I remember a patient, let’s call him John, telling me about a family dinner. He had a story he really wanted to share, a funny one from his youth. But when he tried to speak, his voice was so soft, almost a whisper. The words felt jumbled, and he saw the strained, though kind, expressions on his family’s faces as they leaned in, trying to understand. He eventually just…trailed off. That feeling of not being heard, of your thoughts getting stuck, is something many people with Parkinson’s disease experience, and it can be incredibly isolating. If this sounds familiar, please know you’re not alone, and we can work on improving Parkinson’s communication.
Why Does Parkinson’s Affect Speech?
So, what’s going on here? Parkinson’s disease, as you might know, affects the nerves that control our muscles. This doesn’t just mean the muscles for walking or writing; it also includes the intricate muscles we use for speaking.
We call speech difficulties dysarthria. In Parkinson’s, this can happen because the disease can impact:
- Your voice box (larynx)
- Your throat
- The muscles you use to breathe (respiratory muscles)
- The roof of your mouth, your tongue, and your lips
- Even the muscles that help you make facial expressions
It can also affect the parts of your brain that process hearing and how you plan your speech. It’s a complex system, and when Parkinson’s steps in, things can get a bit… well, difficult. It’s quite common, actually. Somewhere between 75% to 90% of folks with Parkinson’s will face some voice or speech challenges.
What Might You Notice? (The Symptoms)
You, or your loved ones, might start noticing a few things. Sometimes, these changes are subtle at first.
- A softer voice: People might ask you to speak up more often.
- Monotone speech: Your voice might lose its usual ups and downs, sounding flat.
- Hoarse or strained voice: It might sound like you’re pushing to get words out.
- Breathy voice: Like you’re running out of air as you talk. Speaking can feel like more effort.
- Trouble with pronunciation: Words might not sound as crisp or clear.
- Voice tremor: A shakiness in your voice.
- Slurring speech: Words kind of blend together.
- Short rushes of speech: You might speak in quick bursts.
- “Masked face”: Reduced facial expression can make it harder for others to read your cues.
Interestingly, you might not always be aware of these changes yourself, especially early on. Often, a change in voice quality is the first hint, before speech becomes less fluid or clear. Usually, significant difficulty in being understood happens later in the disease.
Finding Your Voice Again: How We Can Help
If you’re noticing these changes, the first step is to chat with your doctor. We can then get a speech-language pathologist (SLP) involved. These are wonderful therapists specially trained to help with speech, voice, language, and even swallowing problems. I often refer my patients to them.
Some SLPs even have specialized training called the Lee Silverman Voice Treatment (LSVT LOUD®), which is specifically designed to help people with Parkinson’s learn to use their voice at a more normal loudness level. It’s quite effective for many.
An SLP can work with you to:
- Keep your communication skills as strong as possible.
- Teach you techniques to save energy when you speak, and even use nonverbal cues.
- Show you assistive devices if needed.
- Give you exercises to strengthen the muscles involved in speaking.
Practical Tips for Clearer Parkinson’s Communication
There are things both the speaker and the listener can do to make conversations flow a bit easier.
For the Speaker:
- Pick your spot: Try to talk in a quiet place. Turn off the TV or radio. Less background noise really helps.
- Slow down: It’s not a race. Taking your time can make a big difference in clarity.
- Face your listener: Let them see your face. Good lighting helps too!
- Short and sweet: Use shorter phrases. Maybe one or two words per breath if that feels right.
- Pace yourself: Fatigue is a big factor. Your voice might be stronger in the morning. Plan important conversations for when you feel most rested.
- Stay hydrated: Drink plenty of water. Try to avoid caffeine and alcohol, as they can be drying. A humidifier can help if your home air is dry.
- Good posture: Sit or stand tall. This helps airflow.
- Consider an amplifier: If your voice is very soft, a small personal amplifier can boost your volume.
For the Listener:
It takes two to communicate, right? Here’s how loved ones can help:
- Face-to-face: Look at the person when they’re speaking.
- Simple questions: If possible, ask questions that can be answered with a “yes” or “no.”
- Clarify kindly: Repeat the part of the sentence you did understand. For example, “You said you went to the park, and then…?”
- Gentle requests: It’s okay to ask them to repeat, speak a bit slower, or even spell out a word you missed. Patience is key.
When Words Are Still Tricky:
Sometimes, despite best efforts, speaking is just plain hard.
- Pen and paper: If writing is manageable, keep a notepad handy.
- Alphabet board: If writing is tough, pointing to the first letter of words on an alphabet board can help. You can also spell out words.
- State the topic: “I want to talk about the garden.” This gives context.
- Key words: Focus on getting the most important words out.
- Rephrase: Try saying it a different way, or use a synonym.
- Gestures: A simple thumbs-up or a wave can add a lot.
When Words Are Tough: Helpful Tools
If speaking becomes very frustrating or tiring, there are tools that can bridge the gap:
- Amplification: As mentioned, personal voice amplifiers or telephone amplifiers can make a soft voice louder and reduce voice fatigue.
- TTY telephone relay system: This is a phone with a keyboard. You can type your message, and an operator reads it to the listener. You can type the whole thing or just tricky words.
- Low-tech aids: Think simple – alphabet boards, picture boards, or even just writing things down.
- High-tech devices: There are computers with voice synthesizers and dedicated speech-generating devices. An SLP is the best person to guide you on what might suit your needs.
Staying Safe: Emergency Communication
This is so important. We need to make sure you can get help if you need it.
- Intercom/Baby monitor: To alert others in the house.
- Bells or buzzers: If speaking is difficult, have a system. A gentle bell for “I need company,” a louder buzzer for “Help!”
- Pre-programmed phone: Keep your mobile handy with important numbers saved. Program home phones too for automatic dialing of emergency numbers.
- “Life Call” button: If you spend time alone, these services (where you wear a button to press for help) can be a real peace of mind.
A Quick Note on Swallowing (Dysphagia)
It’s worth mentioning that swallowing problems (dysphagia) are also common with Parkinson’s. This can happen at any stage and might affect your speech indirectly because the same systems are involved.
Symptoms can include:
- Drooling
- Choking or coughing, especially when eating or drinking
- Difficulty taking pills
- Taking a long time to eat
- Unexplained weight loss or dehydration
If you notice these, please tell your doctor or SLP right away. The main concern is aspiration, which is when food or liquid goes down the wrong way into your windpipe and lungs. This can lead to serious aspiration pneumonia. While swallowing issues don’t directly cause speech problems, they often go hand-in-hand.
Take-Home Message: You’ve Got This
Living with Parkinson’s communication challenges is tough, no doubt. But here are the key things I want you to remember:
- You’re not alone: Many people with Parkinson’s experience speech and voice changes.
- Help is available: Speech-language pathologists are experts who can provide strategies and exercises, like LSVT LOUD®.
- Small changes, big impact: Simple tips for both speakers and listeners can improve understanding.
- Tools can assist: Don’t hesitate to explore communication aids if needed.
- Address swallowing issues: If you notice problems with swallowing (dysphagia), seek help promptly.
- Patience and persistence: Improving Parkinson’s communication is a journey.
It’s all about finding ways to stay connected, to share your thoughts, your stories, your love. We’ll work with you to find the best path forward.
You’re not alone in this. We’re here to help.