Ask an Expert: Kylie Brajcich, Registered Speech-Language Pathologist, Explores Communication and Swallowing Challenges in Parkinson’s Disease
Kylie Brajcich, BA, MSc, RSLP is a Registered Speech-Language Pathologist (RSLP) currently working at the University of British Columbia (UBC) Center for Brain Health Movement Disorders Clinic (MDC). She holds a Bachelor of Arts (BA) from Simon Fraser University and a Master of Science (MSc) in Speech-Language Pathology from UBC. As a Certified SPEAK OUT!® Provider, she is trained to deliver evidence-based speech and voice therapy. Kylie is passionate about empowering individuals with Parkinson’s disease (PD) and related movement disorders to live meaningful and connected lives through improved swallowing, speech, voice, and overall communication.
Many people may not know the difference between a speech-language pathologist (SLP) and a speech-language pathology assistant (SLP-A). Could you explain what an SLP and SLP-A do? How does the SLP-A role specifically support people with Parkinson’s disease (PD), and how does it complement the work of the SLP?
SLPs are trained professionals who have completed a two- to three-year master’s degree program in Speech-Language Pathology from an accredited institution. In British Columbia, UBC is currently the only university offering this program, with cohorts based in both Vancouver and Victoria. SLPs are qualified to assess, diagnose, and treat a wide range of communication and swallowing disorders.
An SLP-A may also be called a Communication Health Assistant (CHA) or Rehabilitation Assistant (RA), depending on the workplace setting. SLP-As work under the supervision of a fully licensed SLP. SLPs may delegate certain tasks to an SLP-A with appropriate education, training, and consent. While SLP-As are not authorized to conduct formal assessments or make clinical diagnoses, they can carry out screenings for speech, voice, or swallowing concerns. However, interpretation of screening results remains the responsibility of the supervising SLP. For example, at the UBC Movement Disorders Clinic (MDC), the SLP-A conducts preliminary phone screenings with individuals awaiting their initial assessment. During these calls, the SLP-A administers two standardized questionnaires, one focused on speech and voice, and the other on swallowing, to gather information about the individual's concerns. The responses are documented and shared with me, the supervising SLP, to help inform and guide the upcoming assessment. This process ensures that initial evaluations are more targeted and responsive to each person’s needs.
What kinds of speech and voice changes can happen with Parkinson’s disease? Additionally, how does Parkinson’s affect swallowing?
Parkinson’s disease affects the body’s coordination of movement, primarily due to the progressive loss of dopamine-producing cells. As a result, these movements gradually become smaller and less precise. Individuals with PD often experience muscle slowness (bradykinesia) and stiffness (rigidity), which can impact the muscles involved in speech and swallowing. When the muscles of the face, lips, and tongue are affected, speech articulation may become imprecise, leading to reduced clarity and intelligibility. In addition to articulation changes, the rate of speech may increase, often presenting as rapid bursts or ‘rushes’ of speech that can sound slurred to listeners. One of the most common vocal changes associated with PD is reduced vocal loudness, often resulting in a quiet or soft-spoken voice. Individuals may find themselves frequently asked to repeat what they’ve said, particularly in noisy environments. The coordination of respiratory (breathing) and phonatory (voicing) systems is often compromised in PD, which can lead to difficulties sustaining speech and the need to take multiple breaths to complete an utterance. Prosody, or the natural rhythm and intonation of speech, may also be diminished, resulting in a flat or monotone voice.
Swallowing difficulties, known as dysphagia, may occur for several reasons. When the muscles of the face, lips, and tongue are affected, it can become difficult to control and retain food or liquid in the mouth, as well as to chew effectively. As a result, individuals may notice food or liquid dribbling from the mouth or prematurely spilling to the back of the throat before they are ready to swallow. Certain textures and consistencies of food commonly pose difficulties. Examples of these are tough foods (e.g., beef, chicken), dry and crumbly foods (e.g., crackers, cookies), fibrous and leafy foods (e.g., lettuce, spinach, celery), and thin liquids (e.g., water, juice, tea). With PD, changes in the timing and strength of the swallow, combined with reduced control of the mouth and throat muscles, can significantly increase the risk of penetration (food or liquid enters the airway above the level of the vocal folds) or aspiration (food or liquid enters the airway below the level of the vocal folds). Taking pills with water can also present a unique challenge, and many people with PD report that pills become stuck in the throat. This difficulty stems from the need to simultaneously manage and coordinate the swallow of two very different consistencies (small, solid pills in a thin liquid).
What are some of the less obvious ways Parkinson’s affects communication and swallowing that might surprise people?
As a progressive neurodegenerative condition, PD can lead to changes in cognitive function over time. Individuals may experience difficulties with memory, word-finding, or maintaining their train of thought during conversations, all of which can impact effective communication.
PD also affects saliva management, which can further complicate speech and swallowing. Some individuals may experience drooling, dry mouth (xerostomia), or fluctuations between both. PD does not cause an over-production of saliva, rather there is a reduction in the frequency of swallows, which leads to an accumulation of saliva in the mouth. Drooling can impact speech clarity and contribute to a wet-sounding voice, whereas dry mouth impacts speech and swallowing due to a lack of moisture.
When do you think someone with Parkinson’s should start seeing a speech-language professional?
Get connected with an SLP as early as possible! Even if you don’t need active treatment, being on SLP’s caseload ensures regular monitoring and early support. In the early stages of PD, this might mean check-ins every six to 12 months. However, by being connected to an SLP, you’ll be able to access timely intervention as soon as you notice any changes in your speech, voice, or swallowing, without delay. It’s always better to be proactive when it comes to your communication and swallowing health!
How do you help people with PD take what they learn in therapy and apply it in everyday life, like talking with family or eating at a restaurant?
I strive to make my treatment sessions and therapy materials highly functional and personalized to each individual's daily communication needs. I begin by asking patients to identify the environments or interactions they find most challenging. Together, we brainstorm a set of practical phrases or questions commonly used in those contexts. For example, I’ve supported patients in practicing phrases for ordering meat at their local deli, buying a round of drinks at a pub with friends, and speaking with their pharmacist over the phone.
During their SLP sessions, we practice these phrases with focus on volume, rate, and clarity. The goal is for patients to confidently apply these practiced speech skills when they encounter these real-life situations, making therapy directly relevant to their everyday experiences and improving their ability to handle communication breakdowns more effectively.
How do the goals of speech and swallowing therapy change as Parkinson’s progresses?
In the early stage, the focus is on establishing a baseline and providing preventative education. This typically includes an initial assessment along with screenings and questionnaires related to swallowing, saliva management, and speech/voice function. Based on the findings, individualized recommendations are provided, and patients are educated on what to monitor and what changes may occur as the disease progresses.
In the middle stage, more intensive intervention may be needed. This can include programs like SPEAK OUT!® to improve speech volume, clarity and confidence, or Expiratory Muscle Strength Training (EMST) to strengthen respiratory function for speech, swallowing, and coughing.
If swallowing difficulties arise, a clinical swallow assessment (CSA) may be recommended. In a CSA, an SLP observes the eating and drinking of several consistencies and textures to see if there are any obvious signs and symptoms of difficulty, such as coughing. Depending on the results, swallow imaging may be warranted to get a better look at how the muscles and structures of the swallow are functioning. A Videofluoroscopic Swallow Study (VFSS) is an X-ray exam that takes brief videos of the mouth and throat to see how various foods and liquids mixed with barium are swallowed from a side (lateral) view. You may hear this exam be referred to as a Modified Barium Swallow (MBS) exam as well. The other swallow imaging option, depending on available equipment and trained clinicians, is a Fiberoptic Endoscopic Evaluation of Swallowing (FEES). In a FEES exam, an SLP inserts a small scope with a camera through the nose and down the throat to view how foods and liquids are swallowed from a top-down view. Based on the findings of swallow imaging, a modified diet or specific swallow maneuvers may be recommended to reduce the risk of penetration or aspiration.
The primary focus in the later stages is to maintain quality of life through both communication and safe swallowing. Continued use of modified diets helps ensure safe swallowing, while communication support may shift to augmentative and alternative communication (AAC) methods. This can include tools such as a voice amplifier, alphabet boards, or text-to-speech apps, enabling the individual to continue expressing their needs and engaging with others, even if verbal speech output becomes limited.
How do you involve family and caregivers/carepartners in supporting communication and swallowing?
I always welcome and encourage spouses, carepartners, and family members to attend both assessment and treatment sessions. Their presence is particularly valuable during SPEAK OUT!® therapy, as it allows them to observe how the SLP models exercises, delivers cues, and provides feedback. This shared understanding ensures that the individual with PD will receive supportive cueing during their daily home practice.
In addition to working with the individual with PD, I provide practical communication strategies to their family members and carepartners. For example, rather than responding with a general “What?” when speech is unclear, it is more effective to offer specific feedback, such as “Can you say that again louder/slower?”.
I also guide communication partners in creating a supportive environment to facilitate communication. For example, I recommend reducing background noise (e.g., turning off the TV), reduce the distance between speakers to be face-to-face, and ask ‘yes/no’ or close-ended questions to reduce the communication burden (e.g., “Would you like soup or a sandwich?”) instead of open-ended questions (e.g., “What would you like for lunch?”). These small but meaningful adjustments can greatly enhance communication success and confidence.
What kinds of day-to-day activities can help strengthen communication and swallowing outside of therapy sessions?
Use your voice every day! Daily voice use is essential for maintaining speech strength and clarity. If you enjoy reading newspapers, magazines, or books, try reading a paragraph or a page out loud each day. Also, consider recording yourself speaking or reading out loud and listen to the audio, this is a good way to monitor your own speech and voice! If singing brings you joy, create a playlist of your favourite songs and sing along at home. You can also participate in programs like Parkinson Society BC’s SongShine, which focuses on breathing and vocal exercises through music in a supportive group setting.
If you've been assessed by an SLP and have completed the SPEAK OUT!® program, LSVT LOUD®, and/or the EMST150® protocol, you should continue practice of these programs to maintain the skills gained. You can continue to complete the SPEAK OUT!® and LSVT LOUD® exercises daily and the EMST150® protocol as prescribed by your SLP. Regular practice helps to strengthen the muscles involved in voice, speech, and swallowing, and contributes to improved respiratory support and vocal function over time.
Are there any myths about speech and swallowing, and how they relate to PD, that you would like to clear up?
One common misconception I hear is that people with PD are “lazy” or “unmotivated to speak,” which is thought to be the reason behind quiet or slurred speech. In reality, the underlying cause is neurological, not behavioural. Dopamine, the key neurotransmitter affected in PD, plays a vital role not only in movement coordination, but also in motivation and drive. As dopamine levels decline, individuals with PD may experience reduced motivation and increased apathy. Understanding this distinction is essential. It reinforces why support, encouragement, and tailored intervention are so important in helping individuals with PD maintain their communication and swallowing skills, as well as quality of life.
Additionally, there are three common misconceptions regarding swallowing safety in PD: to thicken all liquids, drink using a straw, and to use a chin tuck when swallowing. These strategies may be helpful for some, but may increase the swallow difficulties in others. Several swallowing exercises and maneuvers should be tried with imaging (VFSS or FEES) first to ensure swallow safety. Before attempting any strategies or making changes, you should first consult your SLP to discuss recommendations that are personalized to you.
This content was published in the Winter 2025 edition of our quarterly magazine, Viewpoints. The content was accurate as of this publication date.