• Assessing your communication (incorporating speech, language and voice).
• Assessing the movement, coordination and strength of muscles of your face and mouth. 
• Assessing your swallow function with fluids and diet.
• Providing you with advice re: symptom control if there are difficulties related to speech, voice, swallowing or language/thinking.
• Providing you with guidance, information and support regarding evidence-based interventions available which have been shown to help to optimise speech and swallow function in people with Parkinson’s Disease around the world (an example of this is Lee Silverman Voice Therapy).
• A Registered Speech and Language Therapist will work alongside you and your multidisciplinary team (e.g. Neurologist, Public Health Nurse, Physiotherapist) to help tailor the model of therapy offered to best suit your individual needs and to assist you in setting treatment goals for yourself.
• A Speech and Language Therapist will advise you regarding what compensatory techniques will help you and what active exercises might help to maintain or improve your communication or swallow function.

• Low vocal volume (voice changes are often the first speech feature to be observed in people with Parkinson’s Disease).
• Breathy, weakened voice quality.
• Less clarity when producing speech (sometimes described as “slurred” speech).
• Reduced pitch variation (e.g. questions and statements can have the same intonation pattern).
• Feeling like you are running out of air when speaking.
• Accelerated rate of speech.
• Facial expression can appear reduced.
• Difficulty finding/saying the right words (especially under time pressure).
• Dysfluency or hesitation/repetition of speech sounds (like an acquired stammer).
• Difficulty being understood when talking (e.g. on the phone or in a crowd).
• All of these difficulties can be collectively referred to medically as Dysarthria. The type of dysarthria that is most associated with Parkinson’s Disease is Hypokinetic Dysarthria.

A Registered SLT will help you by assessing your communication and evaluating the best person-centred treatment for your communication changes. This plan will take into consideration your own goals and the needs of you and your family.

A Speech and Language Therapist will empower you to help you to optimise your communication function. They will also provide education to you and your communication partners on how best to support your communication.     

Treatment may focus on exercises to prevent or slow down muscle weakness/incoordination affecting your  speech and voice, or may focus on compensatory strategies to optimise your speech intelligibility and overall communication.         

Treatment generally requires consistent practice from the person with Parkinson’s Disease and the development of self- monitoring skills.     

Lee Silverman Voice Therapy (LSVT) is frequently recommended for people living with Parkinson’s Disease. It is delivered by LSVT Certified Speech and Language Therapists and aims to improve vocal function, maximise loudness and optimise pitch range.

Other interventions used with people with Parkinson’s Disease include respiratory intervention (e.g. diaphragmatic breathing/improving respiratory support), high effort respiratory training such as Expiratory Muscle Strength Training (EMST), work on pacing, over articulation, contrastive stress work etc.

In cases of severe communication difficulties; a Speech and Language Therapist will help to support a person with Parkinson’s Disease and their families with set up and use of augmentative devices (e.g. voice amplifier) or alternative communication means (e.g. alphabet boards, text to speech electronic devices, iPad apps), increased use of gesture, handwriting props etc

Deep Brain Stimulation is a surgical treatment that has some limited evidence to support that it may improve speech/communication function. Programming of a DBS unit involves a number of variables that can impact on speech quality or function. It is important to link in with your Speech and Language Therapist before and after this surgical treatment.   

• Link with your speech and language therapist, use your therapy strategies: think LOUD and be LOUD, slow down, exaggerate or emphasise the sounds you say, use PAUSE to replenish your breath support.
• Check with listeners to make sure they understand you.
• Reduce background noise.
• Where possible; communicate face to face.
• Optimise conversational opportunities when you are most alert. If you are feeling fatigued, try to rest before important communication interaction.      
• Keep sentences short and clear.
• If you cannot relay your message verbally, there are a number of other ways of getting a message across effectively eg. gesturing (such as nodding or shaking your head), writing, typing words onto your phone or tablet device, pointing, emailing or texting).
• You may wish to carry a card in your wallet explaining that you have Dysarthria explaining how a conversation partner can support you . 

You can download a dysarthria card here

• Difficulty with saliva management e.g. sensation of “too much saliva” 
• Reduced strength, coordination and range of motion of tongue movements
• Difficulty initiating movements within the mouth      
• Difficulty controlling food or fluid in the mouth 
• Difficulty chewing food
• Slowed or delayed movements during swallowing
• Presence of residue (food or drink) in the mouth or throat post swallow
• Movement of food/drink through the throat /oesophagus can be slowed  
• Aspiration of food and /or drink    
• Sensory changes in the mouth and throat      
• Eating can become more effortful, meals take longer to finish or are not finished
• Unintentional weight loss can be a problem

A registered speech and Language Therapist will help you by assessing your swallow and evaluating the best person-centred treatment for your difficulties. This treatment plan will take into consideration your own concerns and goals around your eating and drinking, your quality of life and your safety.      

As part of your assessment you may be referred for instrumental swallow assessment; including Videofluoroscopy or you may be referred for Fiberoptic Endoscopic Evaluation of swallow (FEES).

A speech and language therapist will help to empower you to optimise your swallow function and efficiency when living with Parkinson’s Disease. A speech and language therapist will also provide education for you and your family/friends (as appropriate), on how best to support someone who presents with swallowing difficulties.      

Intervention for swallowing difficulties varies from case to case but there are a number of evidenced- based swallow interventions for people with Parkinson’s disease. Swallow exercises may be recommended by your SLT to help to maintain or improve the comfort and safety of your swallow. 

Your SLT may:

• introduce aids and special utensils to improve your comfort and control whilst swallowing. 
• recommend strategies to improve sensory stimulation when swallowing.  These strategies may include using hot/cold temperatures to stimulate the senses, increasing flavour, using carbonated fluids.
• recommend you to use certain compensatory strategies, posture and positions while swallowing.       
• recommend strategies to manage fatigue while swallowing and how best to compensate for this.

Read the general IASLT supporting swallowing difficulties here 

• Avoid overfilling the mouth with food and drink before swallowing     
• Reduce distractions within the mealtime environment
• Ensure upright positioning during mealtime and for 30 minutes after eating /drinking.      
• Ensure slow pace when eating and drinking      
• Have a drink close-by while eating but avoid mixing food and drink in the mouth. Swallow food first and then take a sip of fluid.
• Avoid talking and laughing when swallowing, as this reduces airway protection.   
• Complete regular oral hygiene (especially before and after meals).     

*These are general guidelines or tips and do not constitute professional advice, clinical judgement is required as each individual may have unique requirements.  It is important you link with your GP and/or speech and language therapist if you have any concerns.

The key features of PD are resting tremor, bradykinesia (slowness of movement; difficulty initiating and coordinating movement) and rigidity/stiffness (Jankovic, 2008). PD is also associated with impaired balance, change in gait and risk of falls.

• Parkinson’s Association of Ireland - Membership at 25 euro per annum

- Freephone Helpline 1800 359 359 for a Nurse led call back service.

- Regular newsletters, magazine, information videos, Siel Bleu classes

• Clinical Specialist PD Nurses are available in a number of hospitals within Republic of Ireland
• Move4Parkinsons association 
• Voices of Hope Choir/other local choirs               
• Parkinson’s Awareness week is run each year nationally
• Local Parkinson’s Disease support groups (eg Tipperary Parkinson’s Association club Nenagh, Co. Tipperary Contact Marion Burke Support Group Coordinator 087 2967296) 
• HSE Primary Care services (eg. Physiotherapy and Speech and Language Therapy). Be proactive in asking your GP / PHN to signpost you to these services early in your condition
• World Parkinson’s Virtual Congress takes place from May 17th – 21st 2021 
• 2021 Insight into Parkinson’s Online International Conference takes place 11th – 13th April 
• National Brain Awareness Week is run nationally each year 
• European Parkinson’s Disease Association (EPDA) www.dpda.eu.com 
• www.lsvtglobal.com for more information about LSVT BIG and LSVT LOUD.