Parkinson’s affects speech, swallowing and voice due to the symptoms of stiffness and slowness of movements.

The most common communication problem associated with Parkinson’s is a soft and quiet voice. Changes in voice clarity and quality may lead to communication challenges which then impact the desire to participate socially or professionally.

How Parkinson’s affects speech, voice, & swallowing muscles

Parkinson’s affects your overall movement with body rigidity and bradykinesia (slowness of movements) hallmark symptoms of a diagnosis. However, it is not often considered that this includes movement in your mouth, face and throat affecting voice, speech, and swallowing.

Emerging evidence also suggests voice dysfunction is an early sign of Parkinson’s. However, these changes can happen at any time but tend to increase as Parkinson’s progresses. Symptoms may worsen by stress and fatigue.

Just like traditional exercise helps your body muscles gain strength and movement, your mouth, face, and throat muscles also need exercise.

How do I know if I have a speech or voice problem?

  • People don’t seem to hear me or understand what I’m saying.
  • I don’t like to go to noisy places so my voice issues limit my personal and social life.
  • I feel left out of conversations because of my voice.
  • I don’t like talking on the phone.
  • My voice problem causes me to lose income.
  • I must strain to project my voice.
  • My voice clarity is unpredictable.
  • My voice problem upsets me.
  • People ask, “What’s wrong with your voice?”

Speech problems

Problems arising from Parkinson’s specifically related to speech and voice may include:

  • intonation changes
  • voice volume decreases by as much as 10 decibels i.e. soft and quiet
  • change in sensory processing i.e. your perception of your voice volume changes
  • dysarthria or loss of articulation, i.e. slurring or mumbling and sentences trailing off
  • breathy or hoarse voice
  • tachyphemia, or a stammering or stuttering speech pattern may get hasty, talking rapidly
  • cognitive changes like word-finding may make communication slower
  • loss of facial expression aka masked face may take away certain communication and conversation cues.

DBS & voice

Deep brain stimulation (DBS) surgery can improve motor symptoms in people with Parkinson’s disease (PD), but it can also worsen speech and voice symptoms. Specifically, speech intelligibility can decline after about one year of DBS surgery, even when patients are taking medication and stimulation. This decline can be moderate to severe. However, the impact of DBS on speech can vary, and the deterioration of speech can outweigh the procedure’s motor benefits. The location of the DBS electrodes may be associated with the decline in verbal fluency. 

Tips for voice and speech

  • Stay relaxed when you talk, so that you can put your efforts into speech
  • Keep good posture when you talk
  • Imagine that you are speaking in a big room and try to talk louder (without shouting)
  • Speak slowly and try to make each word as clear as possible
  • Keep sentences short and stress key words
  • Try not to feel embarrassed about your speech, and continue to socialise with family and friends
  • Try singing regularly as it is a great way to exercise your voice and breathing muscles
  • Take a breath before you talk and pause between phrases to take in another breath.
  • Express your ideas in short, concise sentences.
  • Speak louder than you think is necessary.
  • Do not shout over noise.
  • Reduce throat clearing or coughing. Try a hard swallow.
  • Reduce or eliminate heartburn.
  • If the air is dry in your home, use a humidifier.
  • Exercise your voice by reading out loud or singing every day
  • Drink enough water
  • Avoid shouting
  • Rest your voice when tired

Your Care

It is important to get a care team together early. Look to speech therapists as part of your allied health team even before you think you need one and get an early baseline assessment to maintain your quality of life.

Remember:

  • Most speech symptoms can be reduced by exercising your voice.
  • There are apps that can help assess your speech and train your voice.
  • Adjusting your Parkinson’s medications may help with speech and voice issues.
  • Make eye contact
  • Reduce background noise.
  • Socialise in small groups or one-on-one.
  • Practice using physical gestures and feeling words to help convey emotions.
  • Plan social engagements around times when your voice is strongest
  • Use video calls instead of phone calls.

Treatments

Voice exercises

Exercising your vocal muscles can ensure you minimise the loss and impact that Parkinson’s will have on your ability to communicate.

There are many techniques and programs that can strengthen and target the voice and have been shown to provide lasting changes in vocal ability.

These include:

Two evidence-based, Parkinson’s-specific programs led by certified speech-language pathologists are:

  • Lee Silverman Voice Treatment (LSVT)
  • Parkinson Voice Project SPEAK OUT!

These programs will improve:

  • Voice quality and volume
  • Articulation of speech
  • Vocal tones
  • Ability to be understood.

All the above programs can also assist with swallowing difficulties (dysphagia), which is common with Parkinson’s. Related issues may include coughing, choking or throat clearing during or after eating or drinking. Some people even experience a sensation after swallowing that food is getting stuck as it goes down.

See Swallowing and Parkinson’s Information Sheet.

Injections

Vocal fold injections have been used to treat voice quality and loudness in PD. The purpose of these injections is to build up vocal folds that do not close completely while talking. The procedure involves injecting natural or synthetic materials directly into the vocal folds to improve the voice, specifically loudness and quality. The effect typically lasts about three to six months, though sometimes longer. Injections can be repeated.

The research on the effectiveness of vocal fold injections is preliminary and ongoing. An ear, nose, and throat (ENT) specialist performs this procedure and can help you understand if you are a candidate for this treatment.

Assistive technologies

Speech pathologists and OTs can work together to advise on equipment to use and how to use it. If you are experiencing voice problems, there are some strategies or equipment that may help.

Portable personal amplification devices can increase voice volume. Other communication devices, ranging from printable communication boards to computer technology.

Request an evaluation with a speech pathologist to investigate your areas of concern and develop a plan for maximising your communication success.

Key facts

  1. Dysarthria is a common speech disorder among people with Parkinson’s disease, affecting about 70-100% of individuals.
  2. The type of dysarthria most commonly associated with Parkinson’s is hypokinetic dysarthria, characterised by reduced vocal loudness, monotone speech, and imprecise consonants and vowels.
  3. People with dysarthria may experience vocal tremors, speech that is too soft or too loud, monotonous vocal tone, hoarseness, and difficulty articulating words.
  4. Dysarthria can significantly impact communication, making it difficult for individuals to be understood, which can affect social interactions and quality of life.
  5. While there is no cure for dysarthria caused by Parkinson’s, speech therapy and communication strategies can help improve speech intelligibility and quality. Medical and surgical treatments may also be considered.
  6. Early identification and regular monitoring of speech difficulties are crucial for effective management and improving the quality of life for individuals with Parkinson’s.
  7. Managing dysarthria often involves a multidisciplinary care team, including speech pathologists, neurologists, and other healthcare professionals.

References

  • Behrman, A., Cody, J., Elandary, S., Flom, P., & Chitnis, S. (2020). The Effect of SPEAK OUT! and The LOUD Crowd on Dysarthria Due to Parkinson’s Disease. American journal of speech-language pathology, 29(3), 1448–1465. https://doi.org/10.1044/2020_AJSLP-19-00024
  • Skodda S. (2012). Effect of deep brain stimulation on speech performance in Parkinson’s disease. Parkinson’s disease, 2012, 850596. https://doi.org/10.1155/2012/850596
  • Tabari, F., Berger, J. I., Flouty, O., Copeland, B., Greenlee, J. D., & Johari, K. (2024). Speech, voice, and language outcomes following deep brain stimulation: A systematic review. PloS one, 19(5), e0302739. https://doi.org/10.1371/journal.pone.0302739
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