication Barrier Consider Using An Aac Device

A: They should consider a device when they cannot be understood, cannot make their needs known, feel isolated because of their speech difficulties, or overall cannot participate in communication with familiar and unfamiliar listeners. If an individual feels that their challenges with speaking have impaired their ability to participate in medical decisions, talk to their family members or friends, or overall negatively affect their quality of life, then a referral to an occupational therapist or speech language pathologist who specializes in AAC needs to be considered. When we work with a person with PD, we are doing it in conjunction with a speech language pathologist to make sure that all of their communication needs are being met.