If I Have Parkinsons Disease What Kind Of Speech And Voice Problems May I Experience
If you have Parkinsons disease, some of the voice and speech difficulties seen include:
- Softened voice. Reduced volume to your voice.
- Speaking in an unchanging pitch .
- Having a hoarse or strained quality to your voice.
- Having a breathiness to your voice. Breathiness in the quality of your voice that is easily heard by your listeners. It takes more effort and energy to speak. You run out of gas as you speak.
- Trouble clearly and easily pronouncing letters and words.
- Tremor in your voice.
- Using short rushes of speech.
- Loss of your facial expression.
If you have Parkinsons disease, you may not be aware of the problems with your spoken communication. Changes in the quality of your voice may be the first sign of speech problems followed by the inability to have fluid speech and clear and distinct speech sounds. Speech problems that are severe enough to reduce your ability to be easily understood usually do not occur until later in the course of Parkinsons disease.
What Is Difficulty Swallowing
Difficulty swallowing, or dysphagia, occurs when the muscles and nerves that allow you to swallow become irritated, compressed, or damaged. It is more common with age.
It may feel like food is stuck in your throat or chest, or cause coughing, heartburn, pain when swallowing, regurgitation , and drooling.
Sometimes, difficulty swallowing is caused by something simple, like eating too fast or poor chewing. But it can be caused by physical issues with your esophagus, such as a blockage or swelling. Or it may be a sign of a serious condition, such as cancer or a stroke.
Treatment may include medication, endoscopy, or surgery.
Pro Tip
Difficulty swallowing causes a lot of discomfort, but it can also lead to aspiration, which is when food or liquid gets into the airways instead of the esophagus. Everyone aspirates a little bit, but when people have difficulty swallowing, they can aspirate more, which can lead to pneumonia. Dr. Judy Kim
How Parkinsons Affects Your Eyes
Eye Movement Problems
There are three fundamental types of eye movements.
- Pursuit eye movementsallow the eyes to travel together to follow a moving target in the horizontal or vertical direction.
- Saccadic eye movements are the rapid eye movements that allow the eyes to quickly jump to a new target. They are important when reading as the eyes need to jump from the end of one line and to the beginning of the next.
- Vergence eye movements are used when the target is coming towards or away from a person. When the target comes towards a person for example, the eyes have to move slightly together, or converge, to keep vision of the target clear.
In PD, the saccades tend to be slow, which means reading can be difficult if the eyes are unable to find the correct place on the next line. If a person has Levodopa-induced dyskinesias, the saccades can become fast and erratic which can also be problematic.
Another common eye movement issue for people with PD is difficulty with vergence eye movements. In PD, the eyes are often not able to come together sufficiently as a target draws near. This is called convergence insufficiency, which can cause double vision, especially when focusing on near tasks. This problem can also affect a persons ability to read.
Eye movement solutions
In terms of complementary and alternative therapies, art therapy has been seen to alleviate some of the vision effects associated with Parkinsons disease.
Abnormalities of blinking
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How Do You Know If You Or Your Loved One Has A Problem With Swallowing
Swallowing difficulties can start very subtly and initially not be obvious to either the person with PD or their loved ones. There are signs to look out for before swallowing difficulty becomes overt . Some of the signs you should pay attention to include:
- Slow rate of eating people with difficulty swallowing may slow down their eating in order to avoid coughing or choking
- Fatigue during eating or decreased enjoyment of food
- A sensation that food is sticking in the throat
- Coughing or excessive throat clearing during eating
- Difficulty in swallowing pills
- Unexplained weight loss people with difficulty swallowing may reduce their consumption in an attempt to eat without coughing or choking
- Change in dietary habits people with difficult swallowing may alter their diet in order to avoid foods that cause difficulty. This may not be a choice made consciously
- Diagnosis of a pneumonia this could be caused by aspiration, or entry of a foreign substance into the airway
If you think there might be a swallowing issue, it is important to speak with your doctor about it. There are steps you can take to properly assess the situation and improve your swallowing function. This can in turn reduce your risk of choking, make eating more enjoyable, and lessen the chances of unwanted weight loss and/or other discomforts.
Tips To Help Parkinson’s Patients To Eat And Swallow
Some patients with Parkinsons have difficulty in eating and swallowing, a condition known medically as dysphagia. Others may have difficulty in controlling the production of saliva.
Four main conditions of concern arise because a person with Alzheimers has difficulty in swallowing:
1. Aspiration pneumonia or a chest infection which occurs when food or liquid goes down the wrong way and enters the lungs instead of the stomach
2. Malnutrition or poor general health resulting from an inadequate intake of food
3. Dehydration, constipation and other problems arising from drinking far less water than is required
4. Asphyxiation caused when food blocks the airway and prevents breathing
Why does a person with Parkinsons have difficulty in swallowing and eating?
Parkinsons can result in a weakening of the muscles in the face and jaw. Because of this the patients control over chewing and swallowing is severely compromised. The weakened muscles are not sufficiently strong to close the lips tightly enough making it difficult to swallow. Some patients might not be able to chew food sufficiently to swallow it while in others some portions of food might remain in the mouth. This food which is not swallowed may dribble down the throat and lead to choking.
Parkinsons also affects the muscles in the tongue because of which it tends to push food out of the teeth instead of down the throat. It could also slow down the passage of food to the stomach because of weakened muscles.
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What Typically Causes Closed Eye Hallucinations
Closed-eye hallucinations are related to a scientific process called phosphenes. These occur as a result of the constant activity between neurons in the brain and your vision.
Even when your eyes are closed, you can experience phosphenes. At rest, your retina still continues to produce these electrical charges.
If you close your eyes in a lit-up room or outside in the sunlight, chances are that small amounts of light could create a visual effect. There may also be an increased likelihood of seeing more colors when light pressure, such as a blindfold or sleep mask, is placed against your closed eyelids.
Other causes of closed-eye hallucinations may be related to medical conditions, including the following:
Risks Associated With Dysphagia
Many people can find dysphagia embarrassing or frustrating. Difficulty swallowing can impact your quality of life, but it can also have serious effects.2
Dysphagia can cause malnutrition or dehydration. It can also cause aspiration, the medical term for food going down the wrong pipe. Aspiration can lead to aspiration pneumonia, which is the leading cause of death for people with PD. This is a type of lung infection that occurs when food, saliva, liquids, or vomit is breathed into the lungs or airways leading into the lungs, instead of being swallowed.1
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Diet And Fluid Modifications For Dysphagia
Depending on your level of dysphagia your Speech Pathologist may suggest foods be chopped, minced or pureed and liquids thickened. The International Dysphagia Diet Framework, shown below, outlines the different types of food textures and liquid categories that may be suggested. The framework was developed to provide standardised terminology and definitions to describe food textures and liquid thickness.
Below is a brief summary of some of the common texture modified diets and thickened liquids that may be suggested for people with Parkinsons who have dysphagia. For detailed information on the different food and drink categories as well as testing methods that help ensure consistent production of prescribed foods and liquids visit iddsi.org
Signs And Symptoms Of Dysphagia
Signs and symptoms of dysphagia can range from mild to severe. If you think you or a loved one might have a swallowing problem, it is important to get professional help as soon as possible. Speech Pathologists are experts in dysphagia and can assess your swallowing ability and safety. Seek help from your doctor and a Speech Pathologist if you notice any of the following signs or symptoms:
- A feeling that food or drink gets stuck in your throat
- A feeling that food or drink is going the wrong way
- Long mealtimes or eating slowly
- Coughing, choking or frequent throat clearing during or after eating and drinking
- Becoming short of breath or your breathing changes when eating and drinking
- Avoiding certain foods because they are difficult to swallow
- Unplanned weight loss, or failing to put on weight because of avoiding foods or finding it hard to eat
- Frequent chest infections with no known cause
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What Is A Parkinsons Tremor
Other health issues can also cause tremors, like multiple sclerosis or essential tremor. But Parkinsonâs tremors are different because theyâre usually:
- Resting. Parkinsonâs tremors happen when your muscles are still. They go away when you move. They also lessen while you sleep. For example, if youâre sitting in a chair with your arm relaxed, you may notice that your fingers twitch. But if youâre using your hand, like when you shake someone elseâs hand, the tremor eases or stops.
- Rhythmic. Parkinsonâs tremors are slow and continuous. They arenât random tics, jerks, or spasms.
- Asymmetric. They tend to start on one side of your body. But they can spread to both sides of the body.
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 .;
LSVT® Guidelines
- 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.
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How Do We Swallow
Swallowing is a complex process. Some 50 pairs of muscles and many nerves work to receive food into the mouth, prepare it, and move it from the mouth to the stomach. This happens in three stages. During the first stage, called the oral phase, the tongue collects the food or liquid, making it ready for swallowing. The tongue and jaw move solid food around in the mouth so it can be chewed. Chewing makes solid food the right size and texture to swallow by mixing the food with saliva. Saliva softens and moistens the food to make swallowing easier. Normally, the only solid we swallow without chewing is in the form of a pill or caplet. Everything else that we swallow is in the form of a liquid, a puree, or a chewed solid.
The second stage begins when the tongue pushes the food or liquid to the back of the mouth. This triggers a swallowing response that passes the food through the pharynx, or throat . During this phase, called the pharyngeal phase, the larynx closes tightly and breathing stops to prevent food or liquid from entering the airway and lungs.
The third stage begins when food or liquid enters the esophagus, the tube that carries food and liquid to the stomach. The passage through the esophagus, called the esophageal phase, usually occurs in about three seconds, depending on the texture or consistency of the food, but can take slightly longer in some cases, such as when swallowing a pill.
Recently Fred Has Found His Eyes Are Closed Involuntarily Most Of The Time Though If He Makes An
You dont think, Oh, it would be nice to have my eyes closed now?
The mask that is the expressionless face, typical of many people with Parkinsons, probably distresses the people who have to live with it more than it embarrasses the person who has it. It tends to be the position the face falls into when not actively doing something else. Lack of facial expression can be hard for the family.
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Foods That Are Hard To Chew
Many people with Parkinsons have difficulty with chewing and swallowing foods. A person needs medical help if this is the case. A speech and language therapist may be able to help a person overcome this issue.
However, if a person is finding certain foods hard to chew and swallow, they may wish to avoid these foods.
Such foods include:
- dry, crumbly foods
- tough or chewy meats
If a person does wish to eat chewy meats, they could try using gravy or sauce to soften them and make eating easier.
They could also try chopping meat into smaller pieces or incorporating meat into casseroles, which can make it more tender.
Having a drink with a meal can also make chewing and swallowing easier.
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.
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How Can Listeners Help People Who Have Difficulty Speaking And Communicating
Here are some ways friends and family of people with Parkinsons disease can ease speaking and communication difficulties:
- Talk to the person with Parkinsons disease face-to-face only, and look at the person as he or she is speaking.
- Ask questions that require a simple “yes” or “no” answer.
- Repeat the part of the sentence that you understood.
- Ask the person to repeat what he or she said, to speak more slowly or spell out the words you did not understand.
What Alternative Communication Devices And Tips Can Help With My Voice And Speech Problems
If you have difficulty speaking, are frustrated and stressed by your inability to communicate or tire from the efforts to speak, consider the following devices and methods to be better understood:
- Amplification: This could be a portable personal amplifier or a telephone amplifier that can be used to increase vocal loudness in soft-spoken people. The amplifier also decreases voice fatigue.
- TTY telephone relay system: This is 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.
- Low-technology devices: Paper-based books and boards, alphabet boards and typing devices are examples of low technology assistive methods.
- High-technology electronic speech enhancers, communication devices: Computers with voice synthesizers and speech generating devices are available. Talk to a speech-language pathologist about the available high technology devices best suitable for your needs.
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When To Seek Medical Advice
You should see your GP if you, or someone you care for, have difficulty swallowing or any other signs of dysphagia so you can get treatment to help with your symptoms.
Early investigation can also help to rule out other more serious conditions, such as oesophageal cancer.
Your GP will assess you and may refer you for further tests.
Read more about diagnosing dysphagia.
Dysphagia Or Difficulty Swallowing And Parkinsons
Dysphagia or difficulty swallowing is a common problem that can happen at any stage of Parkinsons and is described as difficulty moving food, liquid, saliva or medication from your mouth to your stomach. Eating and drinking can be uncomfortable, stressful and even dangerous if you have dysphagia. If not managed properly life-threatening medical problems such as pneumonia, choking, poor nutrition and dehydration can occur. Early detection and individualised treatment of dysphagia is crucial to prevent complications and improve your quality of life.
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Patients Who Start To Experience Dysphagia Should Always Inform Their Prescriber And Pharmacist So They Can Obtain The Best Advice On Their Medicines
Many medicines are now available as dispersible tablets, patches or liquid medicines. It is therefore frequently not necessary to manipulate tablets or capsules when a patient has dysphagia. Although the pharmacist is the best person to ask about what is available, there is a website where you can type in the name of your drug to find alternatives visit www.swallowingdifficulties.com for more information. For example, Madopar is available as a dispersible tablet.
Different types of modified release;tablets and capsules
Liquid medicines, which are available for many medications, are designed to be palatable and provide a consistent dose. In many cases, they have a thick consistency to reduce the likelihood of aspiration. However, when there is no suitable alternative, the only option may be to tamper with the tablet or capsule before swallowing.
Tablet casings and coats
Tablets and capsules are very carefully designed to ensure that they are not only acceptable to patients but that the drug is released at the correct speed and in the best location. They each contain a number of different ingredients that are selected to ensure they dont interfere with the drug. It is important, therefore, that different crushed or dispersed tablets should not be mixed together.