The individual affected by Parkinson's disease is often not the first one to realize there may be a problem with his or her voice. Here is a common scenario I come across in my practice:
Spouse: “I can't understand him, he speaks too low!"
Client: "She just can't hear!"
I can’t help but giggle at the playful banter between couples that have been married longer than I’ve been alive. But there is an explanation for this seemingly stubborn response to what should be an apparent problem.
WHY CAN’T OTHERS UNDERSTAND ME?
Changes in sensory processing in Parkinson’s disease affects your ability to perceive your own voice how others hear it. My clients are often surprised to listen to themselves on a recording.
“That’s my voice?? I barely hear anything!”
Often the person feels as if they are "shouting" when given prompts to speak at a louder level. Speech therapy incorporates principles of "recalibrating" your perception of your own voice.
Some people have trouble with their ability to articulate words in conversation, as the rate may be too fast, or words may be unclear. Others have difficulty with the quality of their voice, as it may sound hoarse or breathy. Any one or combination of these factors may make it difficult for you to have a conversation without having to repeat yourself, which can often lead to frustration and result in a devastating social impact in your daily life.
HOW DO I KNOW IF I NEED SPEECH THERAPY?
Typical voice and speech symptoms include:
Difficulty projecting your voice
Hoarse or breathy voice
Unclear or "mumbled" speech
Speaking too fast or too slow
Monotone voice
Running out of air when speaking
It is important to start focusing on your voice, speech, and even swallowing early in the disease process. Voice and swallow function can often be preserved with consistent and diligent practice.
DOES VOICE THERAPY ACTUALLY WORK FOR PARKINSON'S?
One question I am often asked is if therapy will “fix” the problem. The answer is yes, and no. Therapy teaches you how to override the impaired “automatic” system and essentially use your “manual” system. We don’t normally think about things like breathing, speaking, eating, swallowing, or walking. These systems usually “run in the background”. However, you can override any of these functions by giving it conscious thought. You can take a deeper breath, chew more thoroughly, or take a longer stride to match that of the person you’re walking with. It’s the same with your voice. You can change the quality, pitch, and loudness by making adjustments that are taught in therapy. Speech therapy can provide you the tools you need to speak with confidence. While it does get easier with daily practice, you will always have to make the effort to be louder and clearer in your speech due to the progressive nature of the disease.
WHAT DOES VOICE THERAPY LOOK LIKE?
Treatment of speech and voice disorders in Parkinson's may include training "intentional" speech to project the voice, deep breathing and breathing coordination exercises, respiratory muscle strength training to increase respiratory drive, articulation and cognitive exercises, and teaching conversational strategies to reduce frustration (like not talking to one another from different rooms). Therapy should be tailored to your individual needs.
Often, voice and speech difficulties are accompanied by difficulties swallowing, so that may be a focus of treatment in conjunction with voice and speech therapy. Some clients only require an initial treatment period and choose to continue completing home exercises on their own, while others really benefit from ongoing maintenance services for consistent feedback and encouragement in maintaining their abilities. Maintenance therapy is covered by Medicare, and extremely important for those who need ongoing extra support as the disease progresses.
If you are in Palm Beach Gardens, Jupiter, North Palm Beach, Juno Beach, Palm Beach, or surrounding areas, we can come to you! CCSS provides mobile speech therapy services in the convenience of your home. We also provide teletherapy to all Florida residents.
Book an appointment today!
Great information I’m definitely sharing with my patients!! Thank you Crystal!