A while back, I got caught in a speed trap on my usual drive home — which, honestly, shouldn’t have come as a total surprise. I do like my Mazda to go ZOOM ZOOM. Fortunately, the officer was kind and let me off with just a warning. I drove the rest of the way home very deliberately, eyes on the speedometer (a perfectly reliable external cue — if only I’d been using it all along!).
That experience has stuck with me as the perfect metaphor for something I see regularly in my practice: what happens when Parkinson’s disease — or sometimes deep brain stimulation (DBS) — causes the motor speech mechanism to speed up, and a person’s speech rate becomes too fast to control.
What Is Festinating Speech?
When speech rate accelerates and words begin running together, it’s called festinating speech. In Parkinson’s, festination describes a broader tendency to speed up during repetitive movements. It was first identified in gait — that characteristic forward lean with rapid, shuffling steps — but the same pattern can emerge in handwriting and speech as well.
Festination is consistently reported as one of the most disabling Parkinson’s symptoms, in part because it can feel completely outside a person’s control. That loss of agency is frustrating and isolating.
Why Is It So Hard to Manage?
Even for experienced speech-language pathologists, festinating speech is difficult to treat — and even harder for patients to self-manage. Here’s why:
- Internal cueing breaks down — the brain’s built-in feedback loop is no longer reliable.
- People often feel like they’re speaking at a normal rate, even when they aren’t.
- Rate control has shifted from automatic to dysregulated — it’s now a symptom, not a choice.
The Attention Problem
During everyday conversation, our brains are remarkably busy. We’re listening, formulating responses, organizing thoughts, and filtering distractions — all at once. That leaves very little cognitive bandwidth left over for consciously monitoring how we’re speaking.
Even healthy adults can only slow their speech deliberately for short stretches before attention drifts. For someone with Parkinson’s — especially with any degree of cognitive change — sustaining that level of self-monitoring is a genuinely high demand on the brain.
It’s also worth noting: using tapping as a pacing cue, which is a common strategy, can itself slip into a festinating rhythm over time.
So, What Actually Helps?
Rather than relying on internal control alone, people with Parkinson’s often respond better to:
- External structure and cueing — written phrases, pacing scripts, and visual cues like the Hi-VOLT “voice-on-light,” which signals adequate loudness in real time.
- Repetition — to build new, more stable motor patterns over time.
- Intentional pauses — to support breath replenishment and natural phrasing.
- Practicing in meaningful, real-life contexts — not just in therapy.
Behavioral programs like LSVT® LOUD and Speak OUT! are therapist-guided and highly effective for hypophonia (low vocal volume). They may also help normalize rate during structured sessions. However, carrying those gains into everyday conversation — especially for individuals with mild cognitive changes — can be more challenging, and self-monitoring often decreases once the external cueing from a therapist is removed.
Are You Doing the Right Practice for Your Speech Symptoms?
If you’ve worked with a speech therapist — or are currently in therapy — you’ve likely been given home practice tools. Daily practice matters enormously. But the practice needs to match the symptom.
If volume is your primary challenge, your practice should focus on loudness. If rate is your biggest barrier to being understood, then gaining some measure of rate control should be your goal.
And please remember: none of this is easy. Even when you’re working as hard as you can, managing a festinating speech pattern is genuinely difficult. But consistent, targeted practice may help slow the progression of a symptom — and that is absolutely worth the effort.
** I’ve included a sample practice worksheet below that I’m currently using with a patient. It supports a Loud • Slow • Clear approach and is a good example of how external cueing and structured phrasing can be built into daily practice. Scroll to the bottom of this post to download.
A Note to Therapists
No two patients are alike or respond to treatment the same way. If a patient isn’t improving or isn’t satisfied with your current approach, don’t hesitate to try something new. It’s easy to default to what’s familiar — but exploring all evidence-based options as well as including hybrid approaches, is how we best serve each individual.
A Note for Care Partners
If you support someone with Parkinson’s who struggles with fast or festinating speech, your role matters more than you might realize. How you respond in the moment can either add pressure — or create the calm that makes communication possible.
What’s Happening — and Why It’s Not Intentional
Festinating speech is a neurological symptom, not a lack of effort. Your loved one is not speaking fast because they’re nervous, impatient, or not trying. The motor system is simply dysregulated — and no amount of willpower alone can fully override it in the moment.
What makes it harder: they often feel like they’re speaking normally. So when someone reacts with frustration or impatience, it can be confusing, discouraging, and isolating.
Simple Things That Help
- Resist the urge to finish sentences. It’s tempting when speech slows or gets tangled, but interrupting disrupts the speaker’s rhythm and reduces confidence.
- Make eye contact and give your full attention. People speak more clearly when they feel heard. Distracted listening — checking a phone, multitasking — adds pressure. If you wear hearing aids, be sure to use them to maximize communication.
- Slow down yourself. Speaking at a calmer pace yourself can naturally cue your loved one to slow down too.
- If you didn’t understand, A simple “I want to make sure I caught that — can you say it one more time?” is far better than pretending you understood when you didn’t. Inform your friends that it’s ok to ask for repetion when needed. That’s real-time feedback that the PWP needs.
- Acknowledge the effort. This is genuinely hard work. “I’m listening” or “take your time” goes a long way. And don’t forget to let your partner know when their speech actually sounded better. It hwlpsp them feel what they differently and that it worked
Practicing Together
If your loved one is working on rate control exercises, you can be a powerful part of that practice. Sit with them. Listen as they work through the phrased sentences in the worksheet. Offer a calm, attentive presence — not correction, not judgment, just a real communication partner. (I know it’s hard, and you have your bad days, too!)
Real conversations are the ultimate goal of speech therapy. And you’re the most important conversation partner in their life.
👉 Download Worsheet here: (pdf url) https://voiceaerobicsdvd.com/wp-content/uploads/2026/04/RateControl_Worksheet_-Blog-5-2026-1.pdf
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 * Certified End of Life Specialist (CEOLS) * Voice Aerobics® A Whole Body Approach to Voice Practice