Parkinson’s can impact the way you communicate with others: speech, voice, facial expression and handwriting may be affected.
Common communication difficulties arising from Parkinson’s include:
- Speech: this may become fast or slow, rushed, mumbled or slurred. Some people notice a stutter or difficulty starting to speak. Voices can become quieter, breathy, hoarse, or change in pitch. Using the telephone and communicating in social situations with background noise or a lot of people can be difficult. You may find it hard to compose your thoughts and sentences which can make it difficult to respond in a fast-moving conversation.
- Facial expression and body language: both can become slow or reduced. The face at rest may lack expression resulting in people misreading how you feel. Facial expressions, such as smiling or frowning, may become difficult. Sometimes body language lacks spontaneity, and gestures, such as nodding, may be missing. By contrast, abnormal involuntary movements (dyskinesia) can make it difficult to control the face and mouth sufficiently to speak or otherwise communicate.
- Handwriting: this may become small, cramped and ‘spidery’, making it difficult to read. Writing often starts out normally but reduces in size as the line progresses. This is known as micrographia and is one of the earliest signs of Parkinson’s. It is caused by a reduction in the size of a movement over time (hypokinesia) and a lack of control when making small movements.
Communication skills may fluctuate during the day, depending on how well medication is working. It is often family and friends that notice the changes to speech before the person with Parkinson's does. Communication problems can affect quality of life and may reduce confidence to interact with others. It is important though to continue socialising in order to maintain emotional wellbeing and minimise the chance of becoming depressed or socially isolated.
What help is available?
Adjusting Parkinson’s medication may help, for example levodopa may improve your volume and clarity when speaking. However these benefits may only last for a short time and seeking advice from a speech and language therapist will enable proactive strategies to be developed.
A speech and language therapist will be able to advise on ways to improve your speech such as:
- exercises and techniques to improve breathing, voice, speech and word finding difficulties
- equipment and special tools, for example amplifiers to overcome problems with volume, pacing boards to help with your rate of speech, iPad apps to give visual feedback
- advice on dealing with specific situations that make speech difficult, for example in a crowded room, talking on the phone
- alternative means of communication if speech is very difficult to understand. For example, text-to- speech apps, Lightwriters (small, hand-held computers), or picture-based communication aids.
It is a good idea to seek an early referral to speech and language therapy, should any changes to speech, voice or word finding be noted. The therapist will be able to suggest how to prevent difficulties before they arise or reduce their impact. They can also monitor your symptoms, assess how you are coping and suggest new strategies as appropriate.
Facial expression, tone of voice and body language
We all use facial expression, tone of voice and body language to convey our thoughts and mood. Reduced communication using these important tools may mean that you are misunderstood, or your non-verbal expression may not match your verbal communication, which can lead to confusion.
A speech and language therapist can address strategies for supporting conversation, for example, practicing alternative ways to let people know that you have something to add to a discussion. Multidisciplinary team members may also advise on postural exercises to facilitate effective voice projection and greater control over body language.
Visual tools can give feedback on loudness, pitch and melody. Working on vocal pitch, stress and emphasis has been shown to improve intelligibility. There is also an increasing body of evidence showing the benefits of group singing sessions on communication skills in Parkinson’s.
A physiotherapist will be able to help you with techniques and exercises to reduce rigidity and strengthen muscles to give you greater control over your body language.
An occupational therapist can advise on ways to improve your handwriting. They can recommend special equipment and tools, such as:
- thick or padded pens that are more easily gripped
- weighted cuffs to improve control
- clipboards or a non-slip mat to stop paper from slipping
- recording devices to aid memory and recall
How can I help myself?
- Ensure good breath support.
- Project your voice by imagining throwing your voice to the other side of the room.
- Use loudness feedback apps and ask family and friends if the voice you are using sounds a normal level of loudness.
- Record yourself and play it back, judge your own loudness and rate it on a loudness scale.
- Notice if your voice is fading over the length of a sentence and drive your voice louder to the end.
- Practice voice projection by reading aloud so you feel more comfortable using this louder voice.
- Slow your rate of speech using the ‘Loud each word’ technique, ensuring you say all the words in the sentence loudly.
- Pacing dots or an alphabet chart can also be handy for slowing pace of speech – a speech therapist can advise on this further.
- If someone doesn’t understand you, say each word in the sentence loudly.
- Make sure you are sitting or standing comfortably, in as upright a position as possible. Voice quality can be affected by a stooped posture.
- If you are in a situation where you find communication difficult, try to remain calm and relaxed – stress will only make your symptoms worse.
- Try to move away from noise or pause the television.
- Avoid talking to someone who is in a different room.
- If speech is very difficult text-to-speech apps might be useful to explore as a back-up to communication.
- Carry an alert card in your purse or wallet that states you have Parkinson’s and may have difficulty communicating so need to be given time. The EPDA has an online PD Doc with useful messages translated into 25 languages. You can choose your language and enter personal details before printing to keep with you in case you get into difficulties when out and alone.
- Notice when your writing is getting smaller and think ‘big’ exaggerating the size of the letters to keep them big.
- It may help to stop writing after each line and then relax, breathe deeply and stretch the arms widely before continuing.
- If you need to write longer amounts of text on the computer, you could try an audio to text converter, for example Dragon dictation.
- Writing lists and capturing ideas might be logged using an audio recorder, for example the Microspeak sound recorder.
- Signing cheques or other documents may be frustrating when your signature is not consistent. Using a Chip and PIN card may be easier as you need only to enter numbers on the keypad. If you do have to write a cheque, it is worth asking the bank or shopkeeper to fill in the details so all you have to do is sign. You can also shorten your signature so that it is easier to write – but make sure your amended signature is the one registered with your bank. In some instances carrying a form of identification with a photo, such as a passport, can be useful, or some banks may be able to issue a bank card with photo. In some countries rubber stamp signatures are acceptable, but this is not the case everywhere.
- Set up standing orders or direct debits from your bank account for regular expenditure, or use telephone banking.
For family, friends and carers
Communication difficulties also affect family, friends and carers. Problems can be frustrating to deal with and misunderstandings may arise. The following suggestions may help when communicating with someone who has Parkinson’s:
- Be patient and give them plenty of time to collect their thoughts and communicate. Don’t walk away while they do this.
- Don’t interrupt and finish their sentences for them.
- Talk normally, without shouting or sounding stressed or impatient.
- Make sure you are both in the same room and can see each other.
- Listen carefully and turn off any distractions such as the radio or television.
- If you don’t understand something, ask them to repeat it louder and slower. Don’t pretend that you have understood if you haven’t.
- Encourage them to engage in a conversation but without putting them under pressure.
- Reassure them if they have difficulty communicating. A simple squeeze of the hand can be very calming and encouraging.
Your healthcare team
Building a good relationship with your doctor and other members of your healthcare team, is an essential part of living with Parkinson’s. You and your team are partners throughout your journey, and this partnership begins from the moment you receive your diagnosis. Both parties will want to get off to a good start and form a solid basis for ongoing dialogue and support. This will mean that you are comfortable expressing yourself and confident in the advice you receive. Establishing an easy and relaxed relationship with your healthcare team can enhance your quality of life and will help you to manage your Parkinson’s as well as is possible.
Like all relationships, it requires effort on both sides to make it successful. Your doctor or other professionals in your team need to be open and approachable and must be able to understand your needs well. To achieve this, you need to provide the information they require honestly, neither glossing over difficulties you encounter nor exaggerating them. Trust is also an integral part of a good relationship and this too requires effort and commitment - you both need to engage with each other, be open and transparent so that you make the most of the time together.
Support groups and networking
There are many different types of support groups. But they can broadly be defined as a group of people who have something in common - in this context Parkinson’s - who meet to discuss and exchange ideas and information, or voice concerns. The group may also include partners, family and/or carers.
Each group will be individual with varying activities, meeting places, opportunities and capabilities. Sometimes there is a trained leader, such as a counsellor or social worker, although many Parkinson’s groups are run by people with the condition as well as experienced volunteers. Groups often meet once a month, but many meet more regularly.
Most members find participating in a group supportive and a good way to interact with others in a similar position. Many Parkinson’s organisations have support groups. To find out about how groups operate in your own country contact your national Parkinson’s association.
Support groups and Parkinson’s
A support group is not a substitute for the support of family and friends but can provide an opportunity to:
- make new friends and enjoy the social opportunities support groups offer
- extend your support team which can make it easier to get the help you need, when you need it
- provide support for your carer and close family
- minimise feelings of isolation and having to cope with Parkinson’s alone
- share personal experiences and learn from these
- share practical ideas to help with day-to-day living and difficulties you encounter
- share medical information and sources of information on Parkinson’s
- share concerns with people outside your close family and friends, who you may find it easier to talk to
- learn about clinical trials and opportunities to participate in them (but it is important to discuss this with your doctor before committing yourself).
Deciding to join a support group is a very personal. If now doesn’t feel like the right time to join, take note of group details and later you may feel that the support offered could be helpful.
If you’re unsure, it may be useful to attend one or two meetings before you commit to joining a group. Talk to members to find out more about what the group offers and any aspects that are of particular interest to you. Remember that almost everyone is apprehensive about going first time, but if after several meetings you don’t feel comfortable then see if there is another local group as no two groups are the same.
The Parkinson’s association in your country may be able to provide contact details for local groups. Your care team may also have suggestions or you could look in your local library, local newspaper, or on the Internet.
If there isn’t a group in your area then you might want to consider setting one up. Your national Parkinson’s association may be able to provide helpful information on starting a new group.
Networking has many similarities with support groups; it connects people with similar interests who can help each other by sharing information and opening up opportunities for mutual benefit, but without the organised meetings of support groups. Networking operates via the Internet on social networking sites such as instant messaging, blogs, forums and message boards. These provide the opportunity to ‘chat’ with others simply by typing your comments and queries.
Networking allows you to interact outside of set meetings at any time of the day or night. The anonymity of networking is particularly attractive if you are concerned about getting too involved in face-to-face support groups. However, many people find that Internet groups are a useful addition to – but not a replacement for – actually meeting with others to share your concerns, especially when dealing with a condition such a Parkinson’s.
As with any online communication, it is important to be vigilant about providing personal information. Never give anyone you do not know or trust any personal information such as your address or details of bank accounts or credit cards as this may be used fraudulently. For more information see Using computers and the Internet.
Content last reviewed: July 2020
We would like to thank Caroline Bartliff (SLT, Derby Parkinson's Team, UK) for her help in reviewing this information.