Speech, Language and Swallowing deficits in Parkinson’s Disease

Parkinson’s disease (PD) is a slowly progressing neurodegenerative disorder resulting from dopaminergic deficit in the Substantia Nigra. This results in symptoms such as bradykinesia (slow movement), resting tremor (pill rolling tremor in hands), rigidity and postural instability. Symptoms usually initiate on one side of the body and the progression varies from person to person. Recent advancements propose a Prodromal Phase of PD which may be present for many years and the individual may present with non-motor (sleep disorder, mood changes, anxiety and loss of smell) or slight motor symptoms which do not fall under the classic clinical diagnostic criteria.

Speech/ Language and Swallowing problems in PD

Majority of the people with PD may show symptoms of Speech and Language deficits. Most common problems noticed are:

• Reduced pitch range
• Reduced volume
• Dysarthria (slurred speech)
• Poor speech intelligibility
• Difficulty in expressing emotions due to ‘masked face’
• Stammering/cluttering in few cases
• Word finding difficulty
• Poor understanding of language
• Cognitive deficits
• Memory impairment

The individuals diagnosed with PD may also exhibit swallowing problems (Dysphagia). Symptoms may include:

• Drooling
• Choking frequently on food/liquid/medication/saliva
• Feeling of discomfort or pain when swallowing
• Feeling of lump in the throat
• Difficulty in chewing food or keeping food in the mouth when chewing
• Taking too much time in finishing a meal
• ‘Gurgly’ voice quality after eating or drinking something
• Coughing during eating or after swallowing 
• Multiple swallows needed for a single bolus
• Getting tired after finishing a meal
• Shortness of breath during or after having food
• Regurgitation of food/liquid
• Aspiration of food/ liquid (food/liquid going down towards the lungs)
• Dehydration/ Malnutrition/ Weight loss

Speech therapy treatment in PD: Various treatment options are available which can provide better quality of life to persons with PD. Medical intervention should be coupled with Speech Therapy for better results. A skilled Speech Language Pathologist (SLP) will be able to provide the best options and training to the individual based on the most debilitating symptoms presented.

Some of them are as follows:

• Training for the use of AAC and DAF devices to assist with poor speech intelligibility, pitch changes and rate of speech
• Lee Silverman Voice Training (LSVT) program for volume-based intervention and can be provided by a SLP licensed in LSVT
• Language and cognitive deficits can be addressed by Speech therapy by teaching communication strategies to the patient and carrying out counselling sessions for the communicative partner/s
• Advise and training for consumption of appropriate food and liquid consistencies based on National Dysphagia Diet (NDD) after Modified Barium Swallow Study (MBSS)
• Swallowing based interventions in order to teach compensatory strategies and therapeutic exercises to facilitate safe swallowing, reduction in drooling and training for the use of adaptive feeding utensils

An effacious partnership among families, Neurologists and therapists can help an individual with Parkinson’s Disease to live better.

Pallavi Malik

Speech Language Pathologist

Daniela Berg, Ronald B. Postuma. From Prodromal to Overt Parkinson’s Disease: Towards a New Definition in the Year 2040. Journal of Parkinson’s Disease, 2018; 8 (s1): S19 DOI: 10.3233/JPD-181457