Supporting Communication in Parkinson’s: The Role of Speech Therapy

Effective communication is central to personal identity and provides a foundation for social interaction. It allows us to express our needs, thoughts, and emotions, and engage meaningfully with those around us. For individuals living with Parkinson’s Disease (“Parkinson’s”), communication can become increasingly challenging due to neurological changes that affect speech, voice, and facial expressions.

Around 90% of individuals with Parkinson’s will experience changes in their speech as the disease progresses. These changes can manifest as reduced volume, monotonous tone, and articulatory errors, making it difficult to communicate messages effectively.

This article explores how Parkinson’s disease impacts communication and discusses how speech pathology services can support individuals with Parkinson’s to maintain their communication skills and quality of life.

How does Parkinson’s Disease affect speech?

Parkinson’s is a neurodegenerative condition that impacts the neurological control of muscles throughout the body, including the muscles of the head and neck, which are essential to speech. The nerves and muscles involved in the movement and coordination of the larynx (voice box), as well as muscles of the face and mouth, are particularly affected.

Common voice and speech difficulties in Parkinson’s include:

Reduced vocal loudness resulting in a soft, quiet voice;
Vocal hoarseness or a strained voice quality;
Breathiness during speech characterised by excessive air use while speaking;
Running out of air mid-sentence;
Monotone speech, lacking pitch variation;
Imprecise articulation;
Short rushes of speech;
Vocal tremor; and
Reduced facial expressions, often described as feeling like wearing a mask.

It is important to note that Parkinson’s also causes sensory processing deficits, including reduced awareness of vocal loudness deficits. This can result in
individuals with Parkinson’s feeling that they are speaking at a normal level while the listener may have difficulty hearing and understanding them.

Research shows that changes in speech, and the associated impact on overall
communication, can have a significant impact on social interactions and emotional
wellbeing. Studies show that communication difficulties in individuals with Parkinson’s can to lead feelings of embarrassment, reduced confidence, social stigma, and
avoidance of engaging in conversations. Consequently, individuals may withdraw from activities they previously enjoyed, leading to social isolation and a decreased quality of life.

Should I see a Speech Therapist if I am already taking medication for my symptoms?

While Parkinson’s management typically includes pharmacological treatments such as levodopa to manage motor symptoms by replacing dopamine. These medications do not systematically improve the specific speech symptoms associated with Parkinson’s. However, there is strong evidence that early intervention by speech pathologists may have positive results for those diagnosed with Parkinson’s. These early intervention approaches include areas such as voice therapy which is a well-supported, effective, and necessary intervention for individuals with neurologically based voice and speech disorders directly related to the cortical and subcortical changes secondary to Parkinson’s.

Research indicates that speech and voice therapy is an important addition to medical and surgical treatment for patients and is therefore considered an integral component of the treatment plan for those with Parkinson’s disease.

How can a Speech Therapist help with communication for people with Parkinson’s disease?

Speech therapists are trained in assessing and treating individualised therapy plans that aim to maintain communication for those afflicted with Parkinson’s and provide strategies to increase their participation within the community.

Speech Therapy sessions may include the following:

Addressing the underlying motor speech and voice deficits associated with
Parkinson’s to improve speech quality, volume, intonation, and intelligibility;
Providing education around the communication changes that occur as Parkinson’s
Progresses;
Increasing client’s awareness of the sensory processing deficit changes in their
Communication;
Exploring Augmentative and Alternative Communication (AAC) options to improve
overall communication;
Providing communication partner training to improve the client’s family and friends’
ability to support communication; and
Developing strategies with the client and their family to preserve communication
and prevent communication breakdowns.

When should I start seeing a Speech Therapist?

If you, or a loved one, have Parkinson’s and are noticing changes in communication, it’s essential to seek speech therapy sooner rather than later. Early intervention can significantly slow the progression of communication difficulties, allowing you to maintain independence and improve your quality of life.

Whether you’re already experiencing symptoms or just want to be proactive, contacting a speech therapist is a key step in managing Parkinson’s effectively. They can assess your needs, create a personalised treatment plan, and guide you through exercises and

techniques that work best for you.

What strategies can I use if my communication is impacted by Parkinson’s disease?

There are several environmental and personal strategies that can be used to support clear communication. These include:

Before speaking, gain the other persons attention so that you are looking at each
other whilst speaking;
Reduce environmental noise by turning off televisions, radios and other devices
when speaking;
Maintain an upright posture to improve breathing during speech;
Stay hydrated by drinking plenty of water. Avoid beverages containing caffeine and
alcohol as these can be dehydrating;
Monitor your energy levels and take periods of vocal rest to reduce vocal fatigue; and
Take ‘top-up’ breaths whilst you speak to avoid running out of air mid-sentence.

Conclusion

Speech and voice changes are common as Parkinson’s progresses. Communication

difficulties have a significant impact on an individual’s ability to engage meaningfully with family and friends, as well as in work or social settings. Speech Therapy services are an evidence-based effective intervention that can improve communication, reduce functional decline, and improve an individual’s quality of life.

Enquiries regarding how you can use your NDIS plan to access Speech Therapy services and address communication goals can be made to Lift on 1300 082 599 or via email at [email protected]

References

Miller, N., Noble, E., Jones, D., & Burn, D. (2006). Life with communication changes in Parkinson’s disease. Age and ageing, 35(3), 235-239.

Russell, J. A., Ciucci, M. R., Connor, N. P., & Schallert, T. (2010). Targeted exercise therapy for voice and swallow in persons with Parkinson’s disease. Brain research, 1341, 3-11.

Ramig, L., Halpern, A., Spielman, J., Fox, C., & Freeman, K. (2018). Speech treatment in

Parkinson’s disease: Randomized controlled trial (RCT). Movement Disorders, 33(11), 1777-1791.

Pinto, S., Ozsancak, C., Tripoliti, E., Thobois, S., Limousin-Dowsey, P., & Auzou, P. (2004).

Treatments for dysarthria in Parkinson’s disease. The Lancet Neurology, 3(9), 547-556.

Author

Shakira Marin
Generalist Speech Pathologist
Shakira is a generalist Speech Pathologist who completed her Bachelor of Speech Pathology (Honours) at Flinders University. Before becoming a Speech Pathologist, Shakira worked in the disability industry for five years, gaining a strong understanding of client-centred care and advocacy. During her degree, Shakira completed an Honours thesis focused on dysphagia and swallowing mechanics in motor neuron disease. This has fostered her strong interest in working with adults, particularly in neurorehabilitation and supporting clients with neurodegenerative disorders. She has also completed additional training in voice therapy for Parkinson’s disease through the LSVT LOUD program, equipping her to help clients improve their voice and communication. Shakira also enjoys working with children and values creating meaningful connections with clients of all ages. Having lived in Argentina and Italy, Shakira speaks multiple languages, which has supported her understanding of linguistics and deepened her understanding of diverse communication styles. Outside of work, Shakira enjoys painting, playing the piano, camping, and spending time at the beach.