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Parkinson’s and Speech Impairments

Communication difficulties, especially speech impairments, contribute to the isolation of people living with Parkinson’s 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 Parkinson’s 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
  • Decreased saliva control
  • 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 (e.g., pa-pa-pa-parachute)

A speech disorder called hypokinetic dysarthria can appear in different ways and symptoms vary from person to person. [VI3] 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 language
    • Speech delays or long pauses that give the impression that the person does not wish to take part in the conversation
    • Difficulty following a conversation
    • Difficulty remembering words
    • Difficulty identifying and understanding emotions
    • Difficulty detecting humour or sarcasm
  • Changes in writing
    • Micrography (writing gets smaller and smaller)
    • Less accurate writing due to tremors

Speech does not only come from the mouth. It involves good coordination between breathing, which makes the vocal cords vibrate, and muscle movements of the oral structures, such as the jaw, palate and tongue. Parkinson’s disease affects movement control.

Regular symptoms of Parkinson’s disease such as slow movements, muscle rigidity and decreased coordination also apply to the jaw, lips and tongue. These cause changes in speech and voice and lead to speech impairments.

The typical slouching posture is also an impediment to speech production because it interferes with breathing and voice projection.

As with speech and voice, movement coordination and accuracy required for writing can also be affected and lead to micrography.

People 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.

Your speech tone, volume or rate, for example, may seem normal to you but in reality be inadequately understood by others.

Your loved ones will be the first to notice changes in the way you express yourself. You will be more likely to repeat, speak louder or decrease your speech rate. These adjustments can lead to episodes of fatigue after speaking.

On the other hand, micrography is easily recognized, especially when comparing your current handwriting 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. You may also add bridges to the “m” and “n” or have difficulty with letters that have loops such as “l” and “e”.

You have to be able to communicate with your loved ones and health professionals.

A speech therapist could evaluate your communication and make a plan to help you maintain your voice and speech. This professional will also help you develop condition-specific strategies to help you communicate, even if your speech deteriorates.

You can find the contact information of speech therapists in Quebec on the website of the College of audiologists and speech-language pathologists of Quebec.

Here are some strategies and exercises you can easily and safely do:

When talking:

  • Imagine that you are speaking in a very large room and you have to project your voice far away
  • Imagine you are talking to someone who can’t hear well
  • Use shorter sentences and don’t forget to take breaks
  • Avoid tightening your throat, catch 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 are talking to so that they can see your lips move
  • Chat in a quiet place with no background noise
  • Watch your posture! Choose a specific time of 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 LIFTING YOUR CHIN by looking straight and far away
    • Lightly engage your abdominal muscles to straighten your back (if you are sitting, simply push your feet lightly into the ground)
    • Avoid locking your knees if you are standing, keeping them slightly bent
  • Your posture should be firm, but relaxed. Avoid tense shoulders or throat.
  • Do not stop yourself from having conversations. The more you talk, the more you exercise your voice.
  • You can also exercise your voice in support groups or online.

If you wish to continue communicating your ideas on paper, you can use some strategies to help you.

  • Use a bigger pen or pencil.
  • Write on lined paper so that your writing is straight.
  • Use a non-slip material to prevent the paper from slipping.
  • Take your time to write.
  • If you need to sign a document, ask someone else to fill it out so you simply need to sign.
  • Use a device such as a tablet or computer. It can be equipped with voice command and it will be possible to print what you have written.

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

You can find the contact information of occupational therapists on the Ordre des ergothérapeutes du Québec website.

There are no medications that specifically treat speech and writing disorders. However, taking your antiparkinson drugs, which help muscle rigidity and slowness, can have a positive impact on your communication.

Your communication challenges may fluctuate depending on when you take your medication. Talk about it with your neurologist, who will be able to 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 (ex. television or radio)
  • Stand in front of your loved one when you want to talk to them
  • Be patient and give them time to communicate what they have to say
  • Try not to complete their sentences
  • Do not pretend you understood what they said if you didn’t
  • Do not talk for your loved one, unless absolutely necessary
  • Be reassuring and help them relax if they seem stressed.
  • Visit a speech therapist with your loved one.

Speech and writing disorders appear gradually. Speech volume tends to decrease in the early stages of Parkinson’s disease, then speech becomes faster with the advanced stages before resembling a stutter (palilalia). Language difficulties often appear as the disease progresses.

Micrography usually occurs before the diagnosis of Parkinson’s disease and becomes worse as the disease progresses. In the later stages, writing may become impossible.

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