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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.
While voice changes can be upsetting, there are ways to speak more clearly and stay socially active.
Dysarthria is a speech problem that happens when the muscles used for talking are weak or hard to control. It’s common in people with Parkinson’s disease. As Parkinson’s gets worse, movement disorders can affect the voice and make speech sound quiet, slow, or hard to understand.
People with Parkinson’s disease 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. When dysarthria is caused by weak muscle control, it’s called 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. This often leads to speech that sounds raspy and quiet. 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.
The other kind of dysarthria is called hyperkinetic dysarthria. Taking certain Parkinson’s medications for a long time can cause involuntary movements, called dyskinesia. When the muscles used for speech move in an unsteady way, speech can sound jerky, too.
Some people have hypokinetic-hyperkinetic dysarthria. This type of dysarthria can make speech sound uneven in speed, volume, and tone. It’s different from hypokinetic dysarthria, where speech often sounds very flat.
Speech changes may be one of the earliest symptoms of Parkinson’s disease. These changes 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 from 75 percent to 90 percent of people with Parkinson’s will develop some type of dysarthria. Hyperkinetic dysarthria is the less common type among people with Parkinson’s.
Parkinson’s disease can affect how people hear their own voice. Some people with Parkinson’s don’t realize they’re speaking quietly and think their voice sounds normal. This 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, as many MyParkinsonsTeam members have shared. “Has anyone else noticed that friends you have had for years no longer call or ask you to do anything? 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,” one team member shared.
Another member said, “When my facial expression is frozen, and I can’t turn my head and have trouble with speech, people think I am ignoring them.”
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 interventions, such as vocal or breathing exercises, to help. There are different kinds of speech therapy that 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). LSVT LOUD is a type of speech therapy that helps people with Parkinson’s 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 for themselves or a loved one say it only works if you keep practicing. “The key is to do the sessions daily,” a caregiver commented about improving vocal loudness.
“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.
The Lee Silverman Voice Treatment Articulation program (LSVT ARTIC) is another type of speech therapy for people with Parkinson’s. 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 designed to strengthen breathing muscles has shown some benefits for people with Parkinson’s. These breathing exercises may include air stacking, which involves inhaling slowly at different time points, so breaths stack on top of each other. It may also involve diaphragmatic breathing, which requires you to inhale through the nose as your lower belly fills with air. After that, you slowly breathe out.
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 help people with Parkinson’s manage communication problems. The SpeechVive earpiece can help some people with quiet voices sound louder. A personal amplifier can also help improve speech volume. Other methods of communication, like text-to-speech devices and apps, may be helpful.
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 and help you stay socially connected. Your doctor or neurologist can help you find a speech-language pathologist or another clinician who can suggest helpful communication tools.
On MyParkinsonsTeam, the social network for people with Parkinson’s disease and their loved ones, members come together to ask questions, give advice, and share their stories with others who understand life with Parkinson’s disease.
Are you living with low-volume speech or other speech problems? Have you tried voice therapy or found techniques that help improve your speaking? Share your experience in the comments below, or start a conversation by posting on your Activities page.
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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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