Speech problem or difficulty in speaking (dysarthria) is one of the most common symptoms that develop in a patient with Parkinson’s disease besides the major symptoms such as tremor, rigidity, slowness of movement and loss of postural reflexes. It is estimated that about 60 to 90 percent of patients with Parkinson’s disease have difficulty with their speech, which may take various forms such as a soft, monotonous, or slurred speech, speaking too fast or repeating words, or sometimes hesitating before speaking. Problems with speech can be due to reduced movement of the muscles involved in breathing, talking and voice intonation as a result of Parkinson’s disease.
Types of Speech Problem in Parkinson’s Disease
- Reduced volume of speech which is usually the first change that takes place related to problems with speech. The person tends to speak too softly although he may feel that he is speaking in a normal tone of voice.
- Fading of voice where the initial speech starts in a strong voice but tends to fade as the person keeps on talking.
- Monotonous speech is when the person speaks in a flat voice, with no variation in tone or expression.
- Fast rate of speaking where speech is too fast, with words and sentences running into each other without a break, giving a rushed quality to the speech.
- Hesitation in speaking is when the person has problem in initiating speech, often due to difficulty in word finding.
- Slurred speech where the speech is unclear, with endings being trailed off or omitted.
- Voice quality may become hoarse or tremulous, or there may be indistinct articulation of words.
- Muffling of voice may be increased due to drooling.
- Repetition where there may be uncontrolled repetition of words or phrases while speaking.
Treatment of Speech Problem in Parkinson’s Disease
- Medication. Treatment with levodopa or levodopa-carbidopa combination to replenish dopamine concentration in the brain do improve symptoms related to voice quality, articulation, and variation in pitch.
- Speech therapy. Dysarthria is improved with traditional speech therapy, and intensive programmes significantly improve volume of speech.
- Besides communication with speech, non-verbal communication is also an important factor. The typical mask-like face of Parkinson’s disease may make expression of feelings difficult for the patient. A speech therapist, if consulted early on in the disease, can help with facial and voice exercises.
- Surgical procedures. Unilateral surgical procedures may improve dysarthria but bilateral procedures often lead to worsening of symptoms.
- Deep brain stimulation. Stimulation of subthalamic nucleus help by improving certain types of speech problem, but decrease of intelligibility may be a side effect of surgery.
- Collagen injection into vocal cords.
- Devices to help with speech like :
- Palatal lift apparatus – to lift the soft palate and prevent air from escaping during speech.
- Personal amplifier – to increase volume of voice.
- TTY telephone relay system – a telephone with a keyboard, where speech can be typed and read out by a relay operator.
- Low technology devises – such as notebooks and language devices.
- High technological communication devices and speech enhancers – computers with voice synthesizers and communication devices.