Recently I was working with a client who has Parkinson’s disease (PD) and we began discussing the vocal changes identified during her evaluation. With recognition of the developing symptom and good humor, she confessed she had a growing suspicion that the entire family was experiencing hearing loss. Although she laughed about it at the time, her quiet voice was becoming a true deficit during her daily activities. As an active grandmother, she had after-school responsibilities with the school-aged grandkids and participated in regular phone calls with family across the country. These activities became much more difficult once she could no longer be heard.

A prevalent symptom of PD is change in vocal quality and vocal volume. According to the National Center for Voice and Speech, approximately 75-90% of individuals with PD have speech and voice disorders at some point in the course of their disease. The signature vocal change in PD is a quiet voice, rendering it difficult for others to hear. Some people with PD also experience increased breathiness, harshness, and inability to moderate intonation of the voice.

Another component of vocal change in PD is decreased use of prosody. Prosody can be defined as the rhythm, intonation, and emotion added to convey a message. Various components of language contribute to prosody, but the voice plays a significant role. Often, it is the nuance of a voice that leads listeners to understand sense of humor, sarcasm, fear, and urgency, to name a few examples. When vocal changes are present, the intent of a message can get lost in translation due to lack of intonation, rhythm, and emotion.

Sometimes people with PD have difficulty identifying when their voice has changed and to what degree. Although some people may believe they are experiencing changes in hearing, this phenomenon has more to do with the perception of sound. Many people report they feel as if they are shouting when, in fact, they are using an appropriate volume for conversational speech. If you are unsure if you are experiencing vocal changes as a result of Parkinson’s disease, review these questions:

• Are you frequently asked to repeat yourself?
• Do feel like you run out of air when you speak?
• Is it effortful to speak loud enough for others to understand?
• Can others identify when you are telling a joke or being sarcastic?
• Does it appear like others aren’t aware you are speaking when you are in social settings?

 
If you think you may be experiencing changes in vocal volume or vocal quality, discuss your symptoms with your treating physician. Your movement disorder specialist can discuss your options and make appropriate referrals for further evaluation and treatment of the voice.

All Speech-Language Pathologists (SLPs) are trained and qualified to provide evaluation and treatment of voice disorders. For Parkinson’s-specific programs, there are two protocols of treatment that require additional certification. Lee Silverman Voice Treatment (LSVT) LOUD program was developed for the treatment of voice disorders in Parkinson’s disease. LSVT LOUD® is a highly researched program that is provided by certified SLPs with the sole focus of loudness. The Parkinson Voice Project developed another program called SPEAK OUT!®, designed for people with PD with a focus on speech, voice, and cognition also to be provided by certified SLPs.

Click here to locate SLPs who are certified in LSVT LOUD®.

Click here to locate SLPs who are certified in SPEAK OUT!®.