If you have Parkinson’s disease (PD), you are probably aware that people ask you to repeat what you just said more than they used to. Speaking clearly and intelligibly becomes a little more difficult when you have PD. While 89% of people with PD experience some type of speech problems, less than 5% get treatment for those speech problems. This is unfortunate as research shows that effective treatments are available for speech, voice and language problems of PD.
Speech Problems Associated With Parkinson’s Disease
The most common speech problems experienced by people with PD involve reduced volume (hypophonia), reduced pitch range (monotone), and difficulty with articulation of sounds or syllables (dysarthria). In essence, you can’t speak as loudly as others, you find it more difficult to convey emotion when you do speak, and you find it difficult to form the words you are trying to pronounce.
You don’t need me to tell you that this combination of factors makes speaking extremely frustrating. When you couple all of these voicing problems with the so-called ‘masked faces’ of PD, the difficulty in expressing emotions via facial expression, it's no wonder that people occasionally find it difficult to understand what you are trying to say.
The whole thing can become so frustrating that it is tempting to withdraw from conversations with others altogether, but that would be a mistake. You need others. You need to interact with others on a daily basis no matter how frustrating it becomes. The good news is that there are treatments, such as voice exercises, that can dramatically improve the voicing problems associated with PD. Take a look at the Speech and Language Therapy links below.
Language Problems of Parkinson’s Disease
Besides the frustrating speech and voicing problems of PD, there may also be language problems. These language problems very likely make the speech problems more difficult to deal with, so it is important to identify these language difficulties when they appear.
Speech is about expressing ideas via the use of language. Language is a cognitive ability that can be present even when you cannot speak. In the case of people with PD, they may exhibit word-finding difficulties and grammatical difficulties. They tend, for example, to use simplified sentence structures with an increase in the ratio of open-class items (nouns, verbs, adjectives) to closed-class items (determiners, auxiliaries, prepositions, etc.), as well as an increase in the frequency and duration of hesitations and pauses.
When listening to others speak, it is sometimes hard for persons with PD to understand the other’s language if they use complicated sentences to express their ideas. Thus, in both production of language and in comprehension of language, people with PD sometimes experience significant difficulties.
Speech and Language Therapy for Parkinson’s Disease
Potential treatments for speech and language problems of PD include medication, behavioral therapies and surgery. The most recent assessments of these therapies suggest, however, that surgery (particularly deep brain stimulation) is not effective for speech problems, although it may improve some of the severe motor problems of PD. In addition, there are no medication therapies that are effective when used alone.
Treating the basic motor problems of PD optimally (with medication) appears to be a prerequisite for improving speech problems. That is, if the PD motor problems are untreated, the speech problems do not respond well to behavioral treatments. PD medication is therefore necessary but not sufficient. In short, the optimal treatment strategy for speech and language problems of PD appears to be a combination of PD medication (like levodopa) plus some form of behavioral speech therapy.
Behavioral Speech Therapy
Behavioral speech therapy usually involves a series of voice exercises administered by a trained and certified speech therapist. These exercises include training in control of speech rate, stress/intonation or expression of emotion, loudness, articulation and breathing so as to support the voice. Sometimes the therapist uses assistive instruments, such as delayed auditory feedback, voice amplification devices or pacing boards.
Some investigators have claimed significant success with PD patients by using the so-called Lee Silverman Voice Treatment (LSVT), an intensive program of voice exercises that targets vocal intensity, quality and variation -- precisely the areas of difficulty for persons with PD.
The LSVT approach centers on a single therapeutic target at a time so that effort can be invested in achieving that target alone. A therapeutic target might be ‘increasing vocal loudness’ or ‘enhancing speech intelligibility’. In pursuing these sorts of therapeutic targets, the patient is drilled on a series of voicing exercises and is taught to be aware of sensory feedback from the voice, as well as to self-monitor voicing patterns and voice quality. The increased self-awareness of voice allows for correction of errors and for faster progress toward the target.
The LSVT regimen usually involves 4 training sessions per week for one month (16 sessions).
The available evidence suggests that these sorts of behavioral speech therapy regimens really work, so there is no reason for you to keep having frustrating conversations with others who pretend they understand what you are saying. Instead, you will re-learn to clearly and loudly speak your mind.
Ramig LO, Fox C, Sapir S. Speech treatment for Parkinson's disease. Expert Rev Neurother. 2008 Feb;8(2):297-309. Review.