Parkinson's Speech Therapy: What Works and What to Expect
Parkinson's disease can make your voice softer or flatter, even when it sounds normal to you. As a result, other people may have trouble hearing or understanding you, and Parkinson's speech therapy can help you speak more loudly and clearly.
In this article, you'll learn why changes in voice and communication happen, which Parkinson's-specific programs are available, what sessions involve, and when to start. This article is for adults with Parkinson's disease who are being asked to repeat themselves more often, and for family members who want to understand how to help their loved ones.
Speech changes can be subtle at first, and you may not notice them right away. An early evaluation can give your speech-language pathologist a baseline for tracking changes over time.
Key Takeaways
Parkinson's speech therapy: Speech therapists specialize in treating speech and swallowing challenges.
Why you sound normal to yourself: Parkinson's disease can blunt your sense of your own loudness, so your speech feels normal when others find it too quiet.
Two Parkinson's-specific programs: LSVT LOUD and SPEAK OUT! pair sessions with daily home practice.
What Is Parkinson's Speech Therapy?
How Does Parkinson's Disease Change Speech?
Which Programs Have the Most Evidence Behind Them?
What We See Working with Clients
What Is Parkinson's Speech Therapy?
In Parkinson's speech therapy, a speech therapist helps you improve changes such as reduced loudness or unclear speech. They check your loudness, speech clarity, pitch, speaking rate, and breath support and coordination, then plan sessions around the communication situations that matter in your daily life.
How Does Parkinson's Disease Change Speech?
Parkinson's disease is a neurodegenerative disorder, meaning it affects the nervous system and progresses over time. It can make the movements used for speech smaller and slower. Your voice often becomes quieter or more monotone, your speech can become less clear, and you may sometimes speak faster.
Speech therapists call this motor speech disorder hypokinetic dysarthria. A 1978 study of 200 people with Parkinson's disease found 89% of Parkinson's patients develop speech or swallowing problems. Parkinson's can also make it harder to judge your own loudness, so speech that sounds too quiet to others may feel normal to you. This difference in how you judge your own loudness is one reason reminders to "speak up" often don't last.
Parkinson's can also affect swallowing. A 2012 review of twelve studies found that about a third of people with Parkinson's report swallowing problems, while four in five have difficulty on swallowing tests. Coughing during meals, food feeling stuck, drooling, or unplanned weight loss are reasons to ask your medical team for a swallowing evaluation.
Which Programs Have the Most Evidence Behind Them?
LSVT LOUD is one of the most widely researched voice treatments for Parkinson's. SPEAK OUT! is another voice treatment backed by published research. Both use individual sessions and daily practice at home to make speech easier to hear and understand.
| LSVT LOUD | SPEAK OUT! | |
|---|---|---|
| What it trains | A stronger, sustained sound, starting with a loud "ah" and carrying that effort into conversation | Speaking with intent, meaning you consciously put more effort into how you speak, through speech, voice, and thinking exercises |
| Schedule | 16 one-hour individual sessions over four weeks, plus daily home exercises | Typically eight 30-minute individual sessions, twice a week for four weeks, plus daily home practice |
| After the program | Daily home exercises, with extra sessions from an LSVT-certified speech therapist if needed | Weekly SPEAK OUT! Classes (once called the LOUD Crowd) and a refresher visit every 6 to 12 months |
| Who runs it | LSVT Global, delivered by LSVT-certified speech therapists | Parkinson Voice Project, delivered by SPEAK OUT!-certified speech therapists |
| Online delivery | Yes, with research suggesting similar results to in-person sessions for many people | Yes, offered by certified providers over video |
| Connected Speech Pathology | connectedspeechpathology.com | ||
LSVT LOUD, short for Lee Silverman Voice Treatment, is developed by LSVT Global and centers on a strong, sustained "ah." SPEAK OUT!, from the Parkinson Voice Project, uses daily home exercises to teach you to speak with intent, meaning you consciously put more effort into how you speak.
After the LSVT program, you can continue the exercises at home and return for additional sessions if needed. With SPEAK OUT!, you continue daily practice and join weekly group classes, once called the LOUD Crowd.
Choosing between the two treatment options depends on your speech challenges, goals, health, and schedule, so ask about both at your evaluation.
A Guide to LSVT Speech Therapy
How the program works, step by step.
What Happens in the Sessions?
Your first session is an evaluation. Your speech therapist checks how Parkinson's is affecting your speech and chooses exercises based on what they find. Before starting LSVT, you also see an ear, nose, and throat doctor to have your vocal folds examined and rule out other causes of voice change.
Common exercises include a strong, sustained "ah," pitch glides (sliding your voice up and down), and reading aloud while a sound level meter gives you visual feedback on how loud you are. As you progress, you practice using these skills in everyday conversations and social settings.
Treatment can also address other communication problems you are experiencing. If you have trouble finding the right words, your speech therapist can include cognitive exercises for word finding. If your voice remains difficult to hear, especially in background noise, a voice amplifier may make communication easier.
Breathing may be another part of treatment. A handheld breathing trainer, used for expiratory muscle strength training, has you blow against resistance to strengthen your breathing muscles.
When Should You Start?
It can help to see a speech therapist soon after a Parkinson's diagnosis, even if your speech still sounds fine to you. Speech changes can begin in the early stages of Parkinson's disease. An early evaluation gives your speech therapist a baseline for tracking changes over time, as recommended by the Parkinson's Foundation.
It is not too late to get help if your Parkinson's is more advanced. In the advanced stages, speech therapy focuses on compensatory communication strategies that help others understand you, and augmentative communication, such as a voice amplifier, can be part of the plan.
What We See Working with Clients
We work with adults with Parkinson's disease on making their speech easier to hear and understand in the situations that matter to them. Here are two examples based on real clients we have worked with. Identifying details have been changed to protect privacy.
One woman in her late sixties was becoming frustrated because her grandchildren often asked her to repeat herself on the phone. In online voice therapy, she worked on increasing her vocal loudness and carrying that stronger voice into conversation. Instead of practicing only structured exercises, she rehearsed the kinds of conversations she regularly had with her family. Over time, she became easier to hear on the phone and needed fewer reminders to speak louder.
Another client, a man in his seventies, noticed that he was participating less in his volunteer board meetings. His speech had become faster and less distinct, making it harder for other members to follow what he was saying. Speech therapy focused on slowing his rate, pausing between phrases, and speaking with greater intent and clarity.
Because contributing during meetings mattered to him, his practice focused on that goal. He read meeting materials aloud, practiced explaining his ideas clearly, and worked on finding words when he lost his train of thought. He reported feeling more comfortable speaking up and participating in discussions again.
Frequently Asked Questions About Parkinson's and Speech
1. Can the exercises strain a voice that already tires easily?
Your speech therapist adjusts the exercises so they don't strain your throat muscles. A louder voice should not feel like shouting, and your speech therapist changes the exercise if you strain or tire.
2. Do the gains last?
Improvements can last after the sessions end. In a 2018 trial of LSVT, participants still had louder speech seven months later than an untreated group.
3. How long do the programs take?
The initial schedule for LSVT and SPEAK OUT! usually lasts about a month. LSVT runs 16 one-hour sessions over four weeks, and the Parkinson Voice Project describes SPEAK OUT! as eight 30-minute sessions over the same four weeks, followed by weekly classes and home practice.
4. Does Parkinson's medication help speech?
Parkinson's drugs affect speech symptoms differently in each person. Some people notice better speech when their medication is working well, but medication does not reliably restore loudness, so speech therapy works directly on the voice. Your prescribing neurologist decides dose changes.
5. Can the sessions be done online?
Online sessions work well for many people. A 2016 randomized trial found similar results when LSVT was delivered at home, either via video or in person.
How Connected Speech Pathology Can Help
At Connected Speech Pathology, our licensed speech-language pathologists provide speech therapy for Parkinson's disease online, and many are certified in LSVT LOUD and SPEAK OUT!
Therapy focuses on carrying the skills you practice into everyday life. You might work on being heard during phone calls, speaking clearly at the dinner table, or contributing confidently in meetings. Family members can also join a session to learn how to support your communication at home.
Summary
Parkinson's can make your voice quieter and your speech faster or less clear, sometimes before you realize it. Speech therapy helps you strengthen your voice, improve speech clarity, and use those skills in everyday conversations. Programs such as LSVT LOUD and SPEAK OUT! are specifically designed for people with Parkinson's disease. Starting with a speech evaluation soon after diagnosis gives you a baseline and helps determine the right approach for you.
About the Author
Allison Geller, M.A., CCC-SLP, is a communication coach, speech-language pathologist, and founder of Connected Speech Pathology, an international online practice providing professional communication coaching and speech therapy for children, teens, and adults. With more than two decades of experience, she has worked in medical and educational settings and published research on aphasia. Today, she leads a team of specialists who help clients improve their skills in public speaking, vocal presence, accent clarity, articulation, language, fluency, and interpersonal communication.
