Parkinson’s disease: common voice and speech problems and what can be done about them

Parkinson’s disease is a progressive and incurable neurological condition affecting 1 in 350 Australians, including 12,000 people of working age.  By 2031, it is estimated that more than 115,000 Australians will live with the condition.  In 2011, the direct financial costs of Parkinson’s disease were estimated to be $775 million, with the total economic burden of the disease estimated at $8.3 billion.

Around 65% of people with Parkinson’s disease encounter voice problems.  However, only 3-4% receive treatment from a speech pathologist, despite clinical evidence that the right kinds of therapies can help with voice problems.

Common problems include:

  • reduced loudness;
  • monotone voice;
  • vocal tremor; and/or
  • hoarseness, or a breathy quality of voice.

Alone or in combination, these problems can be debilitating.  Reduced volume is often the most serious voice issue because of its debilitating social effects.

No single cause accounts for Parkinson’s voice issues.  General motor symptoms of the disease – muscle rigidity, slow movement, tremor and instability – may affect the lungs, larynx, tongue and jaw.  Many people with Parkinson’s disease also lose their ability to self-monitor or calibrate the volume of their own speech – they may feel like they’re shouting when, in fact, they can barely be heard.

Voice therapy that works – the Lee Silverman Voice Treatment (LSVT LOUD™)

Developed specifically for people who have Parkinson’s disease, LSVT LOUD™ is an evidence-based program proven to improve voice and speech.  LSVT LOUD™ is based on five concepts:

(1) a focus on vocal volume;

(2) improving perception of effort (or calibration);

(3) a high effort style (‘use it or lose it’);

(4) intensity; and

(5) measuring changes objectively.

High quality clinical trials have demonstrated that:

  • the treatment works, with gains maintained two years after treatment; and
  • targeting vocal loudness can trigger a range of other improvements, including in the co-ordination of speech, vocal fold closure and even swallowing. 

How is LSVT LOUD™ delivered?   

LSVT LOUD™ is a 16-session, intensive and direct treatment delivered face-to-face by a speech pathologist to an individual over four weeks.  The program is very intense – with four sessions a week and daily homework for 30 days.  It’s designed to re-calibrate the client’s perception of loudness so he or she can be heard and understood in the real world.

In conjunction with clients and their families, speech pathologists can work collaboratively with other professionals –  including GPs, neurologists, psychologists, specialist nurses, occupational therapists, social workers and dieticians – to deliver holistic care. This multidisciplinary approach can be particularly effective for clients recently diagnosed with the disease.

Voice therapy improves lives

Voice disorders can devastate people with the disease and their families.  People may be forced into early retirement, and to give up on other activities they enjoy.  Some people understandably become depressed and isolated.  The inability to understand a loved one can put enormous pressure on families and caregivers.

Voice therapies like LSVT LOUD™ can improve social and family relationships by helping patients to speak more loudly.  The treatment may enable people with Parkinson’s to stay in the workforce and to participate actively in other social activities.

Lots more information about LSVT LOUD™ can be found here.

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Man with glasses standing in front of a bookcase

Hi there, I’m David Kinnane.

Principal Speech Pathologist, Banter Speech & Language

Our talented team of certified practising speech pathologists provide unhurried, personalised and evidence-based speech pathology care to children and adults in the Inner West of Sydney and beyond, both in our clinic and via telehealth.