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Speech and Hearing in Parkinson's

Communication is a fundamental part of our lives that allows us to convey emotions, socialize, work, and fulfill our basic needs. Unfortunately, speech and communication difficulties are among the most common non-motor symptoms experienced by people with Parkinson’s disease, affecting up to 89% of individuals with the condition (Speech Therapy and PD, n.d.). Studies have also found that people with Parkinson’s (PwP) are more likely to have hearing loss compared to those without PD. Early in the disease, individuals may have trouble projecting their voice, and as the disease progresses, communication challenges become more pronounced. Speech and hearing difficulties associated with PD include frozen jaw, tongue, and lips, slurred speech, soft voice, monotone speech, and impaired articulation. Moreover, PD motor symptoms, such as decreased facial expression, slowness, and stooped posture, can exacerbate communication difficulties by conveying incorrect nonverbal cues. Cognitive problems, including finding the right words or having slower thought processes, may also compound communication challenges (Speech & Swallowing Problems, n.d.). These symptoms can cause individuals with PD to avoid social interactions and become less confident in conversations, negatively impacting quality of life (Treating Speech Disorders in Patients with Parkinson’s Disease, n.d.). It is important to note, however, that not all people with PD develop these symptoms, as everyone is unique.

 

Causes of Speech and Hearing Issues

Communication difficulties in PD are described as hypokinetic dysarthria, which refers to impaired speech production due to disturbances in muscular control of the voice and speech mechanism. The impacted motor system of people with Parkinson’s disease is one of the primary reasons for changes in speech and hearing. Muscle activation problems cause slow movement (bradykinesia) and small movements (hypokinesia) in the limbs, which also affect speech muscles, leading to reduced breath support, vocal loudness, and clarity of speech. Sensory processing changes related to speech also cause voice impairment in PD, making it difficult for individuals to realize their speech is becoming softer and less clear (Speech & Swallowing Problems, n.d.).

Hearing problems in PD are not directly caused by the disease but are associated with aging. Poor hearing seriously interferes with communication, and when compounded with the difficulties PwP have with their speaking, can significantly diminish the quality of communication interaction. Noise, certain medications, and age can contribute to permanent hearing loss. Most types of hearing loss can be treated effectively with hearing aids. If you suspect a hearing loss or are the spouse or caregiver of a PwP, it is essential to seek professional consultation with an audiologist, who specializes in hearing evaluation and treatment.

 

Communication Evaluation

The Radboud Oral Motor Inventory for Parkinson’s Disease (ROMP) is a self-assessment tool to evaluate perceived problems with speech, swallowing, and saliva control in individuals with PD or atypical Parkinsonism. This can be used to identify initial concerns or monitor any changes. Pay attention to signs of communications problems, such as the following:

  • Difficulty participating in conversation
  • Frequent need for repetition
  • Increased frustration with communication
  • Decreased desire to participate in social activities
  • Decreased effectiveness in the workplace
  • Decreased desire to answer the phone
  • Decreased ability to express wants and needs

Share your results with your physician and healthcare team to help facilitate the appropriate support. We recommend completing the ROMP every six months to a year or whenever you think there has been a change in your drooling, communication, or swallowing. It is a good idea to keep copies of previously completed ROMPs for comparison.

 

Speech Therapy

For individuals with PD, effective communication plays a crucial role in enhancing their quality of life and boosting their self-image and self-assurance. Various treatments are available to manage speech and hearing difficulties in PD, including medication and deep brain stimulation, but speech therapy has been shown to be the most effective. Speech therapy involves working with a speech-language pathologist (SLP) to improve your voice volume, articulation, and intonation. If you are experiencing any changes in your speech or voice, contact your primary healthcare provider, who can help find a SLP in your local area. You can ask for a referral and a prescription for a speech evaluation and treatment (Speech Therapy and PD, n.d.).

It is recommended to start working on your speech and voice early, even if changes have been minimal, as early intervention can be preventative. SLPs trained in working with Parkinson's patients, such as those who use the Lee Silverman Voice Treatment or Parkinson Voice Project SPEAK OUT! can provide specialized care, including memory-building exercises for cognitive issues. They can also teach techniques to conserve energy, use non-verbal communication skills, and introduce assistive devices and techniques to improve communication. Their recommended exercises can also help improve muscle strength and movements needed to enhance speech and communication (Ramig et al., 2008).

 

Tips to Improve Communication

Apart from speech therapy, individuals with PD who struggle with speech and hearing difficulties can utilize tips and tricks regularly to ease their interactions with others (Tjaden, 2008). Here are some that can help improve communication:

  • Exaggerate. Speak slower and louder than you think to get your message across. • Choose a quiet, low-noise space if possible. Turn off televisions, radios, and other devices that create noise when more attention is required.
  • Ensure face-to-face conversations where the listener can clearly see you. This increases the ability to be understood.
  • Plan periods of vocal rest before planned conversations or phone calls. Remember that fatigue significantly impacts the ability to speak. • Choose the best time to communicate. “On” periods (when medication is working optimally) can be a better time to have a conversation.
  • Stay hydrated. Avoid beverages containing caffeine or alcohol, which can dry out your throat.
  • Keep an upright posture, straight chin, and slightly lifted neck to improve airflow from lungs to vocal cords.
  • If you can write without difficulty, always carry a paper and pen as a backup to write down what you are trying to say.
  • Tap into other ways to communicate like gesturing, changing tone, and using engagement cues. Use gestures for commonly recognized words while saying the word. For example, palm facing forward for stop.
  • Participate in voice activities such as singing, acting, and reading aloud.
  • Consider joining group speech therapy, which can be beneficial in improving communication skills. (Contact PSBC for a list of BC providers.)

By incorporating these tips into daily life, PwP can improve communication abilities and maintain quality of life (Improving Communication in Patients with Parkinson’s Disease, 2020).

 

Tips for the Listener

Difficulties in communication can be a frustrating experience for both the person with PD and their family, friends, and carepartners/caregivers. Be mindful that communication is a partnership and both parties carry the responsibility to make the interaction successful (FriedOken et al., 2015). To stay closely connected and ease speaking and communication difficulties, here are some tips for carepartners, friends, and family of PwP to learn new and different ways to communicate:

  • Focus your attention. Make eye contact, pay attention to body language, and encourage the person with PD to speak loudly. Slow your pace. You may be a person who naturally speaks very quickly. If this is the case, you may need to slow down to the point where you are closer to the pace of the person with PD. This will help the person feel more comfortable and reduce the need to respond quickly.
  • Do not speak to a person who has difficulty hearing from another room. Make sure you have their attention first.
  • Be positive and reassuring and give ample time for the person to respond. Take a deep breath and keep listening!
  • Be kind and forgiving. Avoid over-correcting errors made by the person and completing their sentences.
  • Repeat the message in other words, if needed. If the person with hearing impairment does not appear to understand what is being said, rephrase the statement rather than simply repeating the misunderstood words.
  • If you are a caregiver/carepartner, make a plan to equip the person with PD to be able to communicate in the case of an emergency. For example, use a baby monitor to alert others, use ‘codes’ that signify urgency, or preprogram a cellphone with the necessary emergency number(s).

Communication difficulties stemming from impaired speech and hearing can significantly affect the quality of life for those with Parkinson's disease. However, speech therapy and other programs have been proven effective in improving these symptoms. To facilitate effective communication and enhance the quality of life, individuals can benefit from implementing the tips mentioned and, most importantly, approaching communication with respect and patience.

 

Sources

Fried-Oken, M., Mooney, A., & Peters, B. (2015). Supporting communication for patients with neurodegenerative disease. NeuroRehabilitation, 37(1), 69–87. https://doi.org/10.3233/NRE-151241

Improving Communication in Patients with Parkinson’s Disease. (2020, August 21). Cleveland Clinic. https://my.clevelandclinic.org/health/diseases/9392-speech-therapy-forparkinsons-disease

Ramig, L. O., Fox, C., Sapir, S., & Rev, E. (2008). Parkinson treatment. Neurotherapeutics, 8(82), 299–311. https://doi.org/10.1586/14737175.8.2.299

Speech & Swallowing Problems. (n.d.). The Michael J. Fox Foundation for Parkinson’s Research | Parkinson’s Disease; The Michael J. Fox Foundation. https://www.michaeljfox.org/news/speech-swallowing-problems

Speech Therapy and PD. (n.d.). www.parkinson.org; Parkinson’s Foundation. https://www.parkinson.org/library/fact-sheets/speech-therapy

Tjaden, K. (2008). Speech and Swallowing in Parkinson's Disease. Topics in Geriatric Rehabilitation, 24(2), 115–126. https://doi.org/10.1097/01.tgr.0000318899.87690.44

Treating speech disorders in patients with Parkinson’s disease using altered auditory feedback (n.d.). www.michaeljfox.org. Retrieved April 20, 2023, from https://www.michaeljfox.org/grant/treating-speech-disorders-patients-parkinsons-disease-using-altered-auditory-feedback

 

This content was published in the May 2023 edition of our monthly support group newsletter, GroupLink. The content was accurate as of this publication date.

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