Do people often ask you to speak up? Do they have difficulty understanding what you say? Parkinson’s disease (PD) can affect a person’s voice, causing them to speak softly or have difficulty forming sounds clearly. You may not even be aware of these and other changes to the voice, but most people with PD will experience them at some time during the course of the disease.
Just as PD affects movement in other parts of the body, it also affects the muscles in the face, mouth and throat that are used in speaking. Beyond producing the sounds of speech, PD symptoms like a frozen or “masked” face can make it harder to communicate the emotions that go along with what you are saying. Others may misinterpret this as a lack of interest in the conversation, or aloofness. In addition, some people with PD struggle to find words, and so they may speak slowly. And in other cases, PD causes people to speed up their speech, so much that it may sound like stuttering.
These and other changes to speech vary from person to person. But they all can make it difficult for people with PD to be understood, and to enjoy socializing. By becoming aware of your own difficulties and how others perceive your speech, you can take action to make your voice heard.
- Soft voice.
- Slurred speech.
- Mumbled or rapid speech.
- Speech sounds flat, like a monotone.
- Breathy or hoarse voice quality.
- Lack of facial expression and gestures.
- Difficulty finding words.
- Difficulty participating in fast-paced conversations.
- Ask your doctor if any of your medications is causing speech difficulties.
- Get a referral to a speech therapist who specializes in PD, also called a speech language pathologist. In PD, getting it’s important to begin speech therapy as early as you can, and to keep up a regular practice.
- Consider working with a speech language pathologist who has expertise in Parkinson’s. This can include someone who is certified in the Lee Silverman Voice Technique (LSVT), a systematic program of exercises aimed at improving speech in people with PD (Note: people with advanced PD, or with more severe cognitive changes, may face challenges in applying this technique). Ask your neurologist or members of your support group for ideas of therapists in your community.
Tips for Coping with Speech Difficulties
- Exercise your voice by reading out loud every day, or singing.
- Take care of your voice by drinking enough water, avoiding shouting and resting your voice when it is tired.
- Train your voice like an actor—sit and stand with good posture, do exercises for articulation, breathing and projecting the voice.
- Get feedback from trusted friends and family members about how others perceive your speech—then develop a cue or code word you can use with them in public to let you know you need to focus on speaking clearly.
- If you have soft speech, consider tools such as a voice amplifier (microphone), which you can place on your shirt, and on the telephone (note: this device may be helpful for those with soft speech, but will not be helpful for those who experience mumbling/stuttering speech). Ask an OT about other tools (including pacing boards) that can help.
- Make eye contact with the person you are talking to.
- Reduce background noise.
- Socialize in small groups or one-on-one.
- If you experience a “masked” face, use ‘feeling’ words to communicate your emotions, e.g., “I feel happy, sad, excited, confused,” or "I totally understand,” or "I completely agree.” Try practicing physical gestures that you can use when appropriate to help convey emotions.
- Determine which times of day your speech is best. Plan social engagements and activities around the times when you feel best.