Addressing Speech and Swallowing Challenges in Parkinson’s: Effective Therapies and Techniques

Parkinson’s Disease: An Overview of Symptoms and Effective Speech Therapy Exercises

Parkinson’s disease (PD) is a progressive neurological condition that primarily affects the body’s control of movement.

Due to a disruption to the brain’s production of dopamine, individuals with PD may struggle to execute and coordinate body movement. As a result, many of the body’s motor pathways are interrupted, which can make everyday activities like walking, maintaining balance, speaking, and swallowing more challenging.

PD manifests differently in individuals. The disease impacts the strength and coordination of mouth and throat muscles to varying degrees. As these changes unfold, alterations in voice, speech, and swallowing functions may occur. Research suggests that up to 9 out of 10 individuals with PD will notice changes in their speech and voice over time, while fewer report challenges with swallowing.

While signs of change will understandably cause many to worry, we are here to assure you that many well-researched, evidence-based speech therapy exercises will improve both speech and swallow function for those living with PD. Recognizing and understanding symptoms will ensure you or your loved one obtain the most effective treatment as early as possible. Speech therapy for adults with PD will optimize the strength and function of skills and delay the progression of symptoms.

In this blog, we will review common signs and symptoms of speech and swallowing challenges in PD. Also, we outline effective speech therapy exercises to help you better understand techniques, benefits, and a specialized dysarthria treatment known as LSVT LOUD®. This treatment has been scientifically studied for over 25 years.

Speech and Voice Changes in PD

Difficulties with speech are prevalent and frustrating symptoms of PD. Changes to voice and speech arise due to disruptions in the neural circuits responsible for controlling the subsystems of the motor speech system. These include the muscles involved in breathing, phonating (voicing), resonance, pitch, and articulation. Similar to the slowing down of body movements experienced in PD, the strength and coordination of movements required for speaking also decrease. These types of voice and speech changes are termed dysarthria.

While symptoms of dysarthric speech can vary, it’s common for those with PD to experience hypokinetic dysarthria. This speech disorder is characterized by reduced volume, changes in rate of speech, and decreased vocal expressivity (monotone speech).

Speech-related issues commonly include:

• Quiet Voice: Individuals with PD may note reduced vocal volume. This makes it difficult for others to hear them, especially in noisy environments.
• Speech Rate Changes: Speech rate may become very fast and oral movements very small, negatively impacting intelligibility; in other instances speech may become slow and labored.
• Monotone: The natural melody and intonation of speech may decrease, making it hard to express meaning through vocal tone.
• Difficulty with Articulation and Pronunciation: It may be difficult to coordinate sounds, leading to imprecise articulation which affects overall crispness and clarity.
• Hoarse Vocal Quality: The voice may sound breathy and raspy, making it difficult to hear and comprehend.
• Stutter: Individuals with PD may acquire a stutter.

Changes in speech patterns can make it challenging to engage in social activities. This may be influenced by a mix of physical difficulties and anxiety that affect one’s comfort and confidence in communicating in various social contexts. These communication challenges go beyond the immediate struggle to convey messages; they can result in significant social and emotional consequences causing everyday activities to become more difficult to navigate. Regrettably, individuals with Parkinson’s disease frequently experience higher rates of depression and report a significant decline in their overall quality of life due to the complex nature of these communication challenges.

Swallowing Changes

PD-related neurological changes can sometimes affect the muscles of the mouth and throat giving rise to swallowing difficulties—or as it’s known medically, dysphagia.

Signs of dysphagia in PD commonly include:

• Difficulty Initiating Swallow: Individuals with PD may experience challenges initiating the swallowing reflex. This can lead to delays or hesitations in the swallowing process.
• Prolonged Meals: As PD leads to reduced muscle strength, individuals may require extended time to adequately chew and move food through the mouth to the throat.
• Feeling like Food is Sticking in the Throat: As PD challenges the strength and coordination of muscles, it may require additional “effortful swallowing” to adequately propel food through the throat to the stomach. Hydration should also be monitored.
• Coughing, Choking, or Respiratory Issues: These symptoms may be signs of aspiration. This occurs when food, liquid, or saliva enters the airway instead of the esophagus, which can lead to coughing, choking, or respiratory issues. Aspiration poses a risk of pneumonia.
• Wet Vocal Quality: Aspiration (when food or liquid penetrates the airway) or difficulties effectively clearing food and liquid from the throat to the stomach can leave residue on the vocal folds causing a wet or gurgly vocal quality.
• Weight Loss: Difficulty, fear, or discomfort in eating can lead to a decreased appetite and difficulty maintaining a healthy weight. This may result in unintended weight loss.
• Anxiety, Fear, Apathy, or Disinterest in Food and Meal Time Activities: Meals may be prolonged and arduous due to muscle weakness affecting comfort, ease, and enjoyment of food and meals which may exacerbate or further contribute to experiences of fear and anxiety around eating.

Effective Therapies and Techniques

Voice and Speech Therapy Exercises:

Take proactive steps to address changes in voice and speech by seeking guidance from a licensed speech-language pathologist for dysarthria treatment. They can assist to significantly improve long-term communication outcomes. Acting early in seeking support will help you or your loved one experience gains faster and help maintain strength of skills longer.

Research shows that early dysarthria treatment aimed at strengthening motor-speech skills preserves function and delays the progression of PD related voice and speech symptoms.

When it comes to voice and speech treatment for PD,  LSVT LOUD® stands out globally as the gold standard treatment. Using a series of specific high effort, repetitious, and salient exercises, individuals with PD are taught to recalibrate mismatched perceptions of vocal loudness. Additionally, they also learn to speak at normal, healthy, vocal loudness levels. Research has proven that these speech therapy exercises focusing on increasing amplitude of movement through the singular cue “loud”, have a positive spreading effect across the entire motor-speech system. This effect may lead to improvements in articulation, expressivity, facial expression, and swallowing.

Candidates who complete the 4-week intensive treatment can expect:

• Improved vocal loudness and voice quality so you can be heard and understood
• Improved breath support and control
• Improved intonation and expressivity in speech
• Improved speech clarity and intelligibility
• Greater ease and success communicating in real-world settings
• Greater social connection and participation
• Improved quality of life

All Open Lines® speech-language pathologists are specially trained and certified in this treatment method including in-house supervision from LSVT Global faculty and clinical expert, Dr. Jessica Galgano.

Swallowing

As with speech and voice related changes, taking proactive steps to strengthen swallow function can help you experience relief sooner. Being proactive will help preserve strength of skills for longer periods. Thus, increasing your sense of comfort, confidence, and joy around meals. As eating is a highly social activity, taking proactive steps to maintain swallow health and safety may further fortify important social connections and meaningful participation in community experiences.

Successful dysphagia treatments must consider the neurophysiological aspects of swallowing. Simultaneously, it should consider the relations of stress, motivation, cognition, and socioemotional elements on swallow function and behavior. This includes incorporating personalized mindfulness strategies to heighten awareness of both physical and emotional states throughout the day. Evidence-based speech therapy exercises, alongside dysphagia treatments, can help strengthen various swallow mechanisms, modifications to posture and behavior. Also, compensatory strategies are reviewed to ensure the safety and efficiency of eating and swallowing.

A licensed speech-language pathologist can guide you through an evaluation to determine the precise nature of your swallowing challenges. They can also work with you to devise a holistic and personally relevant treatment plan. Treatment plans can be targeted, evidence-based exercises, techniques, and strategies to support your swallow health and overall quality of life.

Mindfulness Strategies and Speech Therapy Exercises

Mindfulness-based strategies include regular self check ins to consider and monitor:

• How am I feeling on a scale from 1 to 10?
• When did I take my medication?
• Monitoring interaction of certain foods/nutrients with medications
• Do I feel comfortable and supported by the people around me?
• Did I drink enough water today?
• Have I eaten enough good food?
• Did I get enough sleep and rest?

While eating, you might consider:

• Am I sitting upright?
• Do I like what I’m eating? Take in the smells and sensory details!
• How am I putting food on my fork?
• How quickly or slowly am I eating?
• Am I chewing thoroughly?
• Do I have any food left in my mouth after I eat?

Speech therapy exercises to increase the strength and coordination of swallowing muscles may include:

Masako Maneuver, or Tongue-hold Maneuver: This exercise involves holding your tongue between your teeth as you swallow. The exercise should be completed at least 10 times throughout the day, taking breaks between swallows as needed. This exercise serves to strengthen the base of your tongue and improve constriction of the pharynx. It makes it easier to move food or liquid through your mouth and down the back of your throat when swallowing.

Shaker Technique: This exercise is not for people with neck or back pain, arthritis, or other issues. This exercise supports improved hyolaryngeal movement and upper esophageal opening for improved efficiency and safe swallowing. The exercise involves lying face up and lifting the head to look at your toes while keeping your shoulders on the ground. Hold for 60 seconds; Rest briefly and repeat three times.

Some may benefit from exercises to strengthen the cough reflex. This important reflex is the body’s first defense in protecting its airways. Research-founded methods include expiratory muscle strength training (EMST).

Research also demonstrates that LSVT LOUD® therapy which targets speech and voice using big, mindful movements, can also help swallowing.

Open Lines® team of experienced and compassionate clinicians is committed to providing top-tier speech therapy for adults who are navigating PD. Grounded in evidence-based treatments and adopting a holistic approach, we are here to support you or your loved one every step of the way.

If you’re struggling with communication difficulties, it’s time to turn to Open Lines®. Contact us via phone (212-430-6800), email [email protected], or by filling out our convenient contact form. Improve your communication skills and unlock your potential with Open Lines® Speech and Communication in New York today!