PD Take 3: Are There Strategies to Help WIth My Changing Voice?
The PD Nurse Specialist
Yes, there are many things you can do on a daily basis to improve your communication. But first, you must become aware of the problem.
Be Self Aware: Tape record yourself speaking in front of a mirror. Take note of the issues you discover. Perhaps you are experiencing a lack of expression, low volume or monotone voice. Note your “emotional tone” or lack thereof. Then focus on these issues … and practice, practice, practice.
Improve your "speaking behavior:" Straighten your posture, face and look at your listener, keep your chin up, take deep breaths before speaking and when completing a phrase or sentence. Focus on big and loud sounds and slow and short phrases.
Practice Daily: Read aloud one newspaper article a day, while practicing the breathing and phrasing techniques mentioned above. Sing to improve facial tightness, volume, rhythm and clarity. Develop a subtle cue your partner/family can use in public to let you know you need to focus on your speech. Consider placing a voice amplifier on your lapel, and on the telephone.
Gwyn M. Vernon, M.S.N., C.R.N.P., Penn Medicine Neuroscience Center, University of Pennsylvania School of Nursing, Philadelphia, PA.
The Speech Language Pathologist
Upwards of 80 percent of people with PD may experience voice-related changes, such as reduced loudness, reduced pitch variability, and breathy/hoarse voice quality. Coping with these changes requires a combination of approaches.
Exercise: Try the Lee Silverman Voice Treatment program, an intense, evidence-supported, systematic exercise program that improves voice loudness in PD. Also, look into the Expiratory Muscle Strength Training, which uses a device designed to increase voice volume by improving respiratory support for speech.
Talk above the crowds: Try devices and therapies that use “The Lombard effect,” the involuntary tendency to elevate your voice loudness above others in a noisy environment. These include devices such as SpeechVive and computer apps such as iParkinsons, which deliver background noise that only you can hear, so you will involuntarily speak more loudly.
Amplify the positive: Try a voice amplifier, which uses a mic and a speaker in your ear. Even better, try wireless FM and soundfield systems, which discriminately amplify voice loudness to one or to many listeners.
Angela Roberts-South, M.A., Ph.D. Candidate, Health and Rehabilitation Sciences, Western University, Ontario, Canada
The Movement Disorder Specialist
Speech is an intricate process that involves many of the body’s structures. This means that problems with speech in PD can vary greatly from person to person. To improve your speech, it’s necessary to understand and treat your specific symptoms.
Understand your problem: Common issues include softness of speech, excessively rapid speech, slurred speech and difficulty finding words. Ask your doctor if medications are causing problems. Visit an ENT specialist to evaluate your vocal cords. Most importantly, see a speech therapist who specializes in PD.
Improve soft speech: Use techniques similar to those employed by actors and singers for projecting on a stage: improve body posture, exercise the vocal cords, practice articulation exercises, focus on your breathing, and push a lot of air from the lungs when speaking.
Slow down rapid speech: This is the most challenging situation to treat. You may find that rapid speech improves in practice sessions with a therapist, but deteriorates in real life. It may help to use a device that allows you to hear your speech on a time delay, transmitted through headphones.
Blair Ford, M.D., Professor of Clinical Neurology, Columbia University Medical Center and PDF Scientific Editor, New York, NY.