Speech, language and communication therapy in Parkinson’s
Being able to communicate effectively is essential to maintaining a good quality of life and engaging fully in social life, work, personal and professional relationships.
Speech and language problems
It has been estimated that speech problems may affect around 90% of people with Parkinson’s. Difficulties may arise at any time, the main ones being:
- weak voice or reduced voice volume which means things may need to be repeated
- hoarse voice and limited intonation resulting in a monotonous voice
- slurred or unsteady speech
- speaking too fast or too slow
- difficulty speaking clearly whilst doing other things as speech may require more concentration than before
- stuttering or difficulties getting started
- forgetting what you were trying to say or losing your train of thought in a conversation
- difficulty following a conversation involving several or more people.
Facial expression and body language
Parkinson’s can make it more difficult to control the facial muscles, leading to limited facial expression. Body language can also be affected by slowness of movement (bradykinesia), stiffness or tremor
How can a speech and language therapist help?
If you are concerned about your speech, communication or swallowing you should first talk with your doctor. He or she will be able to refer you to a speech and language specialist if appropriate. By talking to you early on, the speech and language therapist will be able to put in place strategies to enhance your communication and therefore quality of life before difficulties have any significant impact. Early intervention may even be able to prevent or delay other problems so even if you are not experiencing problems or have doubts on whether you are or not, then speaking to a speech therapist as finding out more will help with the management of current or future symptoms. You may also be provided with maintenance exercises used to retain your current skills.
Speech and language therapy will focus on maintaining adequate volume of speech by working on breathing and voice to produce clear pronunciation (articulation). It will work on the muscles in your mouth and throat and how you create words, phrases and sentences. It will also make you aware of your facial expression and other non-verbal skills. In short it will preserve your communication skills.
A speech and language therapist will also discuss other factors such as:
- your environment - this can be an important factor when communicating. For example you may find it difficult to speak over background noise such as a television, or a noisy office may mean you cannot be heard properly. Sometimes simply moving to somewhere quieter can make a big difference to how effectively you communicate
- the importance of facing the speaker to enhance speech and voice
- reducing distractions to help you focus on the task in hand
- making use of all methods of communication including gestures and writing if required.
If you have severe communication problems, your speech and language therapist will advise on alternative means of communication, such as voice amplifiers, alphabet charts or communication books as well as more high-tech electronic communication aids such as iPads, Lightwriters (small hand-held computers) and computers with speech synthesisers.
Swallowing and Parkinson’s
Eating is one of life’s greatest pleasures. Being able to maintain the skills required to eat and drink for as long as possible will lead to better quality of life.
Swallowing and drooling problems
Over time swallowing in people with PD may become more difficult, which can cause problems when eating or drinking. Treating swallowing difficulties is vital to prevent serious problems such as aspiration (i.e food going down the wind pipe, which can lead to chest infections) and choking. Difficulties may arise at any time, and may affect any of the three phases of swallowing: 1) when the food is being chewed in the mouth, 2) when the food is travelling from the mouth through the throat to the food pipe (oesophagus) and 3) when the food is travelling down the food pipe.
Common problems that we should look out for include:
- difficulty swallowing pills
- drooling (too much saliva) or too little saliva
- coughing whilst eating or just after swallowing / eating
- a wet or gurgly voice after drinking
- watery eyes, changes in breathing patterns or chest infections after eating
- the feeling of something stuck in the throat
- food remaining in the mouth after swallowing
- difficulty chewing
- loss of appetite
- weight loss
- taking longer to finish a meal.
How can a speech and language therapist help?
If you notice any of the above difficulties, you should contact a speech therapist. He or she will assess eating and drinking difficulties and then suggest strategies, aids or specialist tools to help. Suggestions may include:
- recommending swallowing techniques and postures for efficient and safe swallowing
- suggesting exercises to strengthen the muscles used for swallowing
- suggesting strategies to reduce the risks of asphyxiation and aspiration
- providing advice on diet to make sure you eat and drink enough, including tips on the consistency and texture of foods that are easier to swallow
- identifying specific areas of difficulty with saliva control – for example poor posture, lip seal, tongue or swallowing problems. He or she can suggest exercises and also devices to achieve good lip seal or remind you to swallow frequently
- discussing with your doctor the use of anticholinergic medications or injections of botulinum toxin to reduce saliva production.
In severe cases an alternative method of eating and drinking may be discussed – for example by a tube inserted directly into the stomach (gastrostomy feeding). See also Eating, swallowing and saliva control.
Effects of medication and surgery on speech
The effects of medication on speech vary from person to person but studies suggest that there is generally no significant effect of medication on speech.
Side effects of medication such as dyskinesia and motor fluctuations can make communication, eating and drinking more difficult though, so it is important to work with your doctor to adjust your medications to give you the best possible motor control.
Surgical treatments (mainly deep brain stimulation in the subthalamic nucleus) may lead to worsening speech. Therefore anyone considering surgery should discuss this risk thoroughly with an experienced specialist.
Lee Silverman Voice Treatment (LSVT)
Lee Silverman Voice Treatment (LSVT) is an intensive speech treatment involving 16 individual sessions over a month (i.e. four hourly sessions per week for four weeks). The main focus is voice volume. LSVT helps people to recognise that their voice is quiet and trains them to produce a loud, good quality voice.
Most people can benefit from LSVT and it can be adjusted to individual communication needs and environments. Speech and Language Therapists need to undergo a two-day training in order to deliver the LSVT.
For more information and to find a trained clinician see www.lsvtglobal.com.
Seeing a speech and language therapist
During the first session your speech and language therapist will talk to you to assess your difficulties. They will also take your medical history and may use some speech and language tests. At the end of the assessment the therapist will tell you:
- whether speech and language therapy will help you and if so how
- how regularly you will need to attend speech and language therapy sessions and for how long
Any strategies that a speech and language therapist may suggest will be tailored to your particular needs.
Many speech and language therapists use group work for people with Parkinson’s. Working in groups can be a very effective way of reinforcing techniques learned in individual sessions and has many social and psychological benefits.
Referral procedures depend on the country in which you live and treatment may or may not be accessible through your country’s national health system.
See also: Communication and Parkinson’s.