News, Parkinson

Communication disorders and Parkinson’s disease

30 July 2020

Communication difficulties, especially speech problems, contribute to the isolation of people living with Parkinson’s disease. Appropriate treatment by speech-language pathologists can help you maintain productive interactions with your spouse, family, friends, and colleagues.

Up to 90% of people living with Parkinson's disease experience changes in voice, speech and language.

Micrography, i.e. increasingly small writing, can also negatively affect communication.

The observed changes in speech are:

❏ Bradykinesia: articulatory movements of the mouth, tongue and lips are slower and less rapid.

❏ Trembling and small repetitive movements of the lips and tongue

❏ Frozen and rigid face that gives the impression that the person speaking has no emotions

❏ Decreased saliva control

❏ Fast speech rate and acceleration: the person speaks very fast and it may seem as if they are stuttering and parts of words are missing.

❏ Palilalia: resembles stuttering due to frequent repetition of syllables in a word (e.g., pa-pa-pa-parachute)

Hypokinetic Dysarthria, a speech disorder, can manifest itself in different ways, meaning that the symptoms may differ from one person to another. In addition to changes in speech, the most common symptoms found in hypokinetic dysarthria are as follows:

 Changes in voice

❏ Hoarse and hoarse voice

❏ Monotony and monointensity: the voice is not very melodious or “flat” and is always produced with the same strength (intensity) which also gives the impression that the person speaking has no emotions.

❏ Reduced voice strength: the person does not speak loudly and it can be difficult to hear them

Changes in language

❏ Delay in voice initiation or long pauses that give the impression that the person does not wish to take a turn in the conversation

❏ Difficulty following a conversation

❏ Difficulty remembering words

❏ Difficulties identifying and understanding emotions

❏ Difficulty detecting humor or sarcasm

 

Changes in writing

❏ Micrography (Writing gets smaller and smaller)

❏ Less accurate writing due to tremors

People living with Parkinson’s disease sometimes have difficulty assessing the extent of their actions. This problem also applies to speech, which must be considered as movement.

The timbre of your voice, its sound level, or the rate at which you speak, for example, may seem normal to you but are in fact insufficient to make you understand others.

Your family and friends will be the first indicators of a change in the way you express yourself. You will be more likely to repeat yourself, speak louder, or decrease your speech rate. These adjustments can lead to episodes of fatigue after speaking.

Micrographs are easily recognizable, especially when you compare your current writing with that of a few years ago. You may notice that you have difficulty writing the first few letters of a text and that your handwriting is getting smaller and smaller.
You may also tend to add bridges to the “m” and “n”, and have difficulty with letters that have loops such as “l” and “e”.

You need to be able to continue to communicate with your loved ones and your health care professionals.

You can see a speech-language pathologist who will assess your communication and make a plan to help you maintain your voice and speech. This professional will also help you develop strategies specific to your condition to enable you to communicate even if your function deteriorates.

You can find contact information for speech-language pathologists on the Ordre des orthophonistes et audiologistes du Québec website.

Here are also some strategies and exercises that you can already implement easily and safely:

 When you speak:  

  • Imagine you’re talking in a very large room and you have to project your voice far away.
  • Imagine that you are talking to a person who cannot hear well.
  • Make your sentences shorter and remember to pause.
  • Avoid tightening your throat by catching your breath before you run out of air.
  • Try to think about conveying your emotions with your face.
  • Position yourself in front of the person you’re talking to so they can see your lips moving.
  • Talk in a quiet place without background noise.
  • Watch your posture!

Choose a specific time in the day to remember to :

  • Straighten your shoulders (if you are sitting down, put your hands on your thighs and press lightly).
  • Keep your head straight, WITHOUT RAISING YOUR CHIN by looking straight and far towards the horizon.
  • Lightly engage your abdominal muscles to straighten your back (if you are sitting, simply push your feet lightly into the ground).
  • Avoid blocking your knees if you are standing, keep them slightly bent.
  • Your posture should be toned, but relaxed! Avoid tensing your shoulders or throat.
  • Don’t get in the way of conversations. The more you talk, the more you exercise your voice!

You can also practice your voice in specialized groups or online.

If you wish to continue communicating your ideas on paper, you can already put in place some strategies to help you.

  • Use a larger pen or pencil.
  • Write on lined paper so that your handwriting is straight.
  • Use a non-slip material to keep the paper from slipping.
  • Take the time you need to write.
  • If you have to sign a document, have someone fill it out and you will only have to sign.
  • Use an electronic device such as a tablet or computer. The computer may have a voice command. You can also print out what you have written.

You can also consult an occupational therapist who will assess your needs and create a personalized plan.

There are no medications that specifically treat speech and writing disorders. However, taking your antiparkinsonian medications, which act on the stiffness and slowness of your muscles, can have a positive impact on your communication.

Your communication difficulties may fluctuate depending on when you take your medication. Don’t hesitate to talk about this with your neurologist, who can adjust your dosage during the day.

You can make it easier to communicate with your loved one by adopting several strategies:

  • Try not to talk when there is a lot of noise (e.g., television or radio).
  • Stand facing your loved one when you want to talk to him or her.
  • Be patient. Give your loved one time to communicate what he or she has to say.
  • Try not to complete sentences.
  • Don’t pretend to understand what he or she has said if he or she does not.
  • Do not speak for your loved one unless it is absolutely necessary.
  • Be reassuring and help him or her relax if he or she seems stressed.

See a speech therapist with your loved one.

Speech and writing disorders appear gradually. The volume of the voice tends to decrease in the early stages of Parkinson’s disease, then the rate of speech becomes faster with the advanced stages and finally resembles a kind of stuttering (palilalia). Difficulties with language often appear as the disease progresses.

Micrography often appears before the diagnosis of Parkinson’s disease. It becomes more and more severe as the disease progresses. In the later stages, writing may become impossible.

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