Speech therapy for Parkinson’s disease
Reviewed by Parkinson’s disease affects the muscles and brain processes involved in speaking, facial expression, and swallowing. Speech therapy for Parkinson’s can help you manage these changes, communicate more effectively, and eat and drink safely.
Speech therapy helps you manage Parkinson’s-related changes in voice, speech, communication, and swallowing. A speech-language pathologist can assess your needs and teach exercises, swallowing techniques, and communication strategies, as well as ways to use assistive tools. Treatment is personalized and may change as your symptoms change.
Your treatment plan may involve exercises, practical strategies, specialized voice programs, or assistive communication tools.
How Parkinson’s affects speech and swallowing
Parkinson’s may cause:
- a softer or fading voice, known as hypophonia
- slurred, mumbled, or rapid speech
- reduced pitch or vocal expression
- difficulty coordinating speech and breathing
- reduced facial expression, or facial masking
- trouble finding words or following conversations
- coughing, choking, or difficulty swallowing
- drooling or difficulty managing saliva
Dysarthria in Parkinson’s refers to speech changes caused by reduced control or coordination of the muscles used for speaking. You may notice that your speech becomes softer, less clear, or more rushed, or harder to understand, particularly in noisy environments.
Dysphagia, or swallowing problems, in Parkinson’s may affect how safely and efficiently you eat, drink, or take medication. Swallowing changes are not always obvious, so tell your care team about coughing during meals, a wet-sounding voice, or a feeling that food is stuck. It’s also good to share if you’ve had any unexplained weight loss or recurring chest infections.
Early assessment can help your speech-language pathologist identify changes and develop strategies suited to your daily life. Your therapy may address voice, speech, or swallowing issues, or several concerns at the same time.
Specialized voice therapy programs for Parkinson’s
Parkinson’s speech therapy may include a structured program developed for people with the disease. Two commonly used approaches are Lee Silverman Voice Treatment, known as LSVT LOUD, and SPEAK OUT!
The programs have different schedules and techniques. A speech-language pathologist can help you decide whether one or the other may be appropriate for your symptoms, health, preferences, and access to treatment.
Lee Silverman Voice Treatment
LSVT LOUD for Parkinson’s is an intensive program that helps you increase vocal loudness while maintaining voice quality. Standard treatment consists of four individual sessions per week for four weeks, along with regular home practice.
In a 2024 randomized clinical trial, people receiving LSVT LOUD reported less voice-related difficulty three months after treatment than those who received no speech therapy or standard speech and language therapy through the U.K.’s National Health Service. The researchers noted that continued practice may be needed to maintain benefits.
Treatment generally focuses on:
- using a stronger voice
- sustaining vocal effort
- carrying vocal strength into conversation
- monitoring how your voice sounds and feels
- practicing between therapy sessions
LSVT LOUD should be delivered by a clinician trained in the program. Your speech-language pathologist can determine whether the standard schedule or another approach is suitable for you.
Parkinson Voice Project
SPEAK OUT! for Parkinson’s teaches you to speak with purposeful effort. The program typically comprises 12 individual sessions, home practice, and continued group practice through The LOUD Crowd.
Small studies suggest that the program may support voice quality and communication. However, the evidence remains more limited than the research supporting LSVT LOUD, and larger controlled studies are needed.
A separate follow-up study found that participants maintained some treatment gains for one year. More frequent group participation was associated with better maintenance, although this finding does not prove that group practice caused the difference.
Swallowing therapy and drooling management
If you have swallowing concerns, your speech-language pathologist may begin with a clinical assessment. You may also be referred for an instrumental test that shows what happens while you swallow. Options for such testing are a video-fluoroscopic swallowing study or a flexible endoscopic evaluation of swallowing.
Your recommendations will depend on what the assessment shows.
They may include:
- changes to posture or positioning
- adjustments to bite or sip size
- changes to eating speed
- swallowing exercises
- strategies for taking medication
- food or drink modifications when necessary
Research on behavioral swallowing therapy for Parkinson’s shows potential benefits. However, available studies vary in quality and do not support one approach for everyone. Your treatment should be based on an individualized assessment.
Drooling in Parkinson’s often results from reduced swallowing frequency or difficulty controlling saliva in the mouth, rather than the body producing too much saliva. It can affect your comfort, speech, skin, and social well-being.
Management may involve:
- reminders to swallow
- changes to head or body position
- strategies for closing the lips
- behavioral therapy
- medication or other medical treatment
Tell your healthcare team if you have frequent coughing or choking, difficulty breathing during meals, or signs of dehydration. Seek urgent medical help if you cannot breathe or believe food is blocking your airway.
Assistive communication devices and nonverbal tools
Exercises and communication strategies may not address every situation. Assistive tools can supplement your speech and help reduce the effort required to communicate.
Among available options are:
- a personal voice amplifier
- a text-to-speech app
- a tablet or communication board
- written keywords or prepared messages
- alphabet or picture boards
- communication-access features on a phone
A voice amplifier for Parkinson’s makes your voice louder without requiring you to increase your vocal effort as much. Your speech-language pathologist can help you choose and position a device appropriately.
Computer-based speech and voice tools may support practice and access to therapy, but research on their effectiveness and long-term use remains limited. The use of any devices should complement professional care rather than replace an individualized assessment.
Nonverbal communication can also help you express yourself.
Useful strategies may include:
- maintaining eye contact
- using facial expressions
- pointing or gesturing
- writing key information
- confirming important details
- agreeing on simple hand signals
Using an assistive tool does not mean you have failed at speech therapy. It is another way to help you stay involved in conversations and communicate your needs.
Tips for family and caregivers
Speech changes can be frustrating for you and the people close to you. Small adjustments can make conversations with family, friends, and caregivers easier without taking away your independence.
You and your communication partners can try:
- reducing background noise
- facing one another
- improving lighting
- discussing one topic at a time
- allowing extra time for responses
- taking breaks during longer conversations
- confirming information when needed
- choosing times when your energy is highest
Speaking deliberately or with greater vocal effort may make speech easier to understand in some situations, including when background noise is present.
Schedule important conversations when your medication is working well, but do not change your medication schedule without consulting your doctor. Ask others to request clarification instead of pretending to understand.
As your needs change, regular follow-up with your speech-language pathologist can help you adjust your treatment and communication tools. With the right support, you can continue communicating in ways that help you feel heard, connected, and confident.
Parkinson's News Today is strictly a news and information website about the disease. It does not provide medical advice, diagnosis, or treatment. This content is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. Never disregard professional medical advice or delay in seeking it because of something you have read on this website.
