The causes and characteristics of speech impairment in individuals with Parkinson’s disease, while common, are complex and variable. Speech production is related to and coordinated by an integrated network of sensory, muscular, respiratory, and cognitive functions, and more and more research is shifting from a singular focus on voice to  include the cognitive-linguistic problems that can arise and impact communication, including slower language processing, difficulty formulating ideas and difficulty retrieving words.

“For the person with Parkinson’s, challenges arise from trying to manage a speech disorder, but what also arises as a problem, is perception by others, and communication difficulties can have a negative influence on relationships, social participation and well-being in individuals with PD.”

In a research publication entitled: Life with communication changes in Parkinson’s Disease,[i]Nicholas Miller a speech-language therapist and researcher from the UK, reported that individuals with PD expressed concern regarding how speech changes affect both their ability to communicate and their self-image. Of main concern to these researchers was not the nature of speech-voice-language changes, but rather, how these affected self-concept, participation inside and outside the family and family dynamics.

While early referral to a speech-language pathologist remains an important goal for improving and preserving communication skills for persons with PD, concerns of the listener are as important as the status of the speaker, and Miller along with others researchers, highlights the importance of  the central involvement of communicative partners in any intervention.

A conclusion drawn by Dr. Millers’ research was “communication that works in the face of inevitable physical decline grows out of the person with PD being in tune with their own strengths, limitations and wishes, coupled with knowledge on the part of the listener of what hurdles speakers face and how best to support them in crossing these.”

Perception of Speech: Same or Different?

At the onset of treatment I typically ask patients to complete a screening tool (Voice Handicap Index-VHI-10). This simple 10 statement questionnaire can provide preliminary insight regarding a patient’s perception of speech difficulties across a variety of settings.  Not infrequently, a patient with a very hypophonic voice (low, soft) will score themselves as having very little impairment, while their spouse is nearly jumping out of the chair to give an item a high score. That first visit becomes an opportunity to identify mis-matched perceptions of a problem that is leading to communication breakdown and stress, and if not addressed will persist well after 30 days of speech treatment.

Speech therapy for persons with PD that is offered in 30 days packages, may give the impression to some patients and their spouses, that this will fix what’s broke. The reality, of course, is that 30 days of therapy is nothing more than an exercise program that will have short-lived results if communication partners are not also prepared to be a part of the journey, which includes exploring and implementing strategies that might improve communication interactions with the individual with PD.

[i] Miller, N., Noble, E., Jones, D., & Burn, D. (2006). Life  with communication changes in Parkinson’s disease. Age and Ageing.35, 235–239

Group Classes Can Provide an Avenue for Learning

Once a month I provide a 90 minute class in North Port, Fl, at no cost to members of the Parkinson’s community. Sponsored by Neurochallenge Foundation, Sarasota, Fl, individuals with PD and their spouses are welcome to attend. The class begins with Voice Aerobics® exercise that focuses on the substrates of speech such as posture and breathing, gradually expanding to include vocal function exercises, cognitive-linguistic activities, and some discussion.  Some participants have never participated in speech therapy, and others report multiple experiences with speech therapy, sometimes with short-lived results.

From the onset of the class, I invite spouses not to coach their partner with PD, a habit that is difficult for some to inhibit, but rather allow me do any necessary coaching. I invite them, instead,  to be present in their own bodies, feel what is required to perform the various movements and voice tasks, so that they can better understand how Parkinson’s may impose limitations for their partner, and also, through my modeling, gain some strategies for supporting and improving communication once home.

As a daughter of a parent who had Parkinsonism, and as a speech therapist, I know that I failed to follow some of my own rules when my dad’s speech was becoming increasingly impaired. I nagged him to “practice,” I told him when he was “mumbling,” and lectured him from time to time. I would like to say that if I knew then, 20 or so years ago, what I know now, that I would take a different approach. That I would have asked him more often: “how can I help?” “what do you need from me, from us, and what can I do differently?”

Voice Aerobics® is held monthly, the 4th Thursday of the month in North Port, Fl. If you would like to attend, please RSVP Carisa Campanella, Neurochallenge Foundation by calling: 941-926-6413 Ext 103 or

The LOUD Crowd® is a weekly speech class held in Port Charlotte, Florida. The class is open to individuals who have previously completed formal speech therapy within a 6 month period. A speech-language evaluation will be recommended if never previously completed.

For more information or to schedule an evaluation, please visit my private practice page:

My Mission

To enlist individuals in their treatment, and help them express their personality & spirit through voice. To educate and empower.
Mary Spremulli, MA, CCC-SLP