Speaking in “Parki-nese”: Challenges with Speech
What if you woke up tomorrow morning and couldn’t speak? How would it affect your life? Think about it. You couldn’t tell your family good morning, cell phones would be useless. Of course you could always text but without the ability to speak, how would people you come in contact with interpret your anxiety driven text? I mean, come on, you just lost the ability to communicate! How could you perform at work? Wait! How could I work today? You’d probably take a sick day or two and eventually lose your job.
The scenario described above, although fictitious, does provoke some questions. In Parkinson’s disease (PD), the loss of speech is normally far more gradual but in some cases, I know people personally whose careers ended because of a speech problem that developed as a result of PD. In fact, my own career as an insurance executive and instructor ended because of speech problems. Usually this happens in later stages of PD however, earlier symptoms do occur on occasion. There are a few specific symptoms of speech problems that I will address.
Problems with speech in PD
- Volume – The ability to speak loud enough for others to hear and to overcome collateral noise (conversational chatter, clanking of dishes, loud music, crowd noise and other noise distractions).
- Projection – Similar to volume, this issue is being able to overcome a large space and to be heard.
- Breath Control – Being able to control the inflow and specifically the rate of exhale because when we speak, it is a reflection of our exhalation.
- Pronunciation – Often PD affects our speech in a way where pronunciation of some words and syllables is difficult. This can result in slurring of words and can be mistaken as appearing drunk hence Parki-nees.
- Complications from other symptoms – Speech can also be affected by other symptoms of PD such as: tremor, dyskinesia, dystonia.
The ability of speaking loud enough to be heard can be impaired by PD. Being heard by other people is important. It is the key to communication and getting your message across. If what you have is important to say, It is essential to be heard. Ignoring this problem can lead to depression, anxiety, and other emotional problems. The good news is there is help in occupational and speech therapy. There are specific exercises that speech pathologists can offer to improve the volume of speech.
Projection is similar to volume but also contains the element of being able to reach a sustainable rate of speech that can be heard over distance.
Breathing is essential for proper speech. It is the basis for which effective speech comes from. Try this exercise: breathe in, then exhale while saying the word, “ah.” What happens to the sound? It diminishes and the tone softens. We speak on an exhale and if you can’t control your breathing, it affects our speech.
Living with PD can make it difficult to pronounce many words or syllables which impede the communication process. Sometimes this issue can create the false impression of appearing in a state of drunkenness by slurring your words.
Complications from other symptoms
There are other symptoms that affect speech. Tremor can cause a vibration of the vocal chords causing a trembling of the voice. Dyskinesia and dystonia can further complicate speech issues by restricting the esophagus and vocal chords thereby limiting the ability to speak more clearly and loud.
Are there treatments available?
Problems with speech in PD is not a new phenomenon. It is just more recognized by the medical community and earlier intervention is being taken. Speech pathologists have an arsenal of therapies that include various vocal and physical exercises including singing and music to assist mind and body that strengthen and make control over speech possible. There are also medical interventions such as Botox and medical devices that boost breathing. It is possible to control of the speech problem associated with PD, but it takes a proactive approach and a commitment to overcome the symptoms which are all together intertwined. For example, without breath control, you can’t speak loud enough to be heard or understood. I struggle with speech every day. People are always saying “what did you say?” It is my most frustrating issue in dealing with PD, but I utilize every tool available to me because I am dedicated to being victorious over PD. In the end, when I finally take my last breath, you can be sure it will be long and loud for everyone to hear. Keep fighting the battle against PD. Quitting is not an option.