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If you have Parkinson’s disease and have trouble speaking clearly or loudly, you’re not alone. Changes in speech are common symptoms of Parkinson’s. Many people with Parkinson’s speak in a quiet or breathy voice, which can make it hard to talk with others and can make social situations uncomfortable.
“My voice gets thinner and softer as the day wears on,” one MyParkinsonsTeam member said.
Although voice changes like these can be upsetting, there are ways to speak more clearly and stay socially active.
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Dysarthria — a speech problem that occurs when the muscles used for talking become weak or hard to control — is common in Parkinson’s disease. As Parkinson’s gets worse, movement disorders can affect the voice and make speech quiet, slow, or hard to understand.
People with Parkinson’s who have dysarthria may find it frustrating or hard to speak clearly. “My husband’s voice has gotten very quiet,” a MyParkinsonsTeam member wrote, “and it is a considerable effort for him to hold a conversation.”
There are two main types of dysarthria — hypokinetic and hyperkinetic — and both are linked to Parkinson’s disease.
Weak muscle control leads to hypokinetic dysarthria. Parkinson’s disease can cause stiffness in the rib cage and weakness in the diaphragm, the muscle that helps you breathe. With less control over their breathing, people with hypokinetic dysarthria often have to speak from their belly.
The muscles in the larynx (voice box) that control vocal folds may also stop working well. This can cause dysphonia — trouble controlling speech tone. Motor function problems in the lips and mouth can make it harder to form words and often leads to raspy, quiet speech. Doctors may call this drop in voice quality poor phonation.
Hypokinetic dysarthria is sometimes worse after deep brain stimulation, a surgery for Parkinson’s that sends electrical signals into parts of the brain to help control movement.
Taking certain Parkinson’s medications for a long time can cause involuntary movements called hyperkinetic dysarthria. When the muscles used for speech move in an unsteady way, speech can sound jerky, too. Hyperkinetic dysarthria is the less common type among people with Parkinson’s.
Some people have hypokinetic-hyperkinetic dysarthria, which can make speech sound uneven in speed, volume, and tone. This is different from hypokinetic dysarthria, in which speech often sounds very flat.
Speech changes may be among the earliest symptoms of Parkinson’s disease and often get worse as Parkinson’s progresses. People who start speech treatment early may have better results and keep a stronger voice as Parkinson’s gets worse.
Dysarthria can be hard for loved ones and Parkinson’s caregivers to understand and manage. This speech problem usually shows up before dysphagia (trouble with chewing and swallowing). Studies show that 75 percent to 90 percent of people with Parkinson’s will develop some type of dysarthria.
Parkinson’s disease can affect how people hear their own voice. Some don’t realize they’re speaking quietly and think their voice sounds normal, which can make it even harder to communicate. Neurology researchers aren’t sure why this happens, but it may be linked to trouble hearing emotion in speech — another possible effect of Parkinson’s.
Parkinson’s-related speech impairment can make it harder to connect with others. “Has anyone else noticed that friends you have had for years no longer call or ask you to do anything?” one MyParkinsonsTeam member asked. “We never hear from people who we thought were close friends. It is very isolating and hurtful. We wonder if it is because my husband’s speech isn’t very good.”
“When my facial expression is frozen, and I can’t turn my head and have trouble with speech, people think I am ignoring them,” another member said.
Speech therapy is the best treatment for Parkinson’s-related speech problems, including dysarthria. A speech therapist can figure out what’s making speech harder and suggest beneficial interventions, such as vocal or breathing exercises. Different kinds of speech therapy can help people with Parkinson’s disease speak more clearly and improve their quality of life.
Some MyParkinsonsTeam members have improved their speaking abilities with the Lee Silverman Voice Treatment LOUD program (LSVT LOUD), a type of speech therapy that helps people speak louder and more clearly.
“I completed LSVT LOUD six months ago. So far, I have maintained my voice control. I highly recommend it,” a MyParkinsonsTeam member reported.
Another shared, “My wife just completed the sessions. They helped so much. Everyone comments on how her voice has improved.”
People who’ve used LSVT LOUD say it only works if you keep practicing. “The key is to do the sessions daily,” a caregiver commented about improving vocal loudness for their loved one.
“It is all good if the therapy is kept up and worked on daily. It is like learning a foreign language. It is a ‘use it or lose it’ deal,” another member agreed.
Another type of therapy, the Lee Silverman Voice Treatment Articulation program (LSVT ARTIC), aims to help people with Parkinson’s speak with improved articulation. However, studies have found that LSVT LOUD is more effective.
Intensive respiratory training to strengthen breathing muscles has shown some benefits for people with Parkinson’s. Breathing exercises may include techniques like air stacking — slowly inhaling at different time points so that each breath builds on the last.
Another common method is diaphragmatic breathing, in which you inhale through your nose as your lower belly expands, then exhale slowly.
One MyParkinsonsTeam member described their trick for improving speech volume: “I chant the Ramones chorus of ‘Hey! Ho! Let’s Go!’ to pump up my voice before I get on a phone call.”
Assistive devices can also support people with Parkinson’s in managing communication challenges. For example, the SpeechVive earpiece may help increase speech volume in people with a quiet voice. Personal amplifiers can also make speech easier to hear. Other tools, such as text-to-speech devices and mobile apps, may offer additional ways to communicate more clearly.
Speech changes from Parkinson’s can be frustrating, but there are ways to get help. A speech therapist can work with you on clearer communication so that you stay socially connected. Your doctor or neurologist can recommend a speech-language pathologist or another clinician who can suggest useful communication tools.
On MyParkinsonsTeam, people share their experiences with Parkinson’s disease, get advice, and find support from others who understand.
Have you tried voice therapy or found techniques that help improve your speaking? Let others know in the comments below.
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I've Always Been Soft Spoken Even As Child And Before My Diagnosis I Always Have To Speak Up To Be Heard
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Along with the low speech my husband has a lot of mucous that he can’t seem to clear up . It makes it almost impossible to understand him . Does anyone know what to do about this ?
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