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Voice Problems and Parkinson’s: Causes and Management

Updated on September 16, 2021
Medically reviewed by
Amit M. Shelat, D.O.
Article written by
Lorelei Tucker, Ph.D.

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

One MyParkinsonsTeam member said, “My voice gets thinner and softer as the day wears on.” Another member replied, saying their speech was dwindling, too. Fortunately, with the help of your clinician and a speech-language pathologist, you can find ways to communicate and maintain a fulfilling social life.

Dysarthria, Low-Volume Speaking, and More

Dysarthria is a communication disorder in which speech is impaired. People with this condition have a hard time controlling their vocal cords and other muscles. Talking uses many muscle groups, and dysfunction can cause speech problems such as low volume and slowness that make a person hard to understand. This can wear on a person with Parkinson’s as they try to communicate with their loved ones. “My husband’s voice has gotten very quiet,” one MyParkinsonsTeam member wrote, “and it is a considerable effort for him to hold a conversation.” Dysarthria can be caused by motor symptoms that occur as Parkinson’s progresses or by movement disorders from long-term use of levodopa/carbidopa.

Types of 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 (the muscle that helps the lungs move in and out). This means people with hypokinetic dysarthria have to speak from their belly and have less air control.

Additionally, the muscles in the larynx (voice box) that control the vocal folds may stop working properly. This causes dysphonia (poor control of speech tone). Impaired motor function in the lips and mouth makes forming words more difficult. This often results in a raspy, low-volume speech. Doctors may call this drop in voice quality poor phonation. Hypokinetic dysarthria is sometimes worse after deep brain stimulation surgery, a treatment used for PD.

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 becomes jerky as well.

It’s possible to have hypokinetic-hyperkinetic dysarthria. This condition causes a speech rate, cadence, volume, and tone that jumps up and down while speaking. It is different from the monopitch in hypokinetic dysarthria.

Either type of dysarthria occurs in the later stages of PD. However, this symptom usually appears before dysphagia (impaired chewing and swallowing). Throughout the disease, up to 90 percent of people with Parkinson’s will develop some form of dysarthria. Hyperkinetic dysarthria is the less common version of the two, affecting 10 percent to 20 percent of people with Parkinson’s disease.

Interestingly, it appears that Parkinson’s disease affects a person’s perception of their own voice. Sometimes, people living with PD are not aware of the low volume of their voice, thinking they are speaking at a normal level. This makes talking even more difficult. Doctors aren’t sure why this is. However, some believe it may be related to general difficulties recognizing emotions in speech in Parkinson's.

Social Impact of Voice Problems

Low-volume voice and other Parkinson’s-related speech impairment can have a significant impact on members’ social lives. “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 MyParkinsonsTeam member shared.

Another member added, “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

The gold standard for treating Parkinson’s disease-related speech disorders like dysarthria is speech therapy. Speech therapy can help with many aspects of speech and improve overall voice quality. In speech therapy, a trained specialist called a speech therapist, helps a person with communication problems identify their specific issues and work through different vocal or breathing exercises to treat them. There are a few different kinds of speech therapy used to treat vocal issues in Parkinson’s disease, with varying degrees of success.

Many MyParkinsonsTeam members have greatly improved their speaking abilities with the Lee Silverman Voice Treatment – LOUD (LSVT-LOUD) program. 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 member wrote. A husband to a wife with PD shared, “My wife just completed the sessions. They helped so much. Everyone comments on how her voice has improved.”

Those who credit LSVT-LOUD with improvement in the loudness of their or a loved one’s speech 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 taking a foreign language. It is a ‘use-it-or-lose-it deal,’” another MyParkinsonsTeam member agreed.

There is another kind of therapy related to LSVT-LOUD called Lee Silverman Voice Treatment Articulation (LSVT-ARTIC) that is meant to help people with Parkinson's speak with improved articulation. However, studies have found that LSVT-LOUD is more effective. In addition, intensive respiratory training designed to strengthen breathing muscles has shown some benefits, but it is still not as effective as LSVT-LOUD.

In addition to speech therapy exercises, MyParkinsonsTeam members have other tricks to improve their 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,” one member shared.

Assistive Devices

Assistive devices can also help people with PD overcome communication problems and improve their quality of life. The SpeechVive earpiece has been shown to help people with a low-volume voice. A personal amplifier can also improve speech volume. When these devices are not available, other methods of communication like text-to-speech devices can be used in a pinch, although accessibility options are a must to account for motor disabilities.

Talk With Others Who Understand

MyParkinsonsTeam is the social network for people with Parkinson’s disease. On MyParkinsonsTeam, more than 79,000 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? 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. Perception of Speech by Individuals With Parkinson's Disease: A Review — Parkinson’s Disease
  7. Perception of Emotional Speech in Parkinson's Disease — Movement Disorders: Official Journal of the Movement Disorder Society
  8. 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
  9. 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
  10. Comparison of Speech and Language Therapy Techniques for Speech Problems in Parkinson's Disease — The Cochrane Database of Systematic Reviews
  11. Increased Vocal Intensity Due to the Lombard Effect in Speakers With Parkinson's Disease: Simultaneous Laryngeal and Respiratory Strategies — Journal of Communication Disorders
Amit M. Shelat, D.O. is a fellow of the American Academy of Neurology and the American College of Physicians. Review provided by VeriMed Healthcare Network. 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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