Speech and Voice
Up to 90% of persons with PD will experience voice and speech symptoms [1, 2]. The motor symptoms such as slowed movement and rigidity that are experienced in other parts of the body due to basal ganglia dysfunction also affect the motor movements of voice and speech.
The profile of speech symptoms most typical in PD is termed 'hypokinetic dysarthria'  and is characterized by decreased vocal intensity, reduced articulatory precision, reduced pitch variation perceived as monotone speech, and hypophonia (hoarse, breathy voice). Speech rate may be slowed (although persons may also experience rapid rushes of speech). Overall, there is a reduction in speech intelligibility. Additionally, due to sensorimotor changes, a person with PD may not be able to detect changes in their own voice. Their friends and family may be finding it more difficult to understand them, but the person with PD has the sensation that they are "yelling" to achieve a voice that is loud enough for others to understand them.
The progression of communication symptoms differs between individuals; some persons experience no or minimal reduction in their functional communication skills, or not until the later stages of the course. It is advisable to consult with an S-LP early in the course of PD. Such consultation will give you accurate information to make informed decisions with. Moreover, when intervention is provided early, greater gains can be achieved in less time, worsening symptoms may be delayed, and functional speech is maintained longer.
Non-Intensive Individual Speech/Voice Treatment
Treatment programs are developed based on the specific needs of individuals. A treatment plan can be developed to improve vocal volume, vocal quality, speech clarity, and breath support for speech. Dosage of treatment may be one or two 60-minute appointments per week with daily home practice.
Our voice group is for those who would like to work on improving and/or maintaining their voice in a small group (maximum 4 persons). This group is suitable for those with early stage voice difficulties or those who have finished one-on-one treatment and are seeking support with maintenance. Contact us for more information about eligibility.
LSVT LOUD Treatment (Lee Silverman Voice Treatment)
LSVT LOUD is an intensive treatment protocol developed for persons with Parkinson's disease. Outcomes typically include improvements in breath support, volume, speech clarity, vocal strength, pitch range, facial expression, and confidence.
It is critical that those considering LSVT LOUD treatment are able to commit to the minimum dosage:
4 consecutive days per week (60 minute sessions)
over 4 consecutive weeks
over 30 days
This is the minimum dosage required to achieve the outcomes expected from LSVT LOUD. Some people - such as those who have more severe symptoms - may require more than 16 sessions. The days between S-LP-led sessions involve homework and carryover tasks to ensure that treatment gains are made and maintained outside of the treatment room. The breakdown of the schedule is:
4 days - 60 minutes of daily treatment with S-LP plus 10 minutes of home practice plus carryover activities
3 days - daily home practice twice a day for 15 minutes each plus carryover activities
Carryover activities are 'assignments' in which clients intentionally apply new skills to real life situations. An example for someone who has been having trouble talking on the phone would be calling a relative and maintaining a loud enough voice for the entire conversation.
Completion of daily homework is required and is necessary in order to see an improvement in your daily speech outside of the treatment room. On treatment days there is an additional 10 minutes of home practice. On days when you don't have a treatment session, homework consists of two periods of 15-minute practice.
At about 6 months post-treatment (ranges from every 3-12 months depending on the stage of PD and severity of voice symptoms) there is a follow-up visit scheduled, and for every 6 months after that. If tune-up sessions are required at any point, they can be arranged at that time.
In order to maintain the gains your make during treatment, you will need to continue to practice for 10 minutes a day.
There is certainly a level of commitment required, but it's worth it!!
For more information about this treatment, please visit:
In this video, a gentleman shares his experience with LSVT LOUD:
Before initiating treatment, a laryngeal exam should be completed by an Ear Nose and Throat medical specialist ('otolaryngologist'). Your doctor can make this referral.
Pamela Coulter is a LSVT LOUD Certified Clinician. For a list of certified clinicians, visit:
Many people find it beneficial to use a device to amplify their voice when in groups and noisy situations. Shoreline's clients may borrow an amplifier to see if this would be beneficial before purchasing one.
Take advantage of text-based systems to supplement your speech and be understood.
Learn how to support your spouse, family member, or client with PD to maximize their success when communicating.
Please bring the following to your appointment or send them ahead of time. If you do not have access to these reports, please just bring the name/contact information of the health professional who provided the service. With your consent Shoreline will be able to request these reports on your behalf.
results of any recent hearing test
copy of report from laryngeal exam by an ENT medical specialist
list of medications
medical history (if you have a history of cardiac disease or surgery, medical clearance will be required before starting voice treatment)
copy of report from neurologist
Before initiating treatment, a laryngeal exam should be completed by an Ear Nose and Throat (ENT) medical specialist ('otolaryngologist'). Your doctor can make this referral. For a laryngeal exam, the ENT (or specially trained S-LP) will place a scope in your mouth so that they can look down your throat to your vocal folds. This scope only goes to the back of your mouth. In some cases, a flexible scope may need to be passed through your nose to your throat. Topical anesthetic will be used to make this more comfortable. From this position, your vocal folds can also be viewed. The ENT/S-LP will discuss this with your before starting the procedure. The laryngeal exam is important in order to identify or rule out any structural reason for the voice changes you are experiencing (e.g., nodules).
A laryngeal exam may involve a laryngoscopy and stroboscopy. The videos below demonstrate what this typically involves.
University of California, Irvine
Department of Otolaryngology
Yavapai Regional Medical Center
Rigid Videostroboscopy Procedure (video)
Swallowing and Neurological Rehabilitation, LLC
Many people with PD acquire stuttering . These persons may or may not have stuttered as children.
Persons with PD who stutter can improve speech fluency with treatment. Treatment focuses on acquiring increased control over speech through fluency enhancing strategies and stuttering modification. Fluency enhancing strategies take advantage of what is known to be associated with decreased stuttering incidence by reducing motor demands to make it less likely that you will stutter. Stuttering modification techniques are those that can be applied by a person to regain control during a stuttering episode and release the stutter to move forward with speaking.
A large number of persons with PD, over the course of the condition, experience reduced cognitive ability to some extent. Some people will experience cognitive-linguistic symptoms without a diagnosis of dementia, others will develop mild cognitive impairment (MCI), and others may eventually receive a diagnosis of Parkinson's disease dementia (PDD) . Subtle changes in cognition may actually be reported subjectively by persons before the development of motor symptoms and diagnosis .
Cognitive-linguistic symptoms often reported by people with PD include reduced verbal fluency (word finding), informativeness and length of utterances, comprehension of complex grammar, conversation management (e.g., staying on topic), and reading ability [7-9].
Although there is some research demonstrating cognitive training can improve skills in working memory, processing speed, and executive functioning in persons with mild to moderate PD , this area of research is still developing. More reports on cognitive rehabilitation for persons with PD are becoming available , but not necessarily in linguistic skills such as verbal fluency and comprehension.
Strategy-based treatment may be helpful in improving functional cognitive skills (e.g., use of strategies to retain information read) , but this is another area that needs to be further explored in research.
In treatment, persons with PD can develop useful strategies to compensate for linguistic-cognitive changes (e.g., word finding difficulties). Furthermore, a trial of cognitive training can determine whether an individual may benefit from this approach to improve and/or maintain linguistic-cognitive abilities.
Chronic Disease Self-Management
Self-Management refers to the every day activities people living with chronic conditions must do to manage and live well with their chronic condition. Occupational therapists can help people develop these skills so they can live well with their chronic conditions. These strategies may include specific strategies for symptom management, activity modifications, and ergonomics as well as general strategies like goal setting, accessing community resources, and communicating with others (e.g., other health professionals, family, co-workers) about their condition.
Physical and/or Cognitive Fatigue Management
As many as 58% of people living with Parkinson's disease experience, with 1/3 of people with PD rating it as their most disabling symptom. Occupational therapists can help people manage their fatigue using a variety of strategies such as adjusting body mechanics, analyzing activity/work stations, assistive devices/tools, priority setting, and/or activity analysis.
Support with Assistive and/or Adaptive Equipment
Occupational therapists can help identify and procure assistive and adaptive equipment such mobility aids, home safety equipment, and tools/technology to save energy or increase independence.
More Information on Parkinson's Disease
International Parkinson and Movement Disorder Society
University of California San Francisco – Memory and Aging Center
Johns Hopkins Medicine - Parkinson Disease and Dementia
"What is Parkinson's Disease?"
Michael J. Fox Foundation
"Raising Your Voice with Parkinson's"
"Communication Changes in Parkinson's Disease"
Citation: Miller, N. (2017). Communication changes in Parkinson's disease. Practical Neurology, 2017, 266-274. doi:10.1136/practneurol-2017-001635
Parkinson Canada - Dartmouth/Halifax Support Group
Research: LSVT LOUD
List of research studies conducted on LSVT LOUD:
Research: Comparisons Between Different Treatment Approaches for PD
Sackley, C. M., Smith, C. H., Rick, C. E., Brady, M. C., Ives, N., Patel, S., . . . Clarke, C. E. (2018). Lee Silverman Voice Treatment versus standard speech and language therapy versus control in Parkinson's disease: a pilot randomised controlled trial (PD COMM pilot). Pilot and Feasibility Studies, 4(30), 1-10. https://doi.org/10.1186/s40814-017-0222-z
Herd, C. P., Tomlinson, C. L., Deane, K. H. O., Brady, M. C., Smith, C. H., Sackley, C. M.,, & Clarke, C. E. (2012). Speech and language therapy for speech problems in Parkinson's disease. Cochrane Database of Systematic Reviews, 2012(8). doi: 10.1002/14651858.CD002814.pub2
References on This Page
 Müller, J., Wenning, G. K., Verny, M., McKee, A., Chaudhuri, K. R., Jellinger, . . . Litvan, I. (2001). Progression of dysarthria and dysphagia in postmortem-confirmed Parkinsonian disorders. Archives of Neurology, 58, 259–264. Retrieved from https://jamanetwork.com/journals/jamaneurology
 Miller, N., Allcock, L., Jones, D., Noble, E., Hildreth, A. J., & Burn, D. J. (2007). Prevalence and pattern of perceived intelligibility changes in Parkinson's disease. Journal of Neurology Neurosurgery and Psychiatry, 78, 1188–1190. doi:10.1136/jnnp.2006.110171
 Duffy, J. (2012). Motor Speech Disorders: Substrates, differential diagnosis, and management (3rd ed.). Toronto: Mosby.
 Goberman, A. M., Blomgren, M., & Metzger, E. (2010). Characteristics of speech disfluency in Parkinson disease. Journal of Neurolinguistics, 23, 470-478. doi:10.1016/j.jneuroling.2008.11.001
 Buter, T. C., van den Hout, A., Matthews, F. E., Larsen, J. P., Brayne, C., & Aarsland, D. (2008). Dementia and survival in Parkinson disease: A 12-year population study. Neurology, 70, 1017-1022. https://doi.org/10.1212/01.wnl.0000306632.43729.24
 Postuma, R. B., Aarsland, D., Barone, P., Burn, D. J., Hawkes, C. H., Oertel, W., & Ziemssen, T. (2012). Identifying prodromal Parkinson's disease: Pre-motor disorders in Parkinson's disease. Movement Disorders, 27, 617–626. doi:10.1002/mds.24996.
 Schalling, E., Johansson, K., & Hartelius, L. (2017). Speech and communication changes reported by people with Parkinson's disease. Folia Phoniatrica et Logopaedica, 69(3), 131–141. https://doi.org/10.1159/000479927
 Ash, S., Jester, C., York, C., Kofman, O. L., Langey, R., Halpin, A., ... Grossman, M. (2017). Longitudinal decline in speech production in Parkinson's disease spectrum disorders. Brain and Language, 171, 42–51. doi:10.1016/j.bandl.2017.05.001
 Colman, K. S., Koerts, J., Stowe, L. A., Leenders, K. L., & Bastiaanse, R. (2011). Sentence comprehension and its association with executive functions in patients with Parkinson's disease. Parkinsons Disease, 2011, 1-15. http://dx.doi.org/10.4061/2011/213983
 Leung, I. H. K., Walton, C. C., Hallock, H., Lewis, S. J. G., Valenzuela, M., & Lampit, A. (2015). Cognitive training in Parkinson’s disease: A systematic review and meta-analysis. Neurology, 85, 1843-1851. doi:10.1212/WNL.0000000000002145
 Foster, E. R., Spence, D., & Toglia, J. (2018). Feasibility of a cognitive strategy training intervention for people with Parkinson’s disease. Disability and Rehabilitation, 40, 1127-1134. doi:10.1080/09638288.2017.1288275