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).

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.

Making conversation

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:

• tremor
• lack of co-ordination
• muscle stiffness
• difficulty controlling small movements
• difficulty putting enough power into your movements

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).

Physiotherapy

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.

Occupational therapy

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.

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.

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.

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. Read more about apps and devices that can help with the day-to-day management of your symptoms..

• AbilityNet - A charity that can help you adapt and adjust your computer to make it easier to use.
• Disabled Living Foundation - Provides information and advice on aids and equipment such as products to help with handwriting.