Parkinsons And Speech Impairments
Communication difficulties, especially speech impairments, contribute to the isolation of people living with Parkinsons disease. Appropriate treatment by speech therapists can help you maintain productive interactions with your spouse, family, friends, and colleagues.
Up to 90% of people with Parkinsons disease experience changes in voice, speech and language. Micrography, i.e. increasingly small writing, can also negatively affect communication.
Some changes in speech are:
- Bradykinesia: articulatory movements of the mouth, tongue and lips are slower and weaker.
- Tremors and small repetitive movements of the lips and tongue
- Frozen and rigid face that gives the impression that the person speaking has no emotions
- Speech acceleration: the person speaks very fast and it may seem as if he or she is stuttering and parts of words are missing.
- Palilalia: resembles stuttering because of frequent syllable repetition of a word
A speech disorder called hypokinetic dysarthria can appear in different ways and symptoms vary from person to person. In addition to changes in speech, the most common symptoms of hypokinetic dysarthria are:
- Changes in voice
- Hoarse and raspy voice
- Monotony and monointensity: voice is flat and always produced with the same energy, giving the impression that the person speaking has no emotion
- Reduced voice strength: the person does not speak loudly and it may be difficult to hear them
- Changes in writing
- Less accurate writing due to tremors
Enlarged Area Of Mesencephalic Iron Deposits In Adults Who Stutter
- 1Department of Neurology, University Medical Center Göttingen, Göttingen, Germany
- 2Institut der Kasseler Stottertherapie , Bad Emstal, Germany
- 3Department of Clinical Neurophysiology, University Medical Center Göttingen, Göttingen, Germany
Purpose: Childhood onset speech fluency disorder is possibly related to dopaminergic dysfunction. Mesencephalic hyperechogenicity detected by transcranial ultrasound might be seen as an indirect marker of dopaminergic dysfunction. We here determined whether adults who stutter since childhood show ME.
Methods: We performed TCS in ten AWS and ten matched adults who never stuttered. We also assessed motor performance in finger tapping and in the 25 Foot Walking test.
Results: Compared to controls, AWS showed enlarged ME on either side. Finger tapping was slower in AWS. Walking cadence, i.e., the ratio of number of steps by time, tended to be higher in AWS than in control participants.
Discussion: The results demonstrate a motor deficit in AWS linked to dopaminergic dysfunction and extending beyond speech. Since iron deposits evolve in childhood and shrink thereafter, ME might serve as an easily quantifiable biomarker helping to predict the risk of persistency in children who stutter.
Symptoms Of Parkinson’s Disease
Many patients with Parkinson’s disease may notice a slight tremor as their initial symptom, which usually begins in one arm or leg and slowly spreads to other areas of the body. Additional symptoms associated with Parkinson’s disease may develop over time and include the following:
- Tremors or shaking
- Sexual dysfunction
Blood pressure may also be affected by Parkinson’s disease and patients may experience pain in specific areas or throughout the body.
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The Effects Of Parkinsons On Speech
Parkinsons disease is a nervous system disorder that slowly progresses over time. The first signs of the disease can be small, and unnoticeable at first. It may be a small tremor in your hand or a loss of expression in your face. As the disease progresses many of the people affected begin to notice an effect on their speech. Some may notice their voice gets softer and monotone, slower and slurred, and can have a hard time finding the words they want to say. The cause of this disease is usually genetic, but in some cases, it can occur because of exposure to certain toxins. The symptoms start to occur at an older age, usually when people are in their sixties.
Problems With Speech And Voice
If you experience problems with your speech and voice you may find your speech sounds slurred or unclear, or that you speak more quickly than before. You may also find you have to slow down to make yourself understood. It can also become harder to control how quickly you speak.
Your voice can also change. It may sound:
- unsteady and flat
- difficulty putting enough power into your movements
Speech and language therapists are healthcare professionals who can provide assessment and advice on all aspects of communication, from facial expression and body language to speech and communication aids.
Clinical guidelines recommend that your GP, specialist or Parkinsons nurse should consider referring you to a speech and language therapist with experience of Parkinsons when youre in the early stages of the condition.
This is important because you may not notice changes to your speech and communication if they are subtle. But a speech and language therapist can uncover any issues, help you manage them and stop them becoming worse.
You may find it helpful to have regular check-ups. This will allow your speech and language therapist to monitor whether there are any changes with your speech. If there are, they can recommend specific exercises or programmes to help you.
Another recommendation in the guidelines is that youre given equipment to help you communicate if you need it .
Medication such as levodopa may help improve how loudly and clearly you speak.
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How To Recognize The Signs Of Parkinson’s Disease
This article was medically reviewed by . Dr. Litza is a board certified Family Medicine Physician in Wisconsin. She is a practicing Physician and taught as a Clinical Professor for 13 years, after receiving her MD from the University of Wisconsin-Madison School of Medicine and Public Health in 1998.There are 17 references cited in this article, which can be found at the bottom of the page. This article has been viewed 138,910 times.
Experts say that symptoms of Parkinson’s disease usually start slowly with a tremor in one hand, along with stiffness and slowing movement. Over time, you may develop more symptoms on both sides of your body.XTrustworthy SourceMayo ClinicEducational website from one of the world’s leading hospitalsGo to source Parkinson’s disease is a condition where your brain’s nerve cells don’t produce enough dopamine, which effects your motor skills. Research suggests that Parkinson’s disease can be difficult to diagnose because there’s no test for it, so your doctor will likely review your medical records and do a neurological exam.XTrustworthy SourceMedlinePlusCollection of medical information sourced from the US National Library of MedicineGo to source Getting an early diagnosis can help you get the best treatment to help manage your symptoms, so talk to your doctor if you think you might have symptoms of Parkinson’s disease.
Speech And Communication Problems
Speech and communication problems are common for people with Parkinsons.
They can include problems with your voice, body language, making conversations and small handwriting. But with the right help and support there are lots of ways you can improve any symptoms.
Changes in the brain in people with Parkinsons mean that your movements become smaller and less forceful than before. This can lead to problems with your speech and communication.
Issues may relate to making sure your voice is loud enough, making your pronunciation clear enough and getting the right tone to your voice.
Problems creating movements that are powerful enough can also affect chewing and safe swallowing. Because of this you may find mealtimes more difficult, with an increased risk of food going down the wrong way.
Find out more: see our information on eating, swallowing and saliva control.
Other communication issues in people with Parkinsons are linked to the way you think. Brain changes mean you may not be able to process thoughts as quickly as you need to.
This includes difficulty finding the right words you need or understanding what other people mean straight away. It also includes problems getting your thoughts together quickly enough to respond to someone in the flow of a conversation. In particular, this can happen when you have to do several different things at once .
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How Are Speech Problems Treated
There are many options to help improve your speech. A speech-language pathologist can help you pick the right approaches for you. Speech-language pathologists are trained health care professionals who specialize in evaluating and treating people with speech, swallowing, voice, and language problems.
Ask your doctor for a referral to a speech-language pathologist. It is also important to contact your health insurance company to find out what therapy and procedures are eligible for reimbursement and to find a list of SLPs covered by your plan. Finally, visit a SLP who has experience treating people with PD.
Treatment Of Parkinson’s Disease
Although there is no cure available for Parkinson’s disease, there are many treatments available to help control symptoms. For most patients, medication is prescribed to increase the brain’s supply of dopamine, which helps to control tremors and problems with movement and walking. Levodopa is the most effective medication for Parkinson’s disease. This natural substance is converted into dopamine when it passes through the brain. Other medications commonly prescribed for Parkinson’s disease may include:
- Dopamine agonists
Patients with advanced stages of Parkinson’s disease who are not be responding to medication, may benefit from a surgical procedure known as deep brain stimulation. During this procedure, electrodes are surgically placed within the brain to deliver electrical stimulation and help control movement. Symptoms of Parkinson’s disease may be reduced as a result of this procedure, however, there are risks which may include infection, stroke or brain hemorrhage.
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The Lee Silverman Voice Treatment
The Lee Silverman Voice Treatment is the first speech treatment for PD proven to significantly improve speech after one month of treatment.
- Exercises taught in the LSVT method are easy to learn and typically have an immediate impact on communication.
- Improvements have been shown to last up to two years following treatment.
- LSVT methods have also been used with some success in treating speech and voice problems in individuals with atypical PD syndromes such as multiple-system atrophy and progressive supranuclear palsy .;
- Must be administered four days a week for four consecutive weeks.
- On therapy days, perform LSVT exercises one other time during the day. On non-therapy days, perform LSVT exercises two times a day.
- Once you complete the four-week LSVT therapy, perform LSVT exercises daily to maintain your improved voice.
- Schedule six-month LSVT re-evaluations with your specialist to monitor your voice.
- If available in your area, participate in a speech group whose focus is on thinking loud.
- A Digital Sound Level Meter can help you monitor voice volume. Place the meter at arm distance to perform the measurement. Normal conversational volume ranges between 68-74dB.
Lack Of Facial Expressions
- Do people have a hard time reading your emotions?
- Do you find yourself expressionless in pictures?
Communication happens quickly and even slight speech changes can drastically affect your quality of life. You may avoid social engagements or even speaking on the phone, which isolates you from friends and loved ones. You may notice that others are speaking for you or not involving you in conversations as often as they used to. If your speech difficulties are preventing you from being understood the first time, others may lack the patience to wait for you to repeat yourself. This can lead to others making assumptions about you or decisions for you.
Sometimes people with Parkinsons Disease do not believe or having difficulty detecting that they have a speech problem until they hear themselves in a recording.
Heres a tip that can help you or your loved one : Take a one minute recording of yourself in conversation. It doesnt matter what you talk about, just as long as you are talking normally and comfortably. Listen to the recording. What do you think? Does it sound like you?
If you are surprised by what you hear, dont panic!
Therapy can help.
If you or a loved one are suffering from speech difficulty associated with Parkinsons Disease, contact The Speech and Swallowing Tele-Clinic for more information on how you can receive specialized speech therapy online from the comfort of home through our one-on-one live video conferencing platform.
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What Changes Can Occur
There are several ways PD may affect speech:
- The voice may get softer, breathy, or hoarse, causing others difficulty hearing what is said.
- Speech may be slurred.
- Speech may be mumbled or expressed rapidly.
- The tone of the voice may become monotone, lacking the normal ups and downs.
- The person may have difficulty finding the right words, causing speech to be slower.
- The person may have difficulty participating in fast-paced conversations.1
Some of the medical terms that describe the speech changes that can occur with PD include:
- Dysarthria, which is a motor speech disorder or impairment in speaking due to PD affecting the muscles required for speech
- Hypophonia, which means soft speech, is an abnormally weak voice caused by the weakening muscles
- Tachyphemia, also known as cluttering, is characterized by an excessively fast speed of talking and a rapid stammering that makes it difficult to understand the person speaking2,3
Types Of Stuttering: Developmental & Acquired
Stuttering is a speech fluency/rhythm disorder resulting in the involuntary repetition of sounds or words that has two fundamental types: developmental and acquired stuttering. In general, stuttering is characterized as instability in the language loops of the brain resulting in disruptions in speech production.3 Palilalia is a condition with similar-presenting symptoms typically associated with advanced PD.
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Stuttering And Parkinson’s Disease
Below is information on stuttering behavior sometimes seen in association with Parkinson’s Disease. If anyone has more information they would like to add, please contact
I am fascinated by these behaviors in PD.
Canter, G. . Observations on neurogenic stuttering: A contribution todifferential diagnosis. British Journal of Communication Disorders, 6,139-143.
How Palilalia Is Treated
The treatment approach for developmental and neurogenic stuttering can be the same. Most often, people who stutter are under the care of a speech pathologist, someone who treats communication and swallowing disorders. They are expert in addressing the needs of people who have experienced neurological conditions including stroke, brain injury, hearing loss, and Parkinsons disease.
Success in treatment of those with PD is often limited because respiration and breath support is affected by decreasing muscle strength. Vocal exercise is one approach, but its success is strongly correlated with the severity of other Parkinsons symptoms. Speech pathologists work to help people with Parkinsons coordinate their breathing and muscle movements in order to eliminate the stutter.
What Can Be Done To Help
Those who have Parkinsons have gone their whole lives with perfect speech, and now in their sixties, they must learn how to cope with the disease and speak again. As people begin to have problems with their speech, it is common that they begin speech therapy. Speech Language Pathologists can work with them to identify problems and find a solution. Along with therapy, many Speech Easy devices are recommended to help with the stuttering and get their speech back to normal.
Researchers Are Using Artificial Intelligence Tools To Evaluate Speech Disorders Related To Parkinsons Disease
November 24, 2020 -;A team from Purdue University is leveraging artificial intelligence technology to collect and automatically measure the speech skills of people with Parkinsons disease.
According to the Parkinsons Foundation, approximately 60,000 Americans are diagnosed with Parkinsons each year, and the disease affects more than ten million people worldwide.
People with Parkinsons may experience changes in or difficulties with speaking. These changes can happen at any time but tend to increase as the condition progresses. Additionally, some patients with Parkinsons may struggle to find words and as a result speak more slowly, while the disease causes other patients to speed up their speech so that it sounds like stuttering.
The team at Purdue has been working to develop telehealth tools to assess and treat speech impairments like those associated with Parkinsons disease. Researchers received a grant from NIH to develop a telehealth and AI platform to facilitate the provision of speech treatment with the SpeechVive device, a wearable medical device designed to improve the speech clarity of people with Parkinsons.
“My personal research passion, and the mission of our lab, is to find ways to improve the quality of life for people with Parkinson’s and other related diseases.”
What Devices Can Help Speech For Those With Parkinson’s Disease
Here’s a sample of the devices that are available to help people with Parkinson’s disease communicate more clearly.
Palatal lift. A dental apparatus that is similar to a retainer. It lifts the soft palate and stops air from escaping out of the nose during speech.
Amplification. A personal amplifier can be used to increase the volume of the voice. The amplifier also decreases voice fatigue.
TTY telephone relay system. A telephone equipped with a keyboard so speech can be typed and read by a relay operator to the listener. Either the whole message can be typed or just the words that are not understood can be typed.
Low technology devices. Notebooks and language boards can be used as alternative communication techniques.
High technology electronic speech enhancers, communication devices. Computers with voice synthesizers and dedicated communication devices are available.
If you are interested in purchasing an electronic communication aid discuss this with your speech therapist before contacting sales representatives for these devices.