Mother with pained expression sitting on couch with her son

People with Parkinson’s (PD) may notice changes in or difficulty chewing, eating, speaking or swallowing. These changes can happen at any time, but tend to increase as PD progresses. Just as PD affects movement in other parts of the body, it also affects the muscles in the face, mouth and throat that are used in speaking and swallowing.

Beyond producing the sounds of speech, PD symptoms like a frozen or masked face can make it harder to communicate the emotions that go along with what you are saying. Others may misinterpret this as a lack of interest in the conversation, aloofness; or even as depression or anger. In addition, some people with PD struggle to find words, and so they may speak slowly. And in other cases, PD causes people to speed up their speech, so much that it may sound like stuttering. All of these symptoms tend to worsen when a person with PD is fatigued.

Often speech and swallowing changes occur together in people with PD. The term for swallowing difficulty is dysphagia. Dysphagia often starts mildly with coughing at meal times, but can progress over time to become a critically important PD symptom. Importantly, dysphagia can lead to malnutrition, dehydration and aspiration (when food or liquid “goes down the wrong pipe”). Aspiration, which can be silent, (a person does not cough or choke) can lead to aspiration pneumonia — the leading cause of death in PD. Thus, it is important to ensure that people with Parkinson's can eat safely.

Answer the below questions to help you figure out if you have a speech, voice or swallowing problem. If many of these statements apply to you, visit a speech-language pathologist (SLP) especially if these changes begin to limit your quality of life.

How do I know if I have a speech or voice problem?

  • My voice makes it difficult for people to hear me.
  • People have difficulty understanding me in a noisy room.
  • My voice issues limit my personal and social life.
  • I feel left out of conversations because of my voice.
  • I cannot participate in telephone calls because of my voice.
  • My voice problem causes me to lose income.
  • I have to strain to project my voice.
  • My voice clarity is unpredictable.
  • My voice problem upsets me.
  • My voice makes me feel handicapped.
  • People ask, "What's wrong with your voice?" 

How are speech problems treated?

There are many options to help improve your speech. A speech-language pathologist can help you pick the right approaches for you. SLPs are trained health care professionals who specialize in evaluating and treating people with speech, swallowing, voice and language problems.

Ask your doctor for a referral to a speech-language pathologist. It is also important to contact your health insurance company to find out what therapy and procedures are eligible for reimbursement and to find a list of SLPs covered by your plan.

Finally, visit a SLP who has experience treating people with PD. Call the Parkinson’s Foundation Helpline at 1-800-4PD-INFO (1-800-473-4636) for help locating a speech-language pathologist in your area. Lee Silverman Voice Treatment, discussed below, is a specific voice therapy for PD but it is not the only way to obtain high quality speech therapy for PD.

Tips for Coping with Speech Difficulties

  • ​​​​​​​Exercise your voice by reading out loud or singing every day.
  • Drink enough water, avoid shouting and rest your voice when it is tired.
  • Train your voice like an actor—sit and stand with good posture, do exercises for articulation, breathing and projecting the voice.
  • Get feedback from friends and family members about how others perceive your speech —develop a cue or code word you can use in public to make you focus on speaking clearly.
  • If you have soft speech, use tools such as a voice amplifier (microphone), placed on your shirt, and on the telephone (this device may help with soft speech, but not for mumbling/stuttering speech).
  • Make eye contact with the person to whom you are speaking.
  • Reduce background noise.
  • Socialize in small groups or one-on-one.
  • If you experience a facial masking, use “feeling” words to communicate your emotions (“I feel happy, sad, excited,” or "I agree”). Practice using physical gestures to help convey emotions.
  • Determine which times of day your speech is best. Plan social engagements around those times.

Even in the early stages of PD, many report that their voices are too soft, causing others to ask them to repeat themselves. Other people with PD may have a gruff or hoarse quality to their voice. Try these strategies:

  • Take a breath before you start to speak.
  • Pause between phrases to take in another breath.
  • Express your ideas in short, concise sentences.
  • Speak louder than you think is necessary.
  • Do not shout over noise when you talk.
  • Rest your voice when it is tired.
  • Reduce throat clearing or coughing. Try a hard swallow.
  • Reduce or eliminate heartburn.
  • If the air is dry in your home, use a humidifier.

How do I know if I have a swallowing problem?

  • I have recently lost weight without trying.
  • I tend to avoid drinking liquids.
  • I get the sensation of food being stuck in my throat.
  • I tend to drool.
  • I notice food collecting around my gum line.
  • I tend to cough or choke before, during or after eating or drinking.
  • I often have heartburn or a sore throat.
  • I have trouble keeping food or liquid in my mouth.

How are swallowing problems treated?

The first step to addressing swallowing issues is to speak to a neurologist about getting an evaluation performed by an SLP. This professional will take a medical history and interview the person with PD about eating and swallowing.

This is typically followed by a video X-ray/ modified barium swallow test so the medical specialist can observe the swallowing process as an individual sips liquid and eats food and these substances flow from the mouth, down the throat and esophagus, to the stomach. In some cases, it is necessary to have an endoscopic examination performed by a gastrointestinal doctor if a cause of dysphagia other than PD (such as a narrowing or stricture in the esophagus) is suspected. With these tests it is possible to see where the trouble is occurring and to recommend therapies.

Follow the recommendations of the swallowing specialist, which may include the following:

heather_wolynic
MY PD STORY: Heather Wolynic

"I noticed I was often off balance, my speech became impaired and my memory was awful. There were times during teaching when my speech would slur, and I would forget everything prepared in my lesson plan."

Additionally, people with PD tend to swallow less often and less completely. As a result, 70% have too much saliva, which often pools in their mouth. Sucking on hard candy, preferably sugarless, can stimulate swallowing and provide temporary relief from drooling. An effective treatment, available by prescription, is atropine eye drops taken orally.

Adjusting anti-PD medications may also make it easier to swallow. In addition, medical conditions unrelated to PD can lead to difficulty swallowing.

Page reviewed by Dr. Addie Patterson, Movement Disorders Neurologist at the Norman Fixel Institute for Neurological Diseases at the University of Florida, a Parkinson’s Foundation Center of Excellence.

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