Improving Communication in People With Parkinson’s Disease

Introduction

Parkinson's disease is an age-related disorder that affects the nervous system, especially the motor system. The motor system in the human body is responsible for various functions, like movements and muscle contractions. When the muscles required for speech get affected, speech difficulties arise. Symptoms of Parkinson's disease appear slowly. People above the age of 60 are at higher risk.

What Are the Symptoms Of Parkinson’s Disease?

Parkinson's disease presents with symptoms like;

• Tremors.

• Slow movement.

• Swallowing difficulties or dysphagia.

• Loss of smell.

• Constipation.

• Changes in handwriting.

• Speech difficulties or dysarthria.

• Stiffness in body parts.

• Limited facial expression.

• Low thinking abilities.

• Depression and anxiety.

• Psychosis.

Speech difficulties in Parkinson's disease is a major issue faced by patients, their families, and caretakers, as communication plays a big role in their daily activities. Studies suggest around 75 % to 90 % of Parkinson's patients will exhibit speech difficulties.

What Communication Problems Are Faced by People With Parkinson’s Disease?

Speech problems appear as early symptoms. Patients find it difficult to have a conversation due to their speech and voice issues. Some of the communication difficulties faced by Parksinon's patients are due to the following:

• Voice with only one pitch or lower pitch.

• Nasal voice.

• Breathy voice.

• Abnormal fluency.

• Slow speech.

• Repetition of words with distinct letters.

• Increased hoarseness in the voice.

• Stammering speech.

• Difficulty in moving tongue, lips, and jaw to speak properly.

• Mumbling words, especially at the end of the speech.

What Is the Reason for Speech Difficulties in Parkinson’s Patients?

As Parkinson's disease affects the motor network of the nervous system, muscles get affected. A group of muscles and nerves work together to produce speech in humans. Parkinson's disease is caused by the reduction of nerve cells in the substantia nigra area of the brain. These nerve cells produce dopamine, a neurotransmitter that helps in muscle movements. The depletion of nerve cells leads to decreased dopamine production, which impairs muscle activities. As a result, speech muscles also get affected, leading to speech difficulties.

Researchers have also found other causes that can contribute to communication problems in Parkinson's patients. ​​Parkinson's patients have been found to speak with less effective chest wall movements than people who speak normally. The speed at which lips and jaws move during speech is also less. In addition, vocal cords open during inhalation and close during speech and swallowing. In Parkinson's patients, vocal cords were found to close partially, which led to speech disruption.

How to Improve Communication in Parkinson’s Patients?

Parkinson's patients are advised to consult a speech therapist when voice and speech difficulties symptoms appear. They help patients enhance their communication by training them in non-verbal communication, which means communicating with eyes, body language, facial expressions, and so on. Speech therapists also introduce devices that assist patients in communicating efficiently.

The following tips help patients to communicate effectively:

• Practice speaking daily by repeating the speech on the radio or television.

• Practice loud reading from newspapers, books, magazines, etc.

• Start speaking slowly. Try to speak only two words in a breath initially. Later it can be increased to more words.

• Practice speaking to family members or caretakers by looking at their eyes.

• Exercises to improve speech, such as deep breathing, laryngeal push-ups, producing sentences, tongue exercises, etc., must be done regularly.

• Throat dryness can disrupt the speech. To avoid this, drink plenty of water and carry a water bottle while going out.

• Patients can learn telegraphic speech, that is, speaking with short and simple sentences without verbs, for example, 'I sit' instead of 'I am sitting.'

• Carrying a pen and paper while going out will help communicate if a patient cannot speak properly. They can try writing or carrying an alphabet sheet to point out letters to convey their needs.

• Consider learning gestures or simple sign languages for basic things.

What Are the Devices Used By Parkinson’s Patients to Communicate Efficiently?

Many electronic and non-electronic devices are available to assist in speech, specifically designed for Parkinson's patients. Some of them are:

• Voice Amplifier: Patients with a low voice can use amplifiers to make their voices more audible and clear. These wearable devices are very easy to use and are available commercially as many companies manufacture them.

• Smartphone Applications: Several smartphone apps have been developed which enable Parkinson's patients to communicate or convey their needs using pictures and voices.

• Telephone Relay System: This is a specific system where a person with speech or hearing disabilities can communicate by telephone using text messages to a person with or without these disabilities. Parkinson's patients with speech disabilities can use this during telephonic communications. It is also available in smartphones nowadays.

• Palatal Lift Prosthesis: It is a dental appliance commonly used in people with speech difficulties. It avoids nasal speech by lifting the soft palate and hence prevents the escape of air from the nose while speaking.

• Computer Voice Synthesizers: These systems can convert text to voice by mimicking human voice.

How Does One Communicate During an Emergency Situation?

• Use bells, buzzers, or alert buttons to alert others about an emergency.

• Carry a whistle or buzzer while going out. During an emergency, this will help to gain people's attention.

• Save all the emergency numbers in the cell phone and pre-program them to dial automatically during an emergency.

• Patients living alone should consider getting an emergency life button.

What Measures Can Be Adopted by the Family or Caretakers?

• Learn gestures and simple sign language along with the patients.

• Always communicate by looking into their eyes.

• Try to ask simple questions where they need to answer only yes or no.

• Help them with electronic speech aids.

• Encourage them to practice speech exercises.

• As listeners, be calm and give them time to form a sentence.

• Accompany them for their speech therapy.

Conclusion

Communication problems are very common in people with Parkinson's disease. About 75 to 90 percent of patients develop speech and voice impairments. Their voice becomes low, nasal, and hoarse, and their speech slow, mumbling, stammering, and repetitive. People face many problems and lose their confidence due to communication issues. However, many methods like speech exercises, loud reading, and practicing sentence formation can improve speech. A speech therapist can train and guide patients to follow different methods and devices to enhance their speaking skills. With proper care and support, Parkinson's patients can improve their communication skills, boost their confidence and improve their lifestyles.