What To Expect From Speech Therapy for Parkinson’s

Parkinson’s disease doesn’t just affect the way you move. It can also change the way you speak, communicate and swallow. If you’ve been diagnosed with Parkinson’s, speech therapy may be one way to help you preserve these abilities and adapt as your needs change.

Speech language pathologist Danielle Brown, MA, CCC-SLP, explains why Parkinson’s affects speech and swallowing, and what treatment looks like.

How Parkinson’s affects speech and swallowing

Parkinson’s disease affects the way your brain communicates with your body’s muscles, including the ones used for speaking and swallowing. As the disease progresses, the muscles in your mouth, throat, face and chest become less coordinated.

“When you have Parkinson’s, your muscles are stiffer and become less coordinated,” explains Brown. “That makes talking feel harder and changes your ability to speak.”

Changes in speech may include:

• A soft or quieter voice
• Slurred words
• Vocal tremors
• Speaking in a monotone
• Speaking too quickly

It can also cause cognitive issues that complicate conversation. It may be difficult to:

• Come up with the right names, nouns and other words
• Stay on topic during conversation
• Understand what someone is telling you

Parkinson’s also causes physical changes, like:

• Shallow breathing and weakened respiratory muscles
• Excessive saliva or drooling
• Difficulty chewing or swallowing

“With Parkinson’s, there’s no telling how the disease will progress,” notes Brown. “You may have more difficulty in some areas than others. But your care team can offer medications, treatments and different therapies to help maintain your quality of life as new symptoms appear or get worse.”

Signs you may need speech therapy

Some people with Parkinson’s experience changes to their voice early on, while others develop swallowing problems later — and some experience both at different stages.

These changes often show up in small, everyday moments:

• Conversations may become frustrating when people ask you to repeat yourself when they can’t hear you or keep up with your rate of speaking.
• Eating may take longer than usual.
• You may cough, choke or feel like food or pills won’t go down when you swallow.

As these moments happen more frequently, it can be alarming and scary. It’s important to get them checked out, even if these symptoms seem mild at first.

“With speech therapy, it’s best to take a proactive approach rather than a reactive one,” advises Brown. “The earlier we start, the better. We can help you figure out ways to eat and speak more comfortably and try to maintain what you’re able to do for as long as we can.”

Dysarthria and speech therapy

Dysarthria is a motor speech disorder that Parkinson’s disease causes. It makes it hard to form or pronounce words. Conversations can become complicated and difficult to manage if you have difficulty speaking and being understood.

“A lot is happening in your brain when you’re having a conversation with someone. You’re processing the information you’re hearing, and you’re coming up with the right words and sentences to express what you’re thinking,” explains Brown. “Speech therapy helps you work on both the physical and mental difficulties of speaking.”

A speech-language pathologist will assess your speech, voice, breathing and communication. They’ll then recommend a treatment plan tailored to your needs. For many, that may include one of two specialized Parkinson’s speech therapy programs:

• LSVT LOUD®: This intensive program focuses on helping you consistently strengthen and increase the volume of your voice. It typically involves five 60-minute therapy sessions every week for four weeks, along with daily at-home exercises.
• SPEAK OUT!®: This structured program also challenges you to use a loud, projected voice when speaking. This form of therapy involves four 60-minute sessions every week for four weeks, along with daily at-home practice.

After completing these programs, your healthcare provider may prescribe an ongoing program or series of exercises to help you maintain your volume and ability to speak. Some of those exercises may involve:

• Using vocal warm-ups to practice making certain sounds and syllables at greater volume
• Speaking common, everyday sentences with a loud, projected voice
• Reading aloud in a loud, projected voice
• Range-of-motion exercises to support the coordination of speaking muscles
• Pacing your speech with the help of a metronome

“While we can’t reverse the effects of this disease, we do have evidence that shows we can train your brain to do things in a different way,” says Brown. “There are lots of strategies and techniques you can use to help your voice be louder or clearer or to help you swallow more safely.”

Dysphagia and swallowing therapy

Dysphagia, or difficulty swallowing, is another common complication that often gets worse with Parkinson’s disease. A speech-language pathologist might have you eat or drink something to evaluate how well you’re swallowing. They may also do a swallowing test under an X-ray. They’ll have you consume items of various textures or consistencies to see how they move from your mouth through your throat.

These tests help determine which treatments or exercises will work best. Based on their findings, a provider might recommend:

• Strengthening exercises for your throat muscles
• Taking smaller bites or alternating bites with sips of liquid
• Eating softer or thicker foods so you can swallow more easily
• Adjusting your posture to improve swallowing safety

“Some swallowing strategies can help one person, but may make swallowing harder for someone else,” notes Brown. “It’s important to have your swallowing evaluated before making changes on your own.”

At-home assistive devices

Speech therapy doesn’t stop when your appointments end. Most people continue practicing speech and swallowing exercises for Parkinson’s disease at home to reinforce what they’ve done in therapy and maintain their quality of life for as long as they can.

“We try to encourage some kind of speech or swallowing exercise every day,” says Brown. “Building a consistent routine can help maintain your quality of life.”

Using technology and other assistive devices like these can also help:

• Decibel meter apps allow you to monitor how loudly you’re speaking in and out of practice.
• Voice amplifiers can make conversations easier in noisy settings or when your voice gets tired.
• Spring-loaded resistance devices for expiratory muscle strength training (EMST) may help strengthen the muscles used for coughing and breathing, and may improve swallowing for some people.

How can listeners help you with speaking and communicating?

Parkinson’s disease may change the way you speak and swallow, but it doesn’t mean you’re on your own. Speech therapy can also be useful for friends, family and other caregivers, as they learn how to better communicate and support your needs.

With the help of a provider, they can learn the importance of:

• Encouraging you to do your at-home exercises
• Reducing background noise
• Facing you when they speak
• Helping others understand your needs

Ask for help

The earlier you begin working with a speech-language pathologist, the more opportunities you’ll have to strengthen existing skills and develop new strategies.

“If you have questions or you’re not sure how you’re doing with speech and swallowing, we’re always here to help,” encourages Brown.