Tips for Improving Communication in People with Parkinson's Disease

Overview

How common are speech and voice difficulties in people with Parkinson’s disease?

Speech difficulties (dysarthria) and voice problems are very common in people with Parkinson’s disease. Of the more than seven million people with Parkinson’s disease worldwide, between 75% and 90% will develop voice and speech problems over the course of their illness.

Why do people with Parkinson’s disease have speech difficulties?

Parkinson’s disease affects nerves and muscles that affect your speech. It affects your:

• Voicebox (larynx).
• Throat.
• Respiratory muscles.
• Roof of mouth, tongue and lips.
• Facial muscle movement.
• Areas of the brain that control hearing and voice and speech processing.

If I have Parkinson’s disease, what kind of speech and voice problems may I experience?

If you have Parkinson’s disease, some of the voice and speech difficulties seen include:

• Softened voice. Reduced volume to your voice.
• Speaking in an unchanging pitch (monotone).
• Having a hoarse or strained quality to your voice.
• Having a breathiness to your voice. Breathiness in the quality of your voice that is easily heard by your listeners. It takes more effort and energy to speak. You “run out of gas” as you speak.
• Trouble clearly and easily pronouncing letters and words.
• Tremor in your voice.
• Slurring of your speech.
• Using short rushes of speech.
• Loss of your facial expression.

If you have Parkinson’s disease, you may not be aware of the problems with your spoken communication. Changes in the quality of your voice may be the first sign of speech problems followed by the inability to have fluid speech and clear and distinct speech sounds. Speech problems that are severe enough to reduce your ability to be easily understood usually do not occur until later in the course of Parkinson’s disease.

What type of healthcare professional helps people with speech problems from Parkinson’s 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 Parkinson’s 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 Parkinson’s 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.

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. Don’t drink beverages containing caffeine or alcohol. 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:

• If you are able to write without difficulty, always carry a paper and pen as a backup so you can write down what you are trying to say.
• If writing is difficult, use an alphabet board to point or scan to the first letter of the words that are spoken.
• Spell words out loud or on an alphabet board if they are not understood.
• Establish the topic before speaking.
• Use telegraphic speech. Leave out unnecessary words to communicate the meaning of the topic.
• Rephrase using synonyms, writing out or spell the difficult words out loud.
• Use gestures for commonly recognized words, like palm facing forward for “stop” while saying the word.

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 (where you point to the first letter of each important word or spell out words) 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 can listeners help people who have difficulty speaking and communicating?

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

• Talk to the person with Parkinson’s 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. (For example, "You want me to go upstairs and get the what?")
• 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 Parkinson’s 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(s).
• 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.

Do swallowing problems in people with Parkinson’s disease also affect speech?

Swallowing problems (dysphagia) are a common problem in people with Parkinson’s 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 (trachea), 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.