Why Does Parkinson’s Affect Speech

What Is Nonverbal Communication

Nonverbal communication, also called augmentative and alternative communication , is a method of communicating without spoken words.

When communication needs cannot be met through speech, the following techniques can help:

• Make the best use out of what speaking ability is left.
• Use expressions and gestures to communicate.

Non-verbal communication can help people with speech difficulties actually speak better by:

• Reducing the frustration and stress of being unable to communicate.
• Alleviating the pressure to speak.
• Allowing the person to be more relaxed and come across in a more understandable manner.

Tips For Managing Drooling In Parkinsons

Sailorrhea, or drooling, refers to pooling of saliva in the mouth. ;It occurs in around 50-80% of all Parkinsons patients, particularly men. ;This blog post explains the cause, risk of aspiration, anxiety, and social embarrassment, with 10 helpful tips & treatment options to help with this pesky problem.

What Are The Common Reasons That Someone With Pd May See A Speech

Often people with PD are referred to an SLP by their physician when they begin to have difficulty communicating or swallowing. Unfortunately, by the time people receive an evaluation from a SLP they have likely been experiencing subtle symptoms for quite a while. People with PD as well as their family members and friends often start being aware of communication issues when the person with PDs voice becomes too soft to communicate effectively. The communication symptoms begin very gradually, so they may first experience difficulty projecting their voice in a noisy environment, or when ordering at a drive-thru window. Over time they begin to experience more and more issues being heard and understood by others. Some people may gradually develop some imprecise/slurred speech and/or a hoarse or breathy voice quality. Communication can also be negatively impacted by changes in nonverbal communication, such as reduced facial expression and speaking with a monotone inflection.

Swallowing issues are often not detected until the person with PD is coughing significantly during meals or struggling to chew and swallow food safely and efficiently. The changes in swallowing can also happen so gradually that people assume symptoms are just related to aging or some other external factor, when in reality, these changes are directly related to the sensory and motor issues associated with PD.

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What Is Parkinsons Disease

At the most basic level,;Parkinsons Disease ;is a disorder of the nervous system. PD causes vital nerve cells in the brain to deteriorate, significantly decreasing the bodys stores of dopamine;and other essential neuro-chemicals responsible for controlling movement.

This results in the tremors that are classically associated with PD.

Tremors, however, are only one of the varied and unpredictable symptoms of PD.

Persons with PD may also experience muscle rigidity or weakness. Movement may be slowed and problems with balance and coordination are common.

Additionally, PD can lead to challenges in thinking, concentrating, or remembering. Patients may even experience hallucinations, delusions, or paranoia as a result of changes in the brain.

Its estimated that more than;10 million people;worldwide have PD, with more than 95% of patients diagnosed after the age of 50.

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.

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Medicines For Parkinson’s Disease

Medicines prescribed for Parkinson’s include:

• Drugs that increase the level of dopamine in the brain
• Drugs that affect other brain chemicals in the body
• Drugs that help control nonmotor symptoms

The main therapy for Parkinson’s is levodopa, also called L-dopa. Nerve cells use levodopa to make dopamine to replenish the brain’s dwindling supply. Usually, people take levodopa along with another medication called carbidopa. Carbidopa prevents or reduces some of the side effects of levodopa therapysuch as nausea, vomiting, low blood pressure, and restlessnessand reduces the amount of levodopa needed to improve symptoms.

People with Parkinson’s should never stop taking levodopa without telling their doctor. Suddenly stopping the drug may have serious side effects, such as being unable to move or having difficulty breathing.

Other medicines used to treat Parkinsons symptoms include:

• Dopamine agonists to mimic the role of dopamine in the brain
• MAO-B inhibitors to slow down an enzyme that breaks down dopamine in the brain
• COMT inhibitors to help break down dopamine
• Amantadine, an old antiviral drug, to reduce involuntary movements
• Anticholinergic drugs to reduce tremors and muscle rigidity

Swallowing And Saliva Management

This one-hour talk is in three parts.; What a speech language pathologist is, how they can help someone with PD.; Why you should be concerned about swallowing problems, some indications you may have a swallowing issue, what a swallowing assessment by an SLP might look like, and recommendations an SLP might make to improve swallowing.; And, why you should be concerned about having either too much or too little saliva and how to manage either situation.

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Why Does Parkinsons Disease Cause A Mask

PD is a chronic, progressive disease that affects the nerves, especially the nerves that control muscle movement. There are at least 43 muscles in the face, which move in concert to create expressions ranging from happiness to anger and despair. Dopamine is the neurotransmitter that transmits the signal from the brain to the muscles to produce movement. When PD damages the nerve cells that produce dopamine, the motor symptoms and ability to control muscles are affected.4,5

Iii Oropharyngeal Swallowing Abnormalities

Some persons with PD also exhibit a delay in triggering the pharyngeal swallow., Although the delay is usually mild, any delay in triggering the pharyngeal swallow is associated with increased risk of aspiration. Once the pharyngeal swallow triggers, pharyngeal wall contraction and posterior tongue base retraction may be reduced, resulting in residue in the valleculae and pyriform sinuses after the swallow., Just as a delay in triggering the pharyngeal swallow is associated with increased risk of aspiration, pharyngeal residue also increases the likelihood of aspiration, as the residual material may fall into the open airway after the pharyngeal swallow is complete. Decreased laryngeal elevation coupled with poor tongue base and pharyngeal wall motion can result in cricopharyngeal dysfunction wherein material is unable to pass into the esophagus. Laryngeal closure also may be incomplete during the pharyngeal stage of the swallow, and cough which is crucial for clearing the airway of foreign material is frequently impaired in PD. Cognitive impairment, upper extremity impairment, and impulsive feeding behavior sometimes apparent in persons with more advanced PD also can exacerbate oropharyngeal dysphagia. Finally, while there is a great deal of variability in the nature and severity of dysphagia PD, it is important to reiterate that oral and pharyngeal stage impairments and even aspiration are frequently observed in patients who have no complaints of dysphagia.

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Speech And Voice Disorders In Parkinsons

There are several reasons people with PD have reduced loudness and a monotone, breathy voice. One reason is directly related to the disordered motor system that accompanies PD, including rigidity, slowness of movement and tremor. For example, the poor muscle activation that leads to bradykinesia and hypokinesia in the limbs can translate to the muscles involved in speech. These problems with muscle activation can result in reduced movements of the respiratory system , larynx and articulation .

Another cause of speech and voice impairment in PD is a change in sensory processing that is related to speech. It is believed that people with PD may not be aware that their speech is getting softer and more difficult to understand. When people in this situation are asked to bring their voice to normal loudness, they often feel as though they are shouting, even though they are perceived by listeners to be speaking normally

Another cause of this condition is that people with PD may have a problem with cueing themselves to produce speech with adequate loudness. Individuals with PD can respond to an external cue , but their ability to cue themselves internally to use a louder voice is impaired. These problems can be frustrating both for the person and for the family.

If I Have Speech And Voice Problems How Can I Maintain And Improve My Communication

Some tips to improve communication include:

• Choose a quiet, low-noise space. Turn off televisions, radios and other devices that create noise.
• Speak slowly.
• Make sure your listener can see your face. Look at the person while you are talking. A well-lit room improves face-to-face conversation, increasing the ability to be understood.
• Use short phrases. Say one or two words or syllables per breath.
• Plan periods of vocal rest before planned conversations or phone calls. Know that fatigue significantly affects your ability to speak. Techniques that work in the morning might not work later in the day.
• Keep your throat hydrated. Drink plenty of water. Dont drink caffeinated or alcoholic beverages. Use a humidifier if the air in your home is dry.
• Keep an upright posture, straight chin, slightly lifted neck to improve airflow from lungs to your vocal cords.
• If you are soft spoken and your voice has become low, consider using an amplifier.

If some people have difficulty understanding you, these additional strategies might help:

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Voice Therapy For Parkinson’s Disease

Parkinson’s disease is a degenerative disorder of the brain affecting control of movement. ;It progresses slowly and most people’s symptoms take years to develop. ;As many as one million Americans – and 7-10 million people worldwide live with PD.*;

Parkinsons disease develops when cells that produce one of the brains chemical messengers – called dopamine – begin to deteriorate and die.; Dopamine transports signals to parts of the brain that control movement.;;With less dopamine, a person has less ability to regulate their movements, and it can also affect speaking and cognition. The combination of difficulties with movement,;thinking, and speaking can make communication for people with PD extremely frustrating. Many people begin to withdraw from conversations and interacting with their loved ones.;

* From the National Parkinson Foundation

Tips For Coping With Speech Difficulties

• Exercise your voice by reading out loud or singing every day.
• Drink enough water, avoiding shouting and rest your voice when it is tired.
• Train your voice like an actorsit and stand with good posture, do exercises for articulation, breathing and projecting the voice.
• Get feedback from friends and family members about how others perceive your speech develop a cue or code word you can use in public to make you focus on speaking clearly.
• If you have soft speech, use tools such as a voice amplifier , placed on your shirt, and on the telephone . Ask an occupational therapist about other tools.
• Make eye contact with the person to whom you are speaking.
• Reduce background noise.
• Socialize in small groups or one-on-one.
• If you experience a facial masking, use feeling words to communicate your emotions . Use practice physical gestures to help convey emotions.
• Determine which times of day your speech is best. Plan social engagements around those times.

Even in the early stages of PD, many report that their voices are too soft, causing others to ask them to repeat themselves. Other people with PD may have a gruff or hoarse quality to their voice. Try these strategies:

Page reviewed by Dr. Chauncey Spears, Movement Disorders Fellow at the University of Florida, a Parkinsons Foundation Center of Excellence.

For more insights on this topic, listen to our podcast episodeImportance of Early Detection of Swallowing Disturbances.

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What You Can Expect

Parkinson does follow a broad pattern. While it moves at different paces for different people, changes tend to come on slowly. Symptoms usually get worse over time, and new ones probably will pop up along the way.

Parkinsonâs doesnât always affect how long you live. But it can change your quality of life in a major way. After about 10 years, most people will have at least one major issue, like dementia or a physical disability.

For Our Readers Who May Be Curious About What To Expect During A Speech Therapy Session Can You Describe A Typical Speech Therapy Session For Pd

A session can vary quite a bit from patient to patient, as we tailor treatment to the persons specific issues. SLP therapy sessions are only provided after a detailed evaluation is completed and a treatment plan is developed. It is best to see an SLP who has experience with PD and uses evidence-based techniques when developing an individualized plan for the person with PD.

One of the gold standard treatments for communication impairments associated with PD is called LSVT LOUD®. LSVT LOUD® has strong evidence associated with it, and it requires that the SLP be specifically trained and LSVT-certified. To preserve treatment fidelity and ensure best outcomes, the sessions must be four times per week for four weeks , with each session lasting one hour. The initial part of the session involves specific voice exercises focusing on loudness and pitch range. The last half of the session focuses on functional communication activities that carry over this normalized volume and voice range into everyday speech in everyday situations.

There is another evidence-based approach also utilized to treat the soft voice associated with PD and this is called the SpeechVive. This device is worn in the ear to introduce babble noise which causes the person with PD to increase their speaking volume automatically. This device also requires that the SLP be specifically trained for its use. The sessions involve an initial calibration of the device with subsequent follow-ups scheduled.

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Speech Therapy And Parkinson’s

Research shows that 89 percent of people with Parkinsons disease experience speech and voice disorders, including soft, monotone, breathy and hoarse voice and uncertain articulation. As a result, people with PD report they are less likely to participate in conversation, or have confidence in social settings than healthy individuals in their age group.

Speech disorders can progressively diminish quality of life for a person with PD. The earlier a person receives a baseline speech evaluation and speech therapy, the more likely he or she will be able to maintain communication skills as the disease progresses. Communication is a key element in quality of life and positive self-concept and confidence for people with PD.

Support For People With Parkinsons Disease

Early access to a multidisciplinary support team is important. These teams may include doctors, physiotherapists, occupational therapists, speech therapists, dietitians, social workers and specialist nurses.;Members of the team assess the person with Parkinsons disease and identify potential difficulties and possible solutions.There are a limited number of multidisciplinary teams in Victoria that specialise in Parkinsons disease management. But generalist teams are becoming more aware of how to help people with Parkinsons disease.;;

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V Management Of Dysphagia

Because lack of awareness of swallowing difficulty as well as silent aspiration are not uncommon in PD, it is critical to monitor weight and provide counseling regarding signs and symptoms of swallowing difficulty even to individuals who report no swallowing difficulties. For patients with documented swallowing difficulty, regular evaluation should help to anticipate problems and put strategies in place to reduce the likelihood of malnutrition, dehydration, and pulmonary problems.

Tip: Do I Have A Speech Or Voice Problem

These are statements many people have used to describe their voices and the effects of their voices on their lives. Choose the response that indicates how frequently you have the same experience. .

• It is difficult for people to hear me0 1 2 3 4
• People have difficulty understanding me in a noisy room0 1 2 3 4
• My voice difficulties restrict personal and social life0 1 2 3 4;
• I feel left out of conversations because of my voice0 1 2 3 4
• My voice problem causes me to lose income0 1 2 3 4
• I feel as though I have to strain to produce voice0 1 2 3 4
• The clarity of my voice is unpredictable0 1 2 3 4
• My voice problem upsets me0 1 2 3 4
• My voice problem makes me feel handicapped0 1 2 3 4
• People ask, Whats wrong with your voice?0 1 2 3 4

To find your score, add up your answers. A score of 10 or higher indicates you might have a speech or voice problem that is affecting your quality of life and you should ask for a referral to a speech pathologist.

*Please note that not all content is available in both languages. If you are interested in receiving Spanish communications, we recommend selecting both” to stay best informed on the Foundation’s work and the latest in PD news.

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