Parkinson’s Disease is a progressive nervous system disorder that affects movement. Symptoms generally start slowly, sometimes starting with a barely noticeable tremor in just one hand. Tremors are common, but the disorder also causes stiffness or slowing of movements.
There is no cure for Parkinson’s Disease, but treatment can help manage symptoms which can help individuals stay active and maximise their quality of life for as long as possible.
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 Parkinson’s Disease progresses.
SPEECH AND COMMUNICATION CHALLENGES AND PARKINSON’S DISEASE
Communication is an important part of our everyday lives and extends beyond speaking. It includes the ability to formulate ideas and put those ideas into words and sentences, as well as the ability to understand messages expressed by others. Communication also includes body language, changes in voice to express emotion, as well facial expressions.
Problems communicating can lead to frustration, depression, and withdrawal from social interactions. There are however strategies and techniques that can assist in more effective and meaningful communication.
Speech Production
Just as Parkinson’s Disease 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. The majority of persons with Parkinson’s Disease experience changes in speech and voice which can vary from mild to severe. Speech difficulties may include the following:
• The voice may get softer and the quality could become breathy or hoarse, causing others to have
difficulty hearing what was said.
• Speech may be slurred.
• Speech may be mumbled or expressed rapidly.
• The tone of the voice may become monotone, lacking the normal ups and downs which convey
meaning.
• Difficulty finding the right words, causing speech to be slower.
Tips for keeping your speech and voice strong
• It is important to take care of your voice. Drink plenty of water or other liquids each day (non-caffeine and non-alcoholic) to stay hydrated. That way, your vocal cords can work optimally.
• Do not strain your voice by shouting over loud noise when you talk.
• Rest your voice when it is tired. Like other muscles in your body, the muscles controlling your speech
need a break sometimes.
• Reduce throat clearing or coughing. Use a hard swallow to clear any irritation in your throat.
• If you have frequent heartburn or a gastroesophageal reflux disorder [GERD], talk to your physician about ways to reduce and/or eliminate these symptoms.
• If the air is dry in your home, consider using a humidifier.
• The best way to practice talking is to talk! Do not limit your speaking because you feel self-conscious or have difficulty. The saying “use it or lose it” applies to speech too.
• Singing is a great exercise for the voice! Singing uses the same muscles that are used for speech production. Try taking a deep breath and singing your favourite songs. Gently reach for the high and low notes and sing the lyrics as clearly as you can. This is not only great exercise – it can help you feel good emotionally, too
Effective communication
Beyond producing the sounds of speech, Parkinson’s Disease 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 or aloofness.
While there are steps that the person with Parkinson’s Disease can take, it is important that conversational partners also improve their skills for listening, sending clear messages, and looking for signals of conversation
breakdowns.
Family and friends are often the best support system for people with Parkinson’s Disease. There are several
things family members and friends can do to help their loved one communicate more effectively. The first and most important thing is to encourage your family member or friend to consider speech therapy when changes in communication are noticed. A speech therapist can develop a program tailored to the person with
Parkinson’s Disease’s needs.
Tips for communicating with a person with Parkinson’s Disease
• Minimize distractions and focus on your conversation partner. Minimize having conversations between
rooms or across long distances. Make sure that the lighting in the room is optimized so that you can
see your partner’s face and mouth movements clearly. Words, facial expressions, and gestures are
easier to understand when you can see and hear them being produced.
• Reduce background noise. Turn off the radio and television, close car windows and shut doors to noisy
areas.
• Choose to have important or more challenging conversations when the person with Parkinson’s
Disease are well-rested and at their ‘best’ time of day.
• Learn to look for signals that your conversation partner is having difficulty following or understanding
what you said. These signals can include requests for repetition or responding with ‘huh’ or ‘I didn’t get that’. However, these signals can also be as subtle as a quizzical facial expression, failure to respond at all or appropriately, fidgeting, looking distracted or gradually withdrawing from the conversation.
• Use a calm and reassuring approach. Repeat or rephrase what you said (without increasing the
loudness of your voice or excessively slowing your speech rate).
• Resist blaming your conversation partner (or yourself) when a conversation breakdown occurs.
Conversations break down because the interaction between two (or more) people went wrong. Work
to find the source of the misunderstanding (e.g., a word not understood, changing topics without
ample warning). When found, repair the breakdown (i.e., resolve any misunderstandings) and get the conversation back on track.
• Resist the urge to give up or walk away from a conversation. When possible, try to clarify the
misunderstanding and keep the conversation going. However, sometimes taking a break from the conversation does help. Coming back to a topic or a conversation at a later time can be useful, especially when partners become frustrated.
• Be aware that people with Parkinson’s Disease may not accurately express their emotions through facial expressions because of rigid facial muscles. This can be complicated by their quieter voices and sometimes difficult to understand words. Instead of assuming that your family member/ friend does not understand your message or that you understood theirs correctly, check in and verify that the
message was understood correctly.
• Be patient. Allow ample time for the person with Parkinson’s Disease to communicate. Do not rush or force responses.
• When necessary, ‘make room’ in the conversation for the person with Parkinson’s Disease by opening the conversation for their turn or slowing down the pace of conversation. For example, “Grant and I were just talking about this yesterday and he had some great ideas… Grant, I’m sure Rebecca would love to hear your thoughts.”
• Preserve dignity and personhood. Minimize talking ‘for’ the person with Parkinson’s Disease or filling
in their responses unless they ask you to do so or you have asked (and received) their permission to respond for them.
• In cases where cognitive decline is more severe:
– Use shorter sentences with one idea per sentence when communicating with the person who has Parkinson’s Disease.
– Use common vocabulary and words that are familiar to the person.
– Ask questions that can be answered in a short sentence or with a “yes” or “no” response.
– Alternatively, ask questions and then provide two or three options to help to help the person make their choice clear (e.g. Do you want something to drink? Coffee or tea?)
– Use multimodal supports including writing down key words/short phrases that capture what you are
trying to communicate, pictures and gestures to help reinforce the message you are conveying. These
multimodal supports can also help provide a way for the person with Parkinson’s Disease to respond by pointing to a picture or to a word printed on a page.
– Provide messages in a number of different ways to help enhance understanding.
– Provide shorter chunks of information and allow extra time to process information.
– Resist slowing down your speech in an exaggerated way or overexaggerating your speech production;
in some cases this can worsen communication.
– Stay calm. Do not raise the loudness of your voice in an exaggerated way when repeating or rephrasing
information. This can be emotionally upsetting for the person with cognitive impairment.
Remember that conversations are also about bonding and maintaining relationships. The words and speech sounds do not always have to be ‘perfect’ for there to be an emotional connection about the topic. Minimize attempts to correct words or speech sounds and instead focus on the intent, the general message and the
emotions being expressed.
Remember: there are many options to help improve your speech and the above tips are recommendations
only. A speech therapist can help pick the right approaches for you.
SWALLOWING DIFFICULTIES AND PARKINSON’S DISEASE
The term for swallowing difficulty is dysphagia. It affects the mechanics of swallowing and quality of life. Many people become frustrated or embarrassed and isolate themselves from social activities, such as dining with friends or family. More importantly, dysphagia can lead to malnutrition, dehydration, and aspiration (when
food or liquid “goes down the wrong pipe”). Aspiration, which can be silent (i.e. the person does not cough or
choke) can lead to aspiration pneumonia — the leading cause of death in Parkinson’s Disease. Thus, it is
important to ensure that people with Parkinson’s Disease can eat safely.
Common symptoms of swallowing problems include the following:
• Slowness in eating.
• A sensation that food is caught in the throat.
• Coughing, throat clearing or choking while eating or drinking.
• Difficulty swallowing pills and drooling.
• Food sticking in the mouth or difficulty chewing.
• A sensation that swallowing takes effort and a feeling of fatigue when eating.
People with Parkinson’s Disease can have a variety of different problems swallowing that range from mild to severe. The techniques and strategies for improving your swallowing are best developed with a medical team that includes a speech therapist and may also include a registered dietitian. Some problems with swallowing may require you to change the texture of your food and possibly the consistency of the liquids you consume.
Other problems may require you to learn to swallow in a different way using a swallowing position or using a different technique. A speech therapist can develop a customized strategy, diet modification and exercise
program for you. When it comes to swallowing problems, there is no ‘one-size-fits-all’ approach. The same strategies that may be helpful for one person may not work (or may create more difficulty swallowing) for another.
Below are merely general tips and strategies, but you should always consult a speech and language therapist if you have difficulty swallowing.
What can be done about drooling?
If you tend to drool, you probably don’t have more saliva than you used to have; you are just not swallowing
it as frequently or as automatically as before. Frequent sips of water or sucking on ice chips during the day can help you swallow more often.
When you are not talking or eating, keep your head up, with your chin parallel to the floor and your lips closed.
Sugar tends to produce more saliva in the mouth, so reducing sugar intake can be helpful. One trick is to suck
on hard candy or chew gum, preferably sugarless. Candy and gum activate the jaw and the automatic
swallowing reflex and can help clear saliva, providing temporary relief from drooling. Another tactic is to wear a sweatband on your wrist. This can be used to discreetly wipe the mouth as necessary and is a relatively
inconspicuous accessory.
GETTING HELP
Early intervention with a speech therapist is key to maintaining and improving communication and swallow
function. It is easier to learn strategies and techniques than it is to rebuild what has already been lost. However,
it is never too late to get help for speech and swallowing difficulties related to your Parkinson’s Disease.