Voice Exercises for Parkinson's
Reviewed by: HU Medical Review Board | Last reviewed: March 2017 | Last updated: December 2018
Some people with Parkinson’s disease (PD) experience changes in their voice or speech. While not everyone with PD experiences a change in speech, for those who are affected, it can be a significant problem, causing difficulties in communication and possibly leading to reduced social interactions.
There are several ways PD may affect speech:
- The voice may get softer, breathy, or hoarse, causing others difficulty hearing what is said.
- Speech may be slurred.
- Speech may be mumbled or expressed rapidly.
- The tone of the voice may become monotone, lacking the normal ups and downs.
- The person may have difficulty finding the right words, causing speech to be slower.
- The person may have difficulty participating in fast-paced conversations.1
Speech pathologists, also called speech therapists, can be helpful for people with PD who experience speech difficulties. They also can help with swallowing issues. Speech therapists can teach several techniques that can strengthen the voice, such as the Lee Silverman Voice Treatment (LSVT). Targeted exercise therapy has been studied in research and has been shown to provide lasting changes in vocal behavior. Targeted exercise therapy is defined as systematic, repeated and controlled activation of particular groups of muscles for specific goal-directed actions.1,2
Lee Silverman Voice Treatment
The Lee Silverman Voice Treatment (LSVT) is a series of exercises for people with PD. Named for Mrs. Lee Silverman who developed the technique in 1987, LSVT has been scientifically studied for 20 years. Also called LSVT LOUD, the technique focuses on simple tasks that are designed to maximize vocal and respiratory functioning. LSVT LOUD exercises have been shown to have several benefits, including:
- Improving voice quality and loudness,
- Improving the articulation of speech,
- Increasing the inflection (the modulation of the tone of the voice),
- Improving the intelligibility of speech (the ability to understand the speech produced by the person with PD).2-4
Research studies have found that people with PD who are treated using LSVT are likely to maintain improvement in their vocal function for up to two years following therapy.3 LSVT LOUD exercises are administered in 16 sessions over a month and include techniques such as:
- Warm-up: While sitting up straight, the patient says “ah” in a loud, clear voice for as long as possible, stopping if the voice becomes scratchy.
- Vocal stretches: After taking a deep breath, the patient starts at a low pitch and glides up as high as possible saying an “Ah” or “Ee” sound.5
Patients are trained to monitor the loudness of their voice and the effort it takes to produce it. The treatment does not train people with PD to shout or yell, but it uses loudness training to bring the voice to a healthy, improved vocal level without strain. Look for a speech therapist who is certified in the LSVT technique or search for a clinician at the LSVT Global website.4
Voice Aerobics is an exercise program for people with changes to speech due to PD, stroke, or neurological problems. It focuses on breath support, posture, and vocal function techniques to improve vocal performance. Voice Aerobics is a program created by Mary Spremulli, a speech-language pathologist, and is available on DVD for use at home.6
Voice Choral Singing Therapy
Voice Choral Singing Therapy (VCST) uses music therapy to help patients increase their respiratory volume and reduce vocal fatigue. Research studying VCST has shown it can improve vocal intensity and intelligibility; however, it does not provide significant improvements in functional measures of vocal quality.2