Speech & Swallowing

Overview: People with Parkinson’s may experience difficulty speaking or swallowing. This can occur at any stage of Parkinson’s but tends to increase as Parkinson’s progresses. Like our limbs, the face, mouth, and throat muscles are impacted by the movement disorder. 

Speech – A lot goes into clear speech: our breathing (affected by the diaphragm), proper closure of the vocal folds in the voice box (phonation), and specific motions of tongue and throat muscles to produce articulation and resonance. Parkinson’s can impact all these symptoms, leading to soft or unclear speech. Additionally, people with Parkinson’s may find themselves speaking very slowly or so quickly that people can’t understand them. As with many Parkinson’s symptoms, these issues are exacerbated by stress and exhaustion. 

Swallowing – Speech issues are often accompanied by swallowing difficulties, also known as dysphagia. This might look like taking a longer time to eat or coughing frequently while eating. It may also show up as excess drooling. This can progress into a significant Parkinson’s symptom leading to malnutrition, dehydration, and aspiration. Aspiration, the accidental inhalation of food or liquid into the lungs, can lead to aspiration pneumonia, the leading cause of death in Parkinson’s. A person who aspirates may not start coughing right away, but symptoms include a persistent cough, wheezing, or hoarse voice. 

Additionally, people with Parkinson’s sometimes find themselves drooling – this is most often indicative of the fact that they are swallowing less frequently. Sucking a hard, sugar-free candy can be helpful to stimulate swallowing. 

Treatment Options (Speech)– The best treatment for speech and swallowing issues is to work with a speech-language pathologist (SLP). These are trained professionals who assess and treat speech, language, and swallowing disorders. Your doctor should provide a referral to an SLP and contact your insurance provider to find covered treatments and specialists in your area. Other treatment options include: 

● The Lee Silverman Voice Treatment – An intensive speech therapy method for people with Parkinson’s which includes four 60-minute therapy sessions a week for four weeks, along with at-home therapy and ongoing exercises after treatment. Find a provider at www.lsvtglobal.com or 888-438-5788. 

● SPEAK OUT! –An intensive speech therapy method which includes 8-12 speech therapy sessions, daily practice via the SPEAK OUT! workbook, speech and singing groups, and re-evaluation every six months. Find a provider at www.parkinsonsvoiceproject.org or 833-375-6500. 

● [CV Local] Songshine – A music-based program that harnesses the power of brain, breath and emotion to help people with Parkinson’s communicate more clearly…and it’s FUN! songshineforparkinsons.com 

● Vocal Fold Injections – Can be used to treat voice quality and volume. Usually lasts 3-6 months. Speak to an Ear, Nose, Throat specialist to learn more. 

● Assistive Communication Devices – Personal amplification devices can improve volume of voice. 

Treatment Options (Swallowing) – Much like speech issues, you will want to seek out an SLP to address swallowing issues in collaboration with your neurologist. For swallowing issues, your doctor or SLP will often recommend a swallow test via video X-ray/modified barium to observe how liquids and solids flow from the mouth, throat, and esophagus to the stomach. Occasionally, an endoscopic examination may be performed by a gastrointestinal doctor to identify whether the swallowing difficulty is caused by something other than Parkinson’s. Other treatments include: 

● The Lee Silverman Voice Treatment – An intensive speech therapy method for people with Parkinson’s which includes four 60-minute therapy sessions a week for four weeks, along with at-home therapy and ongoing exercises after treatment. Find a provider at www.lsvtglobal.com or 888-438-5788. 

● Expiratory Muscle Training – This is a form of physical therapy that strengthens respiratory muscles, improves cough and swallowing, and reduces the risk of aspiration. 

● Dietary Changes – Adjustments to your diet can help with aspiration. For example, thickening liquids can help people who frequently inhale thin liquids like water or tea. Pureeing solid foods may help people who frequently choke on solids. 

● Concentration – Taking smaller bites and chewing thoroughly can help. Mealtimes should be distraction-free, ie no watching TV, reading the newspaper, etc. Keeping conversation to a minimum during mealtimes is also helpful, so the person with Parkinson’s can focus on eating safely. 

In Conclusion – Speech and swallowing issues may seem simply inconvenient, but addressing them swiftly is crucial to the long-term health and well-being of the person with Parkinson’s. Talk to your doctor about speech therapy and treat it with the same level of importance as you would exercise and physical therapy.