Speak up! Voice management in Parkinson’s disease

by Martha A. Nance M.D., medical director, Struthers Parkinson’s Center, an NPF Center of Excellence

May is Better Hearing and Speech Month, an excellent time to think about your voice. We all know that Parkinson’s disease makes the handwriting smaller, and causes short, shuffling steps. But sometimes we forget about the impact that PD has on the voice. If you have Parkinson’s disease, and have a soft, quiet voice, and if you are of an age where maybe some of your friends are a little hard of hearing, this can make for a difficult combination.

But you don’t have to accept having a small, soft voice. Just as in other aspects of Parkinson’s disease, if you work at it, you can make it better! If you are concerned about the quality of your voice, or if your family and friends often ask you to repeat yourself, then you should ask your doctor for a referral to a speech and language pathologist, or speech therapist. These trained professionals can evaluate your voice, recommend strategies to improve it, and in some cases, provide an intensive voice therapy program.

Not everyone with Parkinson’s disease has the same kind of changes in speech and voice.  Some people have a quiet, breathy, or even whispered voice. Others have a harsh, strained speech. Some have excess saliva, and a wet, gurgly-sounding voice (others have the opposite–a very dry voice, made worse by taking in too much caffeine or alcohol or cough drops and not drinking enough water!)  Some stammer or stutter, while others have difficulty coordinating their breaths with their voice, and run out of air in mid-sentence. For an occasional person in the later stages of Parkinson’s disease, the problem may be more of a cognitive one—difficult coming up with the right thoughts or words to say in the first place.

The correct treatment depends on identifying the problem, which is why an evaluation by the speech pathologist is so important. It is important to remember that other things can affect the voice besides Parkinson’s disease. Issues completely unrelated to Parkinson’s disease, ranging from gastrointestinal reflux (GERD) to poorly fitting dentures and emphysema, can all affect the voice. A speech therapist can help to determine whether your voice problems are caused by Parkinson’s disease or something else—or both!

For those with Parkinson’s-related voice changes, sometimes an adjustment in medications can be helpful (stopping a medication that is drying up the throat, for instance, or adding a medication to reduce excess saliva). Instruction in good “voice hygiene” helps many people (drink enough fluids, sit up straight, get those shoulders back, take a big breath before you speak, don’t eat and talk at the same time…) Many people—but not all—benefit  from a rigorous program to improve voice volume and control, called the “LOUD” program. Struthers Parkinson’s Center, we also have two group activities led by our speech and music therapists, called “Speech Boosters” and “CREATE Singers”, designed for anyone with Parkinson’s disease in the community who wants an opportunity to exercise his or her voice.

The next time you see a speech and language pathologist, stand up, put your shoulders back, take a deep breath, and give a nice, loud, THANK YOU!

Note: The information included on this blog is for educational purposes only. It is not intended nor implied to be a substitute for professional medical advice. Readers should always consult their own health care provider to determine the appropriateness of the information for their own situation. Readers should also contact their own providers if they have any questions regarding a medical condition or treatment plan. Reading the information on this blog does not create a physician-patient relationship.

 

 



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