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Voice Problems and Parkinson’s: Causes and Management

Updated on May 24, 2024

If you’re living with Parkinson’s disease and struggle with a quiet speaking voice or other speech problems, you’re not alone. Changes in speech and vocal articulation are common symptoms of Parkinson’s. Many people with Parkinson’s have breathy, low-volume speech, which can make it difficult to communicate and may make social situations uncomfortable.

“My voice gets thinner and softer as the day wears on,” one MyParkinsonsTeam member said.

Fortunately, with the help of your doctor and a speech-language pathologist, you can find ways to improve communication and maintain a fulfilling social life.

Why Parkinson’s Affects the Voice

Dysarthria is a communication disorder in which muscles that control speech are impaired. This condition is common in people with Parkinson’s. Voice disorders caused by dysarthria can be caused by motor symptoms that occur as Parkinson’s progresses or by movement disorders from long-term use of the medication levodopa/carbidopa.


“My husband’s voice has gotten very quiet, and it is a considerable effort for him to hold a conversation.”

— A MyParkinsonsTeam member

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Dysarthria can cause voice problems such as low volume, slow speech, slurring, and other speech problems that can make a person hard to understand.

People with Parkinson’s disease who have dysarthria may find it frustrating or difficult to communicate. “My husband’s voice has gotten very quiet,” a MyParkinsonsTeam member wrote, “and it is a considerable effort for him to hold a conversation.”

Hypokinetic Dysarthria

There are two main types of dysarthria. Dysarthria caused by weakened muscle control is called hypokinetic dysarthria. Parkinson’s disease causes stiffness in the rib cage and weakness in the diaphragm, a muscle that helps with breathing. With less control over their breath, people with hypokinetic dysarthria have to speak from their belly.

Additionally, the muscles in the larynx (voice box) that control vocal folds may not work properly. This can cause dysphonia (poor control of speech tone). Impaired motor function in the lips and mouth makes forming words more difficult. This often results in raspy, low-volume speech. Doctors may call this drop in voice quality poor phonation. Hypokinetic dysarthria is sometimes worse after deep brain stimulation, a surgical treatment used for Parkinson’s.

Hyperkinetic Dysarthria

The other kind of dysarthria is called hyperkinetic dysarthria. Long-term treatment with levodopa/carbidopa can cause involuntary movements, or dyskinesia. When the muscles involved in speech move erratically, speech can become jerky as well.

It’s possible to have hypokinetic-hyperkinetic dysarthria. This condition causes an uneven speech rate, cadence, volume, and tone. It’s different from the speech in hypokinetic dysarthria, which can sound very flat.

Speech Is Affected in Later-Stage Parkinson’s

Dysarthria occurs in the later stages of Parkinson’s and can be difficult for loved ones and caregivers. This symptom usually appears before dysphagia (problems with chewing and swallowing). Studies show that from 75 percent to 90 percent of people with Parkinson’s will develop some form of dysarthria. Hyperkinetic dysarthria is the less common type, affecting 10 percent to 20 percent of people with Parkinson’s disease.

“When my facial expression is frozen, and I can’t turn my head and have trouble with speech, people think I am ignoring them.”

— A MyParkinsonsTeam member

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Interestingly, Parkinson’s disease can affect a person’s perception of their own voice. Sometimes, people living with Parkinson’s aren’t aware of their low volume, and they may believe they’re speaking at a normal level. This can make communication even more difficult. Neurology researchers aren’t sure why this occurs, but some think it may be related to problems in recognizing emotions in speech, which can also occur in people with Parkinson’s.

Social Impact of Voice Problems

Parkinson’s-related speech impairment can have a significant impact on social interactions, as many MyParkinsonsTeam members have discussed. “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 whom 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.”

Treatment for Speech Problems

Speech therapy is the gold standard for treating Parkinson’s-related speech disorders such as dysarthria. A speech therapist can identify specific communication problems and provide various vocal and breathing exercises to help improve speaking. A few kinds of speech treatment are used to address vocal issues in Parkinson’s disease and improve quality of life.

Lee Silverman Voice Treatment LOUD Program

Some MyParkinsonsTeam members have improved their speaking abilities with the Lee Silverman Voice Treatment LOUD program (LSVT LOUD). LSVT LOUD is a form of intensive speech therapy that helps people with Parkinson’s speak louder.

“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 have used LSVT LOUD personally or for a loved one emphasized that progress requires constant practice. “The key is to do the sessions daily,” a caregiver commented.

“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.

Lee Silverman Voice Treatment Articulation Program

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.


“I chant the Ramones chorus of ‘Hey! Ho! Let’s Go!’ to pump up my voice before I get on a phone call.”

— A MyParkinsonsTeam member

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Breathing Exercises

Intensive respiratory training designed to strengthen breathing muscles has shown some benefits for people with Parkinson’s, but research shows that it’s not as effective as LSVT LOUD.

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

Assistive devices can also help people with Parkinson’s manage communication problems. The SpeechVive earpiece has been shown to help some people who speak in a low volume with amplification. A personal amplifier can also help improve speech volume. Other methods of communication, like text-to-speech devices and apps, may be helpful.

Your doctor or neurologist can give you a referral for a speech therapist, who can also recommend appropriate communication devices.

Talk With Others Who Understand

MyParkinsonsTeam is the social network for people with Parkinson’s disease. On MyParkinsonsTeam, more than 102,000 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.

References
  1. Speech and Swallowing in Parkinson’s Disease — Topics in Geriatric Rehabilitation
  2. Patterns of Lung Volume Use During an Extemporaneous Speech Task in Persons With Parkinson Disease — Journal of Communication Disorders
  3. Deep Brain Stimulation Exacerbates Hypokinetic Dysarthria in a Rat Model of Parkinson’s Disease — Journal of Neuroscience Research
  4. Speech-Language Pathology Evaluation and Management of Hyperkinetic Disorders Affecting Speech and Swallowing Function — Tremor and Other Hyperkinetic Movements
  5. Progression of Voice and Speech Impairment in the Course of Parkinson’s Disease: A Longitudinal Study — Parkinson’s Disease
  6. Towards the Identification of Idiopathic Parkinson’s Disease From the Speech. New Articulatory Kinetic Biomarkers — PLOS One
  7. Perception of Speech by Individuals With Parkinson’s Disease: A Review — Parkinson’s Disease
  8. Perception of Emotional Speech in Parkinson’s Disease — Movement Disorders
  9. Survey of Speech and Language Therapy Provision for People With Parkinson’s Disease in the United Kingdom: Patients’ and Carers’ Perspectives — International Journal of Language & Communication Disorders
  10. Single Word Intelligibility of Individuals With Parkinson’s Disease in Noise: Pre-Specified Secondary Outcome Variables From a Randomized Control Trial (RCT) Comparing Two Intensive Speech Treatments (LSVT LOUD vs. LSVT ARTIC) — Brain Sciences
  11. Comparison of Speech and Language Therapy Techniques for Speech Problems in Parkinson’s Disease — The Cochrane Database of Systematic Reviews
  12. Increased Vocal Intensity Due to the Lombard Effect in Speakers With Parkinson’s Disease: Simultaneous Laryngeal and Respiratory Strategies — Journal of Communication Disorders
    Updated on May 24, 2024
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    Kiran Chaudhari, M.B.B.S., M.D., Ph.D. is a specialist in pharmacology and neuroscience and is passionate about drug and device safety and pharmacovigilance. Learn more about him here.
    Lorelei Tucker, Ph.D. has a doctorate in neuroscience from Augusta University. Learn more about her here.

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