Most people link Parkinson’s with a tremor or slower movement.
Fewer know it often affects the voice as well.
The changes tend to creep in slowly. Quite often, a partner or close friend notices them before the person does.
That slow start is part of the problem. When something changes a little at a time, it is easy to put it down to tiredness, age or a noisy room.
In Perth, Perth Speech Therapy sees adults with Parkinson’s at its Subiaco and Alfred Cove clinics, and help with voice and swallowing is closer than many families realise.
This guide covers the signs families tend to notice first, why they happen, and what can help.
The early signs families tend to notice
A quieter voice is one of the most common.
The person feels they are talking at a normal volume, yet others keep asking them to repeat themselves.
Over time, conversations can start to feel like hard work for everyone. Some people talk less at the dinner table or in groups, simply because they are tired of not being heard.
Other changes can include:
- speech that sounds flat or monotone
- words running together or trailing off at the end of a sentence
- a hoarse or breathy voice
- less facial expression while talking
The last one catches many families off guard. A partner may feel they are being met with a blank look, when really the muscles of the face are just moving less than they used to.
Parkinson’s Australia has a helpful overview of the symptoms that have nothing to do with movement, including voice changes.
Why the voice gets quieter
Parkinson’s affects the parts of the brain that control how big our movements are.
Speaking is a movement too. The muscles used for breathing, voice and speech can lose some of their range.
The tricky part is that the brain’s sense of loudness can change as well. A voice that sounds soft to everyone else may feel like shouting to the person using it.
That gap is why it helps to have someone outside the conversation listen in.
It also explains why simply telling someone to “speak up” rarely works for long. They may manage it for a sentence or two, then drift back to the volume that feels normal to them.
Not everyone has the same changes
Parkinson’s looks different from one person to the next, and speech is no exception.
Some people notice voice changes early. Others go years before anything changes.
Medication timing can play a part too. Some people find their voice is stronger at certain times of day and weaker at others.
Keeping a simple note of when speaking feels easier or harder can be useful to bring along to appointments.
Swallowing changes are worth watching
Swallowing relies on many of the same muscles.
Some people start coughing during meals, take longer to finish their food, or feel like food is sticking in their throat.
Others notice drooling, a wet or gurgly voice after eating, or tablets that are harder to get down.
These signs are easy to brush off. They do matter, though, because food or drink going down the wrong way can lead to chest infections.
If you notice any of them, mention them to your GP or neurologist.
When to ask for an assessment
There is no need to wait until speech or swallowing becomes a real struggle.
Many people find it easier to work on their voice while the changes are still mild. It also gives the speech pathologist a starting point to measure against later.
It is worth asking for a referral if:
- family and friends often ask the person to repeat themselves
- the person is avoiding phone calls or social outings
- meals are taking much longer, or there is coughing while eating
- the voice sounds noticeably different from a year ago
The Healthdirect page on Parkinson’s also explains the care team that can be involved, from GPs to allied health.
How speech therapy can help
A speech pathologist looks at voice, speech and swallowing, then works through exercises that suit the person.
Some programs build a louder voice through regular, intensive practice. Others focus on safer swallowing, such as changing food textures or how someone sits to eat.
The first appointment usually involves some talking, reading aloud and simple voice tasks. If swallowing is a concern, the speech pathologist may watch the person eat or drink small amounts.
From there, they will explain what they found and suggest a plan.
Speech Pathology Australia explains what speech pathologists do and how to find one near you.
Many adults are seen in a clinic, though some speech pathologists also offer home visits for people who find travel hard.
Practice matters as much as the sessions
Voice work tends to need regular practice between appointments.
That can feel like a lot to take on, especially alongside everything else that comes with Parkinson’s.
Short, daily practice is usually easier to keep up than one long session a week. Linking it to something already in the routine, like the morning cup of tea, can help it stick.
Family members can help by joining in, without turning into the volume police.
Supporting someone at home
Living with these changes can be frustrating for everyone.
The person with Parkinson’s may feel ignored or talked over. Partners may feel tired of asking “what was that?” for the tenth time that day.
A few small habits can take some of the strain out of it.
Face each other when you talk, so you can see and hear clearly.
Turn off the TV or radio during conversations.
Give the person time to finish without jumping in.
Keep meals unhurried, and sit upright to eat.
In groups, try to make space for them to speak, rather than letting the conversation race ahead.
Looking after the carer too
Partners and family often carry a lot quietly.
Support groups can help, both for the person with Parkinson’s and for those caring for them. Parkinson’s Australia and the state Parkinson’s organisations run groups and information sessions across the country.
Talking to people who understand can make the day-to-day feel a little lighter.
Keep a simple record
If something changes, jot it down.
A short list of what you have noticed makes that first appointment much easier. Note when the voice seems weaker, any coughing at meals, and anything that seems to help.
It also helps you see progress later, which can be easy to miss when you live with someone every day.