Speech and communication problems in Parkinson's
Speech and communication problems are common for people with Parkinson’s.
They can include problems with your voice, body language, making conversations and small handwriting. But with the right help and support there are lots of ways you can improve any symptoms.
Why do people with Parkinson's experience speech and communication problems?
Changes in the brain in people with Parkinson’s mean that your movements become smaller and less forceful than before. This can lead to problems with your speech and communication.
Issues may relate to making sure your voice is loud enough, making your pronunciation clear enough and getting the right tone to your voice.
Problems creating movements that are powerful enough can also affect chewing and safe swallowing. Because of this you may find mealtimes more difficult, with an increased risk of food ‘going down the wrong way’.
Find out more: see our information on eating, swallowing and saliva control.
Other communication issues in people with Parkinson’s are linked to the way you think. Brain changes mean you may not be able to process thoughts as quickly as you need to.
This includes difficulty finding the right words you need or understanding what other people mean straight away. It also includes problems getting your thoughts together quickly enough to respond to someone in the flow of a conversation. In particular, this can happen when you have to do several different things at once (for example, walking and talking).
What speech and communication problems can people with Parkinson’s experience?
Problems with speech and voice
If you experience problems with your speech and voice you may find your speech sounds slurred or unclear, or that you speak more quickly than before. You may also find you have to slow down to make yourself understood. It can also become harder to control how quickly you speak.
Your voice can also change. It may sound:
- unsteady and flat
- breathy, like you are sighing and talking very quietly
- deeper than before
- hoarse, like someone with a sore throat
Problems with the volume of your voice
A quieter voice is more common in people with Parkinson’s. People with Parkinson’s often don’t realise that they are talking more quietly. In some cases, you may think that you are shouting and then speak at a lower volume. If you are unsure if you are speaking at a normal volume talk to your GP, specialist or Parkinson’s nurse. They may be able to refer you to speech and language therapist for support.
You can read more about speech and language therapy further on in this information.
These changes to your speech and voice can make everyday activities, like talking to friends or making phone calls, difficult. In conversations, you may find it hard to:
- take your turn or interrupt naturally to express your opinion
- follow fast-changing topics
- get your thoughts together quickly enough
- take the lead and change the focus
- produce a clear, loud voice
- stress the right words or syllables
- express emotional ideas in your speech
- speak for a long time
- make yourself heard the first time you say something
You may also feel like you have to put more effort into talking and that it’s harder to start talking with confidence.
Problems with facial expressions and body language
Facial expressions, body language and posture are an important part of the way we communicate as they help others to pick up extra information about what we mean. Parkinson’s can make it more difficult for you to make facial expressions, and you might have problems with how you move your body, so friends, family or colleagues might miss signals you’re trying to give. If you also have a quieter voice because of your Parkinson’s, then this could make communicating overall more difficult, so it’s important to get support. A speech and language therapist can help you with any communication issues to make everyday conversation easier.
You can find out more about speech and language therapy in our section below.
Problems with handwriting
People with Parkinson’s may have problems with their handwriting. It may become ‘spidery’ or difficult to read. Some people notice that their writing starts off normally, but becomes smaller over time. This is known as micrographia. There are many things that can cause problems with handwriting. These include:
- lack of co-ordination
- muscle stiffness
- difficulty controlling small movements
- difficulty putting enough power into your movements
How can speech and language therapy help
Speech and language therapists are healthcare professionals who can provide assessment and advice on all aspects of communication, from facial expression and body language to speech and communication aids.
Clinical guidelines recommend that your GP, specialist or Parkinson’s nurse should consider referring you to a speech and language therapist with experience of Parkinson’s when you’re in the early stages of the condition.
This is important because you may not notice changes to your speech and communication if they are subtle. But a speech and language therapist can uncover any issues, help you manage them and stop them becoming worse.
You may find it helpful to have regular check-ups. This will allow your speech and language therapist to monitor whether there are any changes with your speech. If there are, they can recommend specific exercises or programmes to help you.
Another recommendation in the guidelines is that you’re given equipment to help you communicate if you need it (see below).
Other types of therapy that can help
A physiotherapist will use physical treatments, including exercise, to help you manage any stiffness in your joints and restore the strength in your muscles. This may help you improve your movement and make it easier to control your body language. Ask your GP, specialist or Parkinson’s nurse about a referral.
An occupational therapist’s job is to help you carry on with everyday activities you’re finding difficult – including giving you advice to support your handwriting. Ask your GP, specialist or Parkinson’s nurse about a referral.
Can Parkinson’s medication and surgery help improve my speech and communication?
Medication such as levodopa may help improve how loudly and clearly you speak.
But, with long-term use of levodopa, you may also experience wearing off. This is when your drugs wear off before you can take the next dose, causing your symptoms to get worse. As well as affecting your movement, wearing off can affect your speech and body language.
Your voice may be loud and easy to understand when you’re ‘on’ but quiet and difficult to understand when you’re ‘off’.
‘On/off’ periods can be frustrating so speak to your specialist or Parkinson’s nurse if your medication is creating speech and communication problems. They may be able to adjust your dose or suggest a different form of your drug that lessens the effects of wearing off.
Deep brain stimulation
Deep brain stimulation is the main type of surgery used to treat Parkinson’s symptoms. It is usually only considered if Parkinson’s medication is no longer working well to control symptoms. Research suggests that it generally has no effect on speech and that it may have a negative effect in some cases. However, it may improve any motor symptoms (movement issues) that you have. If you are considering deep brain stimulation, talk to your specialist to discuss whether it is right for you.
Our deep brain stimulation information can also help you weigh up the pros and cons of having the procedure and consider what questions to ask your specialist.
practical tips to help your speech
It’s always best to see a specialist, so you can get advice on how to manage your speech problems and what therapy is best. The following tips are strategies that can help promote effective communication:
- Try to relax by making sure you’re sitting or standing comfortably before speaking, with a posture that helps you take in a good breath.
- Every time you speak, imagine you’re speaking (not shouting) in a big room, to people right at the back. This will help you speak clearly and at the right volume. Many people with Parkinson’s don’t realise they’re speaking quietly.
- 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.
Singing as a hobby might help – general exercise for your voice and breathing muscles may help your speech. Many people with Parkinson’s tell us it increases their confidence in their voice, and that it’s sociable and fun. There are singing classes all over the UK for people with Parkinson’s. Some are run by Parkinson’s UK local groups.
- It's important to stay sociable. This will give you opportunities to practise your speech and improve your confidence.
The most effective way to improve your speech in the long term is to see a speech and language therapist. So, ask your specialist to refer you if any issues don’t improve.
Practical tips to help with handwriting
Not being able to write as well as you used to 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 cover to help you get a better grip.
- If you have a tremor, a weighted cuff may give you more control. This is a heavy padded strap that you wear around your wrist. The Disabled Living Foundation can advise you on where to get one. Their details are in the useful contacts section.
- Use a clipboard or a non-slip mat to stop your paper slipping.
- Write on lined paper, so it’s easier to keep your writing straight.
- Take your time to write so it is not as tiring.
- If your voice is loud and clear you could record voice messages instead of writing things down. Try using your mobile phone or a dictation machine.
- 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 like cheques or bill payments can be difficult, but there are some
things you can do or use to get round 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.
- Change 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.
- Use a photo identification card. Some banks offer credit cards that can show your photo instead of a signature. In some cases you can also use a passport or driving licence as proof of identification.
- Use a rubber stamp. 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 accepted in all banks, so check before using them.
- Avoid using cheques for payments. Try to use Direct Debit or standing orders to pay regular bills, subscriptions or donations. Many utility companies give a discount for payment by Direct Debit, so it’s worth asking.
- Use telephone or internet banking. Many people manage their finances in this way and it avoids the need for signatures.
How technology and apps can help with communication
Many people find that using computers, tablets, smartphones, the internet and email can be a useful way to stay in touch with people if other forms of communication become difficult.
- Internet forums are online discussion sites that can be useful. You can talk to other members by posting messages, and discussions are often organised by topic. You can ask other members a question and invite responses, comment on another member’s post, or simply share your experiences on a certain issue. Forums are a great way of meeting people, especially if you don’t go out often or live in a remote area. You can access the Parkinson’s UK online forum at forum.parkinsons.org.uk
- Social media is a good way of staying connected. You can start conversations with others, get updates on news and find out about local or national events. Facebook, Twitter and YouTube are good places to start.
- Voice recognition software helps you use your computer without a mouse or keyboard. It works by speaking into a microphone that then changes your words into text. You can use it to write documents or emails, and also to search the internet or find files.
Newer versions of Windows and Apple computer systems have in-built voice recognition technology, and other software, such as Dragon, is available to buy online. Usually the software needs to be ‘trained’ to recognise your voice and accent, which can take time to get right.
- There are apps for your phone or tablet that can remind you to talk louder and more slowly, for example. Parkinson’s UK has a list of apps and devices which have been tried and test by people with the condition.
Conversation tips for family and friends
Conversation with someone with Parkinson’s can be supported by friends and family. Below we have included some strategies to reduce frustrations and make conversations more successful:
- Make sure you and the person with Parkinson’s can see and hear each other. Facing someone with Parkinson’s can be particularly important to help them communicate clearly and understand you. You don’t need to shout.
- Be patient. Give the person affected the opportunity to get involved in a conversation but don’t pressure them to speak if they don’t want to. They may need extra time to respond, so try not to interrupt or walk away.
- 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.
- If you don’t understand what they say, ask them to repeat it more loudly and slowly. If it’s just a key word you’ve missed ask them to repeat that word.
- Try not to pretend you’ve 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.
Useful contacts for speech and communication issues
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Last updated February 2019. We review all our information within 3 years. If you'd like to find out more about how we put our information together, including references and the sources of evidence we use, please contact us at [email protected].