Speech, Swallowing, and Drooling Problems

Speech & Communication Problems in Parkinson's Disease

Although difficulty with speech is not always associated with Parkinson’s disease, it is a significant problem for some individuals. In fact, a change in speech may be one of the first symptoms. The speech disorder is often characterized by a soft voice and less precise articulation. Another common complaint is a problem with 'fluency' or stuttering, especially at the beginning of a sentence when it may be difficult to start speaking quickly. Alternatively, individuals may complain of rapid bursts of speech. There may also be a loss of inflection leading to a monotonous sounding voice and there may be a reduction in facial expression. These symptoms may impair communication both at work and at home. Dysarthria is the name for the speech disturbance experienced by persons with Parkinson's disease. For some people, antiparkinsonian medications improve speech whereas in others, speech may be worse on medication.

Not all people with Parkinson's disease are aware that their voice is softer or that they are not speaking distinctly. If listeners repeatedly ask the person with Parkinson's disease to repeat what was said, or otherwise act as if they did not hear or understand what was said, this is a strong sign that dysarthria is present. If there is a noticeable change in the speech, the individual with Parkinson's disease should consult with their doctor.

Treatment of Speech Problems

Over the years, a number of speech therapy programs have been developed to improve speech and communication. Our speech thearpists may be very helpful for patients with Parkinson's. The goal of therapy is to increase loudness, improve clarity of speech and increase melody or inflection over the sentence. General suggestions that help some people include the following:

• Face your listener when speaking.
• Express yourself in short, concise sentences.
• Take a breath before speaking and pause between phrases to take another breath.
• Exaggerate pronunciation, particularly of consonants.
• Pretend the listener is hard of hearing.
• Practice reading out loud using these techniques.

Swallowing Problems in Parkinson's Disease

Although most people with Parkinson's disease will continue to eat normally throughout the course of the disease, some will develop difficulty in swallowing. Early symptoms of difficulty in swallowing (so-called dysphagia) are of food sticking in the throat or of liquids “going the wrong way”. For some, chewing may become more difficult or there may be difficulty in getting the swallow “started.” Later, the swallowing problem may become so severe that a diet change is required.

Some suggestions that have helped people with Parkinson's disease eat include:

• If taking medications for Parkinson's disease, eat meals after the medication has taken effect, usually 1 hour after taking the medication(s).
• Ensure that there is adequate time to eat.
• Eat food that has been cut in small pieces-don't hesitate to ask a companion to cut up meat or foods.
• Try using "easy grip utensils."

Swallowing problems should be reported to your doctor. In some circumstances referral to a speech pathologist may be recommended. Often the speech pathologist can provide strategies to facilitate swallowing and avoid choking. Exercises to strengthen the muscles used in swallowing are sometimes helpful.

Drooling

Excess saliva is another common problem in Parkinson's disease. In most cases, the problem is not one of having too much saliva, but rather of not swallowing often enough. If the automatic reflex that causes us to swallow our saliva once every minute or two is not operational, saliva builds up in the mouth until it leaks out and the person notices drooling. This can be very embarrassing, of course. Once the problem is brought to the attention of the individual with Parkinson's disease, it can sometimes be alleviated by developing a habit of consciously swallowing every few minutes. Swallowing can be further stimulated by carrying a bottle of water and taking a sip every few minutes. It may be helped by anticholinergic type medications, although side effects of these medicines including cognitive dysfunction and increased constipation may be problematic. Botox injections into the parotids glands have been helpful as well.