Over 20 years ago I began offering the LSVT® (Lee Silverman Voice treatment) program for persons with Parkinson’s disease (PD), and a few years ago Speak OUT! ® an alternate approach to improving speech clarity for persons with Parkinson’s and related diagnosis.

For much of that time I have heard similar comments from patients. So much so, it led me to create a top 10 list of things people say while on their way to a better voice.

Number 10: “people will think I’m shouting”

The diagram above was proposed by the LSVT® researchers many years ago as a way of demonstrating to individuals with Parkinson’s that the effort required to shift speech back into a normal range of loudness may feel like shouting or speaking loud. Because Parkinson’s is such an insidious disease the decline in voice and speech production is often gradual, leaving the speaker with a mis-perception about the loudness and/or clarity of their speech. It’s one of the many “tricks” Parkinson’s plays on you. Because Parkinson’s affects the automaticity of movements (i.e. the way you moved and spoke all of your life without having to think about it), now, you must give your conscious attention to speaking, applying the techniques you learn in speech therapy to everyday conversation.

Number 9: “people will think I’m yelling at them”

Men sometimes need help distinguishing between speaking loud and speaking with an authoritative tone. Being loud enough to have a conversation should never leave your listener feeling as if you are yelling at them. In SPEAK OUT! therapy,  patients learn to “speak with intent.” A therapist will teach them to “speak as if you were speaking across a parking lot, a ball field, your backyard, the other room.” I think you get the idea. What if every time you spoke, you used “intent” and powered up as if you were speaking to someone in the other room?

Number 8: “I’ve never been loud”

Many people I have met over the years describe themselves as being “quiet,” “soft-spoken,”or “always having a soft voice.” Consequently, the cue to “be loud,” may feel uncomfortable to them. I try to provide re-assurance that the loudness they seek will place their voice back into the normal range of loudness, even though it will feel unusual to them at first, and that the loudness goal of therapy for strengthening may not be the same effort required for everyday speaking.

Focusing on “intent” which is the strategy of the Speak OUT!  protocol may be a more acceptable approach for some individuals who resist the “loud” cue. Participation in a Voice Aerobics® class, where voice practice is coupled with movement may also feel more natural to some people. Try it yourself: “punch it out with a hey, hee, hi, ho”

Number 7 “I don’t talk that much”

This may be a comment from a patient who lives alone, or in an ALF. A challenge for them and me, as their therapist, will be to create opportunities for talking throughout the day and outside of therapy. No one can expect that therapy alone will create a new voice habit. Even when attending therapy 3-4 times/week. Opportunities to use your voice outside of therapy must be created, and community-based classes such as The LOUD Crowd® can provide the social interaction and peer support that helps you maintain the gains attained in therapy. Taking your Hi-VOLT® voice-on-light bracelet to physical therapy and incorporating it into your BIG exercises may provide the voice strengthening you need to sustain your volume in every day conversation. 

Number 6 “I’ll bother the neighbors”

Probably your neighbors will be happy to hear your progress and understand you during conversation. Depending on your living situation, the neighbors may hear you practicing. I have had patients who lived on boats, condominiums, RV’s, and homes, and they all have managed to perform their daily voice exercises without receiving a noise ordinance from the condo association. Remember your ultimate goal is to strengthen your voice and speak loud enough to be heard in everyday conversation. Listeners don’t want to work too hard to understand speech, so improvements as the result of your daily practicing will be welcomed by most people you interact with.

Number 5 “my husband/wife doesn’t hear well”

This has got to be the most common report I hear from patients at the time of our initial meeting. Now, I am not the one to judge the hearing acuity of their spouse, and if their partner is in their 70’s or 80’s, they very well may have some age related hearing loss. However, the good news is that if your partner does not hear well, and suddenly they are able to hear you-well, there’s your proof-you must be talking louder. If you ARE the spouse with poor hearing, please wear your hearing aids. It takes two to be a successful communicator, and it’s unfair to your partner with PD to expect them to work hard to attain a speech goal, while you resist or refuse to manage your hearing loss.

Number 4 “it feels weird”

I already mentioned that Parkinson’s is a sneaky disease,  that creates changes in speech and voice in an insidious way, and because of this, many people aren’t aware of the ways their voice or speech has changed, and they often don’t accurately judge the appropriate level of loudness. Parkinson’s has led you to believe that your soft or mumbled voice is actually normal, and anything else feels “weird.” Remember, we want to create a new “normal.” Creating new habits doesn’t happen quickly, but with practice and persistence it’s possible to create a new voice habit.

Number 3 “people say I sound better”

This is a great comment. Even if you don’t fully recognize it yet, you are beginning to get feedback from listeners that will help you feel what it takes to have a healthier and better sounding voice. In over 25 years, I have never had a patient come back to me and report that people told them they were speaking too loud. Quite the opposite. Patients often report unsolicited feedback they received from friends or family members telling them that they sound “great.” People will unlikely comment on volume, instead, they will notice the energy in your voice, wondering what you are doing different to sound so good.

Number 2 “I can’t remember to be loud”

Depending on the approach to treatment that you undertake, the goal may be to internalize the cue to “be loud” and “stay loud.” Or you may have been trained to “speak with intent,” speaking consciously and with focus in an attempt to bypass the faulty basal ganglia.

But, for some people, memory loss or other cognitive impairments may make it difficult to internalize a cue  and self-monitor speech outside of therapy or when involved in a conversation.  Concurrent feedback using the Hi-VOLT® 4 PD CD and  voice-activated light with a simple cue: “speak loud enough to activate the light,” can often provide the re-enforcement patients need to practice successfully on their own and attain the target loudness goal that has been set in treatment. 

Additionally, several programmable device interventions, such as the SpeechVive are now available. The SpeechVive is a programmable device that fits over the user’s ear much like a small Bluetooth, and the device acts upon the Lombard reflex, triggering the patient to speak louder without requiring any conscious effort. A device intervention can help normalize speech and reduce cognitive load, thereby   enabling patients to participate more fully in social interactions. BUT, even when using a SpeechVive, I remind patients that they still must engage in at least 30 minutes of daily voice use (speaking on the phone, reading aloud, etc) in order to attain maximum long-term benefit.

Number 1 “this doesn’t feel normal”

No question, this is the most common comment I hear from Parkinson’s patients while undergoing speech therapy. I respond by reminding them: “normal is what you walked into my office with, and we want something better, a new normal.” Most of us know that it takes 30 days to establish a new habit, but for many it may take closer to 90 days to solidify a new voice habit. If available, participation in a weekly class like The LOUD Crowd, Voice Aerobics®, or other community-based program may create the opportunity you need to practice and maintain Your Great Voice!

Visit my  website to request an evaluation, learn more about products and programs, including a community-based class here in SW FLorida.

My MissionTo enlist individuals in their treatment, and help them express their personality & spirit through voice. To educate  and empower. Mary Spremulli, MA, CCC-SLP                          FiTOUR® Group Exercise Instructor * Voice Aerobics® A Whole Body Approach to Voice Practice

Voice Aerobics the heART and Science of Voice Practice