Respiratory muscle weakness has been documented in persons with Parkinson’s disease (PWP). While some changes in lung function can be considered a part of normal aging, respiratory muscle weakness may be more pronounced in persons with PD, especially those with more advanced disease, and/or with superimposed dyskinesia or other motor fluctuations. Respiratory muscle weakness and an associated reduction in lung volumes were the findings of researchers reporting results of a randomized, open-label 12- month study evaluating changes in lung function in a large set of patients with idiopathic PD treated with standard PD therapy, and not on investigational therapy (i.e. Levodopa inhalation powder).[i]  

Dysfunction of the respiratory muscles, which appears more pronounced during “off” states of Levodopa, no doubt has a negative impact on speech production and swallowing efficiency and safety, a finding previously reported by dysphagia (swallowing) researchers indicating that persons with PD may be more likely to swallow at abnormal times within the respiratory cycle, such as during inhalation or at low tidal volume. [ii] Chaotic respiratory patterns increase the likelihood an individual will aspirate when swallowing, and for that reason, swallowing treatment which focuses on respiratory muscle strengthening and voice treatment, such as LSVT® LOUD, which emphasizes phonating at a high lung volume, may be especially important for individuals with PD, regardless of stage of disease.

[i] Natural history of lung function over one year in patients with Parkinson’s disease. Kaminsky et al   Respiratory Medicine.  Journal homepage:

[ii] Coordination of Breathing and Swallowing in Parkinson’s disease. Gross, RD, et al.Dysphagia (2008) 23:136–  145DOI 10.1007/s00455-007-9113-4.

What Are You Waiting For?

Recently I was invited to speak to a Parkinson’s support group located in norther California. With approximately 15 people in attendance, I asked ahead of my presentation, which attendees had already participated in speech therapy. Not one person raised their hand. I was stunned. Years ago, it was reported that approximately 4% of people with Parkinson’s were referred for speech therapy. In 2021, with so much more information at our disposal about the benefits of therapy and exercise, I was shocked that so many PWP had not yet been evaluated by a speech-language pathologist.

“My speech is not that bad yet”

The comment above is one I hear from time to time when contacting a patient to schedule an initial evaluation. It’s an odd notion to me, that someone with a progressive neuro-degenerative disease, with somewhat predictable symptoms, would wait until they were very symptomatic to undergo education, treatment, and instruction in exercises which if undertaken early, may actually delay progression or impact of symptoms. Unlike physical therapist, the professions of speech-language pathology and audiology are autonomous, and a physician’s order is not required, so individuals can self -refer if they have concerns or an interest in obtaining speech and/or swallowing therapy. Once evaluated, your neurologist or primary care physician will be sent the plan of care for their signature, documenting for Medicare or other insurers, that the treatment being billed to them is medically necessary.

May is Better Hearing and Speech Month 

If you or someone in your family benefitted from the help of a speech-language therapist or audiologist, Better Hearing and Speech Month, celebrated every May is a great time to thank them. I really miss getting and giving hugs to my patients in our current “hands-off” environment, but, soon, I hope, we will all be back to extending a hand or hug to the patients who entrust us with their care.

Telepractice and Online Coaching No Further Than Your Computer

Take advantage of telepractice for your speech and swallowing therapy. No travel, no weather, NO EXCUSES!


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 * FiTOUR® Group Exercise Instructor * Voice Aerobics® A Whole Body Approach to Voice Practice

Voice Aerobics the heART and Science of Voice Practice