Speech and communication issues
People with Parkinson's may find that they have problems with different kinds of speech and communication, including facial expressions, writing and finding the right words to express their views.
Speech problems and Parkinson's
If you have Parkinson's, you may find you have some problems with your speech.
For example, your speech may be slurred, your voice hoarse, unsteady, or quieter than it used to be. You may find it hard to control how quickly you speak or you may find it difficult to start talking.
People with Parkinson's may find their voice sounds monotonous. These problems can make everyday activities difficult, such as talking to friends or using the phone.
Taking your turn to speak, following fast-changing topics or interrupting conversations may be hard.
You may find it difficult getting your thoughts together quickly enough to follow a fast conversation, so you end up just giving minimal responses. Taking the lead in conversations may also be challenging.
Speech and language therapy
Speech and language therapists are healthcare professionals who can help with all aspects of communication, from facial expression and body language to speech and communication aids.
Guidelines on Parkinson's for the NHS in England, Scotland and Wales recommend that speech and language therapy should be available to everyone living with Parkinson's.
We recommend you try to see a speech and language therapist as early as you can after you've been diagnosed.
Even if you aren't experiencing any specific problems, a speech and language therapist can give you some useful information about possible problems that may arise, how to spot them and what can be done about them before they have any negative effects.
The speech and language therapist may also spot any subtle changes that you may not be aware of. This will help you manage the problem before it becomes difficult.
You may find it helpful to have regular check-ups. This allows the speech and language therapist to monitor whether there are any changes with your speech or getting your message across. If there are, they can recommend specific exercises or programmes to help you.
In most areas, you will be able to get in touch with a speech and language therapist through the speech and language therapy department at your local hospital, local community health services, social services or social work department.
Referrals can also be made through your GP, specialist or Parkinson's nurse.
Other things that can help speech and Parkinson's
For some people with Parkinson's their medication, such as levodopa, may help improve the volume and clarity of their speech.
However, there is a potential side effect of levodopa and some other Parkinson's medication, known as the 'on/off' syndrome.
'On' means your drugs are working and symptoms are well controlled and 'off' is when there is no response to medication and your symptoms become much more of a problem.
As well as affecting your movement, the 'on/off' syndrome can affect your speech and body language.
For instance, your voice may be louder and easier to understand when you're 'on' but be quiet and difficult to understand when you're 'off'. This can be frustrating, but there are ways to adjust your life around 'on/off' periods.
For many people, medication has no effect on everyday speech, so it's important to get advice from a speech and language therapist on other ways of making your speech clearer.
A physiotherapist will use physical treatments, including exercise, to help manage any stiffness in your joints and restore the strength in your muscles.
This may help improve your ability to move and make it easier to control your body language.
Parkinson's alert card
This is a small plastic card you can carry with you to tell people you have Parkinson's. It's useful in case of emergencies, or when you're having problems with movement or communication.
You can order a Parkinson's alert card directly from us.
Computers and the internet
Sometimes, instead of speaking, you may find it easier to use other methods of communication.
For example, using the internet and email can be a useful way to stay in touch.
There are computer programmes that record your voice and type what you speak. They allow you to send a typed conversation by email or the internet.
However, it may take a while for the programme to 'learn' your accent and it may not work so well if your voice has become very quiet or your speech is unclear.
An occupational therapist can advise you on ways to customise your computer so it's easier for you to use.
Tips to help your speech
You can try to train your voice by following a few simple rules. This can take a bit of work at first, but practice will help.
- Difficulty when speaking can be frustrating. Make sure you're sitting or standing easily and comfortably. Stay relaxed so you can put effort into your speech.
- Try to imagine you're speaking (not shouting) in a big room and you're speaking to people right at the back. This will help you to speak clearly and loudly. Many people with Parkinson's don't realise they are speaking quietly. So if you think you're talking at the very top of your voice, you're probably speaking at the right volume.
- Try to make each word as clear as possible, and speak slowly.
- You may find it useful to practise saying things in a simpler way. For example, try to keep sentences short so you don't get out of breath. Make sure you stress key words.
- Don't feel embarrassed about your speech. It's important to keep speaking and stay sociable. People will still value your views. Hobbies such as singing might help as they are fun, provide social contact and general exercise for your voice and breathing muscles.
TIPS FOR FAMILY AND FRIENDS
Difficulties with communication can be upsetting and frustrating for the person with Parkinson's and for those around them. But there are some basic things family and friends can do, to make life a little bit easier.
These tips may not work for everyone, so it's important to consider the best thing to do in your situation:
- Be patient. Give the person affected the opportunity to get into a conversation and time to say their piece. They may need extra time to respond, so try not to interrupt or walk away.
- Give them the opportunity to talk and encourage them to join in the conversation if it's appropriate, but don't put pressure on them to speak.
- Talk normally, as you would with anyone else and don't shout.
- Listen carefully. Their speech may be unclear or their voice may be quiet, but the message is there.
- Make sure they can see and hear you and you can see and hear them.
- Try to avoid speaking above noise, such as a TV or radio. Try not to be too far away, for example, in another room, when talking.
- Be reassuring and help them to relax if you can see they're stressed. For example, they may like it if a family member or friend holds their hand if they're having trouble speaking.
- Vary the tone of your voice and relax. Stress can be heard in your voice.
- If you don't understand what they say, ask them to repeat it louder and slower. If it's just a key word you have missed ask them to repeat that word. Try not to pretend you have understood if you haven't.
- Try not to talk for the person, unless it's absolutely necessary.
- Avoid finishing their sentences.
- Don't accidentally ignore the person affected by asking someone to speak for them.
A speech and language therapist will be able to give you more advice on what you can do to make communication easier.
Facial expressions and body language
We pick up a lot of information from a speaker's facial expression and their general body language and posture.
These may all be affected by Parkinson's. Listeners may misinterpret your mood or your feelings about a topic because of your reduced facial expression or your altered hand gestures and body posture.
They may miss signals you are trying to give to show that you wish to join or stay in a conversation.
For some people with Parkinson's these issues are present all the time. For others, it may be just at certain times in their medication cycle or if they have a poor response to their drugs.
Some therapies for Parkinson's may include working on these aspects of communication – increasing facial expression, using body language to signal you have a point to make in a conversation and making sure your hand and arm gestures match the mood you wish to convey.
You may experience problems with your handwriting. It may have become 'spidery' or difficult to read.
You may also find your writing starts off normally, but becomes smaller and smaller. This is known as micrographia.
It can be caused by tremor, lack of co-ordination, stiffness, a difficulty controlling small movements and difficulty putting enough 'power' into movements.
What can help your writing?
An occupational therapist will be able to give you advice about handwriting and suggest ways of overcoming particular problems.
They can be contacted directly or a referral can be made by your GP, specialist, Parkinson's nurse, local community health services, social services or social work department.
Practical writing tips
Difficulties in writing can be frustrating, but there are some things you can do to make it a bit easier:
- Use pens and pencils with a thick or padded barrel to help you get a better grip.
- If you have a tremor, a weighted cuff may give you more control. The Disabled Living Foundation can advise you on where to get one.
- Use a clipboard or a non-slip mat to stop the paper slipping and write on lined paper.
- It's important to take your time. After writing a line, try to stop and relax.
- If your voice is loud and your speech clear enough, you could try using a dictation machine or tape recorder to record voice messages instead of writing things down. Some mobile phones are also able to record and play back speech.
- If you need to sign a cheque or document, you could ask someone else to fill in the details for you, so you just have to add your signature.
Alternatives to using a signature
Writing your signature on things such as cheques or bill payments can be difficult if you have problems writing, but there are some things you can do or use to tackle the problem.
- Use a credit or debit card template. This is a plastic guide with a hole where the signature should be. They can help make it easier to sign in the right place. Talk to your bank about whether they provide these.
- Changing your signature. Speak to your bank about accepting a simpler signature. For example, you might find it easier to write your first initial and surname, instead of writing your name in full.
- Identification cards. Some banks offer credit cards that can show your photo next to the signature. You might also use a passport or driving licence as proof of identification.
- Rubber stamps. You might find it useful to use a signature stamp. Some banks provide them and you can buy them in most stationery shops. Please note that in Scotland rubber stamp signatures are not always accepted in all banks, so do check before using them.
- Avoid using cheques for payments. Try to use Direct Debit or standing orders to pay regular bills, subscriptions or regular donations. Many utility companies give a discount for payment by Direct Debit, so it may be useful to make enquiries.
- Chip and PIN and contactless cards. Although the main purpose of the Chip and PIN system is to cut credit card fraud, it may also help people who have trouble writing their signatures.
- Telephone or internet banking. Many people manage their finances in this way and it avoids the need for signatures.