Communication
Parkinson's disease is a progressive neurological disorder which may affect all aspects of communication, both verbal and non-verbal. Up to 90% of people with Parkinson’s will experience communications difficulties at some time. These aspects of the condition were first described by Dr James Parkinson in 1817.
Communication involves using gestures facial expression, voice and writing in words and sentences. In Parkinson’s the performance of well learned movement sequences needed for effective communication can be affected.
One or more of the following may occur.
Common Changes in Non-verbal Communication
- Body language changes
- Mask-like face and reduced blink rate
- Handwriting changes
Common Changes in Verbal Communication
- Voice changes (most common)
- Quiet voice
- Husky voice
- Monotone
- Articulation changes (slurred speech)
- Altered speech rate
- Language changes
Non Verbal Communications
Mask-like Face and Reduced Blink Rate
A reduced eye blink and mask-like face can result in people with Parkinson’s appearing to stare at the communicative partner. A non-animated face does not necessarily mean a lack of emotion. Exaggerating facial expression or using words to express emotion is helpful.
Body Language Changes
There may be fewer, slower communicative gestures being used or sometimes dyskinesia (involuntary movements) occurring. Sitting up straight and looking at your listener will help to overcome some problems.
Handwriting Changes (Micrographia)
Writing often becomes increasingly small (Micrographia). This can result in sometimes to illegibility. An Occupational Therapist can provide strategies to overcome this.
Verbal Communications
Voice Changes
Quiet Voice (Microphonia)
Many people with Parkinson’s develop quiet voices and in order to achieve a normal volume they may feel they are talking too loudly.
Husky Voice
This is due to changes in muscle activation of the vocal chords. The voice can become husky, breathy or strained. Learning a better voice technique can help.
Monotone
There is a tendency for the voice to lose pitch variation. Paying attention to emphasising key words and varying your intonation enhances meaning and adds to speech intelligibility.
Articulations Changes (Slurred Speech)
This is sometimes referred to as Dysarthria and often includes mumbled speech. Using a louder voice will help reduce this.
Altered Speech Rate
Speech can become too slow or too fast. Festination is the term used to describe speech that is too fast, sometimes resulting in stuttering.
Language Changes
Many people with Parkinson’s experience a slowness in thought patterns (bradyphrenia) and may have difficulty initiating speech, a slowness in expressing ideas and difficulty finding the correct words. This can lead to problems in joining in or maintaining conversations. Try to focus on the topic and use short concise phrases.
Lee Silverman Treatment (LSVT)
LSVT is an extensively researched intensive voice treatment program developed to improve the speech and voice in Parkinson’s. The goal is to improve functional intelligible oral communication by increasing vocal loudness. There is also evidence to demonstrate improvements in speech articulation, swallowing, neural function and facial expression. Following LSVT, improvements are maintained for up to two years.
Individual and Group Therapy
Speech pathology can also provide help with fluency and language difficulties. It is offered in individual and group settings and is available in both the public and private sectors. Early introduction of therapy may delay speech impairment.
Aids and Equipment
Speaking effectively can become too much of an effort at times. A range of alternative communication devices, including voice amplifiers and litewriters are available. Assessment for and training by a speech pathologist in the use of equipment is essential.
Often people with Parkinson’s will not initially be aware of their communication changes. It can be the reactions and responses of the communication partners which may indicate difficulties. A review by a speech pathologist is recommended before major problems develop. This requires a referral for a General Practitioner. Communication problems are commonly the root cause of personal relationship difficulties and a referral to a psychologist can be invaluable.
Good Communication Tips
- Face your communication partner
- Reduce background noise
- Be patient
- Be concise
- Focus on speaking loudly.