Resources

Voice and Swallowing in Parkinson's disease

 

Voice in Parkinson’s Disease:

• Voice is the sound that is produced at the level of the voice box or larynx.

• Voice dysfunction (dysphonia) is commonly an early sign of the disease in people with Parkinson’s Disease.

• Approximately 70 to 90% of people with Parkinson’s Disease experience notable changes to their voice.

• The speech difficulties in Parkinson’s disease are called “hypokinetic dysarthria”, while the voice difficulties are called “hypophonia”. Symptoms include the following:

  • Notable differences in voice quality (e.g., rough, weak, breathy)

  • Having to frequently repeat yourself due to not being able to produce the correct sounds or low volume

  • Difficulty speaking for long durations of time

  • Difficulty conveying emotion in speech (e.g., excitement, happiness, etc.)

  • Speaking at a variable rate, sometimes slow and other times rapidly

  • Feeling isolated or left out during social conversations in your professional or personal life

• Speech-language pathology services can help target these deficits and improve overall speech intelligibility and voice quality. Treatment options include*:

  • Lee Silverman Voice Treatment (LSVT): An intensive, evidence-based program that targets the improvement of vocal loudness to aid participation in daily communication activities (LSVT Global, n.d.).

  • SPEAK OUT!: An intensive, evidence-based treatment program that helps people with Parkinson’s disease strengthen the muscles necessary for speech and swallowing to supplement intentional communication (Parkinson Voice Project, n.d.).

  • Assistive devices, such as voice amplifiers, can help increase the loudness of your voice. They are portable and often rechargeable.

* We do not endorse any of the following therapeutic or management techniques and do not recommend or endorse any patient undertaking or attempting therapy without the consultation of a licensed and credentialed Speech-Language Pathologist,

 

Swallowing in Parkinson's Disease (PD):

• Swallowing is when food and drinks move from the mouth through the pharynx into the esophagus to reach the stomach. This happens almost automatically and with minimal effort.

• Difficulty with swallowing (dysphagia) is common in people with Parkinson’s disease, even in the early stages of the disease. Difficulty can occur with any type of food or liquid: from water or coffee to bread and cookies.

• Almost all individuals with Parkinson's disease will experience dysphagia at some point.

• In the early stages of Parkinson’s disease, difficulty with swallowing often goes unnoticed. In later stages, some common signs or symptoms include:

  • Coughing during/after meals

  • Throat clearing during/after meals

  • Feeling short of breath during meals

  • Feeling like food is stuck in the chest or throat

  • Taking a very long time to finish meals

  • Feeling full very quickly

  • Drooling

• Frequent chest infections may be a sign of difficulty swallowing.

• Speech-language pathology services can help improve the above-mentioned deficits and improve swallowing. Treatment options include the following*:

  • Respiratory Muscle Strength Training (RMST): Using some type of resistive device, you blow air forcefully out of your mouth. This may help improve lip strength, how strong your breathing muscles are, and improve your ability to cough if things “go down the wrong way” when you swallow.

  • Respiratory-Swallow Coordination (RSC): a skill-based program that may help you coordinate your breathing with your swallowing to keep food or liquid from “going down the wrong way” and coughing it up if it does.

  • Neuromuscular Electrical Stimulation (NMES): A resistive exercise program that helps the muscles you use to swallow move better, faster, and more skillfully. It may help your airway protect itself better.

  • Diet modifications: using consistent practices of modifying the texture and consistency of foods to make them easier to chew and safer to swallow, such as eating softer meats like fish or taking smaller bites.

* We do not endorse any of the following therapeutic or management techniques and do not recommend or endorse any patient undertaking or attempting therapy without the consultation of a licensed and credentialed Speech-Language Pathologist,

 

RESOURCES

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If you are concerned about your voice or swallowing, please contact your neurologist for referral to a speech-language pathologist.

 

Below are resources for more information on Parkinson’s Disease:

• Parkinson’s Foundation on Speech and Swallowing Issues

• American Parkinson Disease Association

• The Michael J. Fox Foundation for Parkinson’s Research on Speech and Swallowing Issues

• LSVT Global on LSVT LOUD

• Parkinson Voice Project on SPEAK-OUT!

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Below are some helpful journal articles:

• Kwon, M., & Lee, J.-H. (2019). Oro-Pharyngeal Dysphagia in Parkinson’s Disease and Related Movement Disorders. Journal of Movement Disorders, 12(3), 152–160. https://doi.org/10.14802/jmd.19048 

• Ma, A., Lau, K.K., & Thyagarajan, D. (2020). Voice changes in Parkinson’s disease: What are they telling us? Journal of Clinical Neuroscience, 72, 1-7. https://doi.org/10.1016/j.jocn.2019.12.029

• Miller, N. (2017). Communication changes in Parkinson’s disease. Practical Neurology, 17(4), 266–274. https://doi.org/10.1136/practneurol-2017-001635

• Sapir, S., Ramig, L. O., & Fox, C. (2008). Speech and swallowing disorders in Parkinson disease. Current Opinion in Otolaryngology and Head and Neck Surgery, 16(3), 205–210. https://doi.org/10.1097/MOO.0b013e3282febd3a

• Suttrup, I., & Warnecke, T. (2016). Dysphagia in Parkinson’s Disease. Dysphagia, 31(1), 24–32. https://doi.org/10.1007/s00455-015-9671-9

• Umemoto, G., & Furuya, H. (2020). Management of Dysphagia in Patients with Parkinson’s Disease and Related Disorders. Internal Medicine, 59(1), 7–14. https://doi.org/10.2169/internalmedicine.2373-18