Voice Changes With Parkinson’s

Ways To Improve Speech In Parkinsons Disease

Communication is important. It helps you forge and deepen relationships, ask for information and express your wishes. Communication skills are also an important part of most jobs.

If youre living with Parkinsons disease, you may find that you:

• Speak quietly in one tone
• Seem to speak without much emotion because of decreased facial expression
• Speak slowly
• Sound hoarse or breathy when you speak
• Slur words, mumble or trail off at the end of a sentence
• Struggle to find the right words.

These changes come about because of the way Parkinsons disease affects the nerves and muscles that are involved in your speech. PD affects your:

• Voicebox
• Roof of mouth, tongue and lips
• Facial muscle movement
• Brains ability to control hearing, voice and speech processing.

So how can you improve your speech if youre living with Parkinons disease? Here are 10 ways.

Other Symptoms Of Parkinsons

The primary motor symptoms of PD are tremor, rigidity, postural instability , and bradykinesia .

PD also causes many secondary motor symptoms, including micrographia , changes in gait , stooped posture, dystonia , cramping, difficulty swallowing, sexual dysfunction, impaired fine motor dexterity, and akathisia .

In addition to these motor symptoms, PD can cause non-motor symptoms such as depression, difficulty swallowing or chewing, urinary problems, constipation, skin problems, sleep problems, pain, and cognitive problems, such as memory problems or slow thinking.1,7

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Effects On Speech And Voice

There are three ways that Parkinsons Disease can affect speech: dysarthria, hypophonia, and tachyphemia. Dysarthria affects the muscles required for speech which can cause mumbling or slurring. Hypophonia, also brought on by weakened muscles, is characterized by a soft, abnormally weak voice. Tachyphemia is rapid, stammering speech, also known as cluttering. Knowing these three conditions and their effects can help you find your best methods of treatment following diagnosis.

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Tip: Do I Have A Speech Or Voice Problem

These are statements many people have used to describe their voices and the effects of their voices on their lives. Choose the response that indicates how frequently you have the same experience. .

• It is difficult for people to hear me0 1 2 3 4
• People have difficulty understanding me in a noisy room0 1 2 3 4
• My voice difficulties restrict personal and social life0 1 2 3 4
• I feel left out of conversations because of my voice0 1 2 3 4
• My voice problem causes me to lose income0 1 2 3 4
• I feel as though I have to strain to produce voice0 1 2 3 4
• The clarity of my voice is unpredictable0 1 2 3 4
• My voice problem upsets me0 1 2 3 4
• My voice problem makes me feel handicapped0 1 2 3 4
• People ask, Whats wrong with your voice?0 1 2 3 4

To find your score, add up your answers. A score of 10 or higher indicates you might have a speech or voice problem that is affecting your quality of life and you should ask for a referral to a speech pathologist.

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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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Speech And Voice Disorders In Parkinsons

There are several reasons people with PD have reduced loudness and a monotone, breathy voice. One reason is directly related to the disordered motor system that accompanies PD, including rigidity, slowness of movement and tremor. For example, the poor muscle activation that leads to bradykinesia and hypokinesia in the limbs can translate to the muscles involved in speech. These problems with muscle activation can result in reduced movements of the respiratory system , larynx and articulation .

Another cause of speech and voice impairment in PD is a change in sensory processing that is related to speech. It is believed that people with PD may not be aware that their speech is getting softer and more difficult to understand. When people in this situation are asked to bring their voice to normal loudness, they often feel as though they are shouting, even though they are perceived by listeners to be speaking normally

Another cause of this condition is that people with PD may have a problem with cueing themselves to produce speech with adequate loudness. Individuals with PD can respond to an external cue , but their ability to cue themselves internally to use a louder voice is impaired. These problems can be frustrating both for the person and for the family.

Talk With Others Who Understand

MyParkinsonsTeam is the social network for people with Parkinsons disease. On MyParkinsonsTeam, more than 79,000 members come together to ask questions, give advice, and share their stories with others who understand life with Parkinsons disease.

Are you living with low-volume speech? Share your experience in the comments below, or start a conversation by posting on your Activities page.

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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 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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How Speechease Can Help

If youre living with Parkinsons disease and would like help to improve your speech, then were here for you.

Some of the SpeechEase staff are trained in the Lee Silverman Voice Treatment Loud approach, an evidence-based therapy that helps you increase your volume and ability to be understood.

Please contact us today. Wed love to help you express yourself.

What Type Of Healthcare Professional Helps People With Speech Problems From Parkinsons Disease

If you have speech and voice problems, see a speech-language therapist. Your primary healthcare provider can help you find a therapist in your local area. Some speech-language pathologists have specialized training that focuses on training people with Parkinsons disease to amplify their voice. This is called the Lee Silverman Voice Treatment.

Speech-language therapists are specifically trained to diagnose and treat speech, language and swallowing disorders. If you have Parkinsons disease, a speech-language pathologist can help you:

• Maintain as many communication skills as possible. Teach you techniques to conserve energy, including using nonverbal communication skills.
• Introduce you to assistive devices and techniques to help improve your communication.
• Recommend exercises to help you improve muscle strength and movements needed to improve your speech and communication options.

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How To Find A Speech Therapist

Tell your doctor If you are experiencing any changes in your speech or voice. Ask for a referral and a prescription for a speech evaluation and treatment. If you have not noticed changes in your speech, but a spouse, care partner or friend has: pay attention to their comments. The sooner you get a speech evaluation and start speech therapy, the better.

Speech therapists work in many settings, including hospitals, outpatient rehabilitation centers and private practice offices. To locate one in your area, contact the American Speech-Language-Hearing Association at www.asha.org, or find a therapist certified in the Lee Silverman Voice Treatment by visiting www.lsvtglobal.com.

Ideally, you should see a speech therapist face-toface for a complete voice and speech evaluation and treatment. However, if a speech therapist is not available in your area, LSVT LOUD the most researched voice treatment for people with PD is virtually offered in select states. The speech therapist interacts with you in your home or office live through your computer screen.

Learn more about speech and Parkinsons by reading our free book Speech and Swallowing. Order online at Parkinson.org/Books or by calling our Helpline at 1-800-4PD-INFO .

Voice Changes For Early Parkinsons Diagnosis

Researchers at Monash University in Melbourne are studying the vocal cords of people with Parkinsons to determine whether measuring voice changes an early sign of the condition could improve early diagnosis.

As part of the trial, 31 people with different severities of Parkinsons and control participants are being assessed using Computer Tomography scans. The scanner takes 50 snapshots to measure the movement of the vocal cords.

Researchers Dr Andrew Ma and Professor Dominic Thyagarajan hope the use of CT scans will result in Parkinsons diagnoses up to eight years before current clinical diagnoses.

The advantages of this technique are that we get measurable, quantitative data. Its also less invasive for patients compared to laryngoscopy which involves a camera down the throat to look at the vocal cords which had been used in earlier studies. If our technique is proven to be useful, it will be easier to roll out in clinical practice, said Dr. Ma.

Its already been shown in the literature that there are strong links between early Parkinsons and voice, and hopefully we can show that CT scans are able to detect these changes.

Voice changes due to Parkinsons include:

• Dysphonia Where the quality of voice is altered to become breathier and hoarser.
• Hypophonia A soft voice.
• Dysprosody Where the cadence of voice pitch and rhythm changes. Patients may lose ranges of expression or begin speaking in more of a monotone.

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How Are Swallowing Problems Treated

The first step to addressing swallowing issues is to speak to a neurologist about getting an evaluation performed by a SLP. This professional will take a medical history and interview the person with PD about eating and swallowing.

This is typically followed by either a video X-ray or an endoscopic examination, so the medical specialist can observe the swallowing process as an individual sips liquid and eats food, as these substances flow from the mouth, down the throat and esophagus, to the stomach. With these tests it is possible to see where the trouble is occurring and to recommend therapies.

Follow the recommendations of the swallowing specialist, which may include the following:

• Exercise and Swallow Hard. Just as exercise can ease other PD-related movement difficulties, it can also help with swallowing. The Lee Silverman Voice Technique® helps a person exaggerate speaking and swallowing. Working with an SLP on an individualized program helps the person to swallow hard and move food from the mouth down the throat.
• Expiratory Muscle Strength Training. This therapy strengthens respiratory muscles, improves cough and swallowing and reduces aspiration.
• Change in food. Modifying liquids and solids can help. For people who find liquids get into the airway, liquids may need thickening. Taking bigger or smaller bites or sips or pureeing solid foods may help. First get an evaluation, so the SLP can recommend how to modify food and liquid.

What Is Parkinsons Disease

At the most basic level, Parkinsons Disease is a disorder of the nervous system. PD causes vital nerve cells in the brain to deteriorate, significantly decreasing the bodys stores of dopamine and other essential neuro-chemicals responsible for controlling movement.

This results in the tremors that are classically associated with PD.

Tremors, however, are only one of the varied and unpredictable symptoms of PD.

Persons with PD may also experience muscle rigidity or weakness. Movement may be slowed and problems with balance and coordination are common.

Additionally, PD can lead to challenges in thinking, concentrating, or remembering. Patients may even experience hallucinations, delusions, or paranoia as a result of changes in the brain.

Its estimated that more than 10 million people worldwide have PD, with more than 95% of patients diagnosed after the age of 50.

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Voice Problems And Parkinsons: Causes And Management

If you struggle with a quiet speaking voice, youre not alone. Changes in speech and vocal articulation are common symptoms of Parkinsons disease . Many people with PD have breathy, low-volume speech, which can make it difficult to communicate. This creates problems in social situations.

One MyParkinsonsTeam member said, My voice gets thinner and softer as the day wears on. Another member replied, saying their speech was dwindling, too. Fortunately, with the help of your clinician and a speech-language pathologist, you can find ways to communicate and maintain a fulfilling social life.

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Pwpd Perspectives On Change In Speech And Voice

In terms of pwPD perspectives, impaired communication results in significant restrictions on daily living activities and social participation, and is strongly associated with reduced quality-of-life.2733 Perceived impact can be significant for the pwPD, even when listeners detect no apparent major issues with voice and speech.28,30,3436 PwPD describe their voice as too quiet, or volume fades fast over an utterance or in conversation they describe voice quality as hoarse, breathy, tremulous, and that they have difficulty initiating or sustaining utterances.37,38 Freezing of voice can be as troublesome as freezing of gait.27 Disturbance to speech prosody is also described as a strong feature.3941 PwPD report the frustrations of listeners seeming to misunderstand or miss the emotion they are aiming to convey, or the constant feeling that people believe them to be depressed, disinterested, and unmotivated when they are not.4244 Such impressions are reinforced by hypomimia.45,46 To listeners, articulation may sound distorted or sounds omitted and/or syllables and words slurred together, which may give the impression that the pwPD is speaking too fast. Listeners also describe sudden rushes of accelerated speech, maybe in an attempt to complete a sentence on insufficient breath.

These points offer a number of important implications for assessment and intervention, as discussed in the next section.

Pwpd Perspectives Regarding Speaking And Voice Treatment

Consistent with the growing emphasis on patient-centered care,52 we need to understand the issues for a pwPD communicating on a day-to-day basis and to hear their experience of living with a communication disability, their experience of voice treatment, and what they would like to see happen in the future. Important contributions emerge when patients and spouses are asked directly to give their opinions through interviews and surveys.55,56 When the views of 24 community dwelling pwPD were sought regarding their communication experiences, five subthemes emerged including: difficult to think about how to speak as well as what to say fatigue related to trying to make the unconscious conscious expressions of frustration, embarrassment, and loss the distracting effect of PD on the other person waiting until the PD pills take effect to talk .55

These aforementioned studies provide important insight into the perspectives of pwPD regarding their lived experiences with a communication disability and their views on voice treatment. Another and often forgotten aspect is finding out from the pwPD spouse and/or caregiver their views on the impact of the communication disability on their relationship and social.

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