Speech and voice changes are common in Parkinson’s Disease, with an estimate that 89% of individuals with Parkinson’s undergo some change in communication abilities. The initial changes in voice and speech may be subtle and represent the insidious nature of the disease, which hovers in the background changing the way respiratory, voice, and speech muscles work. Unfortunately, patients often wait to pursue treatment until symptoms are more pronounced and, by that time, communication habits are more entrenched, improvements in voice are harder to attain, and requests for repetition, nagging, and frustration have become a part of the daily ritual for the non-Parkinson’s spouse/carepartner.

Talking to one’s spouse, which may have been a pleasurable and an emotionally fulfilling part of a couple’s relationship, may gradually disappear and become another burden associated with the disease.

While there are numerous sources for information regarding specific therapy techniques directed at improving voice and speech, such as the Lee Silverman Voice Treatment® program, there is not a lot of information directed at helping couples maintain or improve their pattern of communication when speech has become difficult. Communication that is full of directives: “you need to …” or “speak up…” can become parent-like or demeaning to the individual who may need extra time to formulate a thought or a response. A speech and voice impairment may be erroneously interpreted as a cognitive impairment, resulting in unfamiliar speakers directing conversation to the healthy spouse, while the individual with Parkinson’s sits passively and quietly on the sidelines. If hearing loss is an issue for either partner, as well as refusal to use a hearing aid, day to day communication is guaranteed to deteriorate further.

So, what are some things that individuals can do to improve their communication with a spouse  whose speech and voice have declined due to Parkinson’s?

1. If you have been prescribed hearing aids, WEAR THEM!
2. If you have a very soft voice, consider use of a personal voice amplifier, particularly in social settings where many other people are talking and there is background noise.
3. Turn off the television, car radio, and other sources of noise that are competing to be heard.
4. Sit side by side or face to face with the person you are speaking with. Use a hand signal or some other gesture to signal to the listener, that you are still thinking, still planning your response, that you need more time.
5. If you are planning to enroll in speech therapy, sit as a couple with the therapist, and discuss the patient’s individual goals, as well as your goals, as a couple, for improving your communication at home.

Communication patterns in relationships are typically as unique as the individuals involved, with patterns of interacting established long before the emergence of a communication impairment. When, for instance, a wife says to me: “I wish my husband would talk more,” and I ask: “was he a big talker before his diagnosis?”, and she says: “Not really, he was always kind of a loner,” I am amused. How can we imagine that a man who barely communicated before his diagnosis of Parkinson’s will talk more, when speech and voice are now an effort?

Anyone with a recent diagnosis of Parkinson’s should embark on a program of voice strengthening to maintain and improve communication abilities. But even if your partner is now in the middle or late stages of the disease a qualified speech-language therapist may still be able to assist you in improving your day to day communication.

Mary Spremulli, MA, CCC-SLP resides in SW Florida, where she holds a speech- language pathology and nursing license with the mission of enlisting individuals in their treatment, and helping them express their personality & spirit through voice. She is founder of Voice Aerobics, LLC, a private practice, and is the author of Voice Aerobics DVD™, Voice Aerobics Grand Slam ™, and Voice Aerobics™ Songbirds CD, voice and exercise programs. The Voice Aerobics™ family of products blends the art and science of voice therapy into fun programs designed to be used independently by patients, and which may maximize function and reduce speech and voice symptoms associated with Parkinson’s Ms. Spremulli has worked in the health care field for over 25 years, and has lectured nationally and internationally on health related topics. Ms Spremulli has published in the area of Clinical Ethics and Patients Education. For more information, please visit http://www.voiceaerobicsdvd.com or http://voiceaerobicsdvd.blogspot.com.