Vocal Problems for People with Parkinson’s Disease
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Parkinson’s disease disrupts how the brain communicates with the rest of the body, in particular the muscles. You develop festinating gait. You have tremors. Your handwriting diminishes until it looks like jagged fragments of black thread on the page.
One set of muscles that you might not incorporate in this inventory are the muscles you need to talk. These include the vocal cords, the diaphragm, and other muscles in your chest and throat. Yet according to an article I just read (Voice Characteristics of People with Parkinson’s Disease: An Overview on Baseline Vocal Characteristics and Guidelines for Therapeutic Singing), some 90% of the Parkie population is speech impaired.
Let’s list the problems. Direct quotes are in italics, although I have cleaned up (I hope) many grammatical errors. (It was written by researchers in Malaysia.)
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- Hypokinetic dysarthria: This occurs when the larynx slows down because the muscles aren’t sufficiently activated. The results: soft speech, lack of rising-falling intonation (monotone), slurred speech, vocal tremor, the voice becoming breathy, and reduced support from the lungs and respiratory systems.
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- Increased isolation and depression: “The impaired voice and speech don’t only affect the PwP [Person with Parkinson’s] but also create serious impacts on the PwP’s caretakers and immediate family members, as it causes frustration and further leads the PwP to withdraw from the daily conversations as well as social events, which then increases the risk of developing psychological disorders such as depression and anxiety, which seriously affect their quality of life.”
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- Shallow breaths: You’re likely to breathe more rapidly than normal. According to the article, “the healthy respiratory rate in a healthy adult should be within the range of 12 to 20 breaths per minute.” However, the Parkies in this study were breathing between 14 and 28 breaths/minute, averaging 20 breaths/minute. This leads to the Parkie having a softer voice when speaking, as most of the faster breaths are shallow.
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- Limited vocal range: When singing, many Parkies have a limited range between their lowest note and the highest. Songs that require a wide range of pitch (like “The Star-Spangled Banner”) become impossible.
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- Additional issue: Unfortunately, if you have Deep Brain Surgery, you’re more likely to suffer from speech problems going forward.
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However, despite all this, you can regain some of your vocal powers by working with a speech therapist and by singing. This is especially worthwhile as the disease progresses. Without training in speech and singing, you lose control of your throat and can easily choke when swallowing. I recall part of a blog post I published many years ago about the end of life for the husband of radio host Diane Rehm:
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I can’t deny that a scary end-of-life scenario doesn’t happen for some people with Parkinson’s. Recently the New York Times published an editorial promoting physician-assisted suicide, in which it highlighted the case of John Rehm, husband of radio host Diane Rehm. “Severely crippled by Parkinson’s disease,” the Times notes, “his only option for ending the suffering was to stop eating and drinking.” His wife writes in a subsequent letter that “after suffering two bouts of pneumonia, brought on by John’s loss of muscular ability to swallow correctly, his doctor determined that John had six months or less to live and prescribed hospice care.” His agonizing death from self-imposed starvation was, Diane Rehm says, “an example of a courageous man who saw his disability as continuing to lead him to further degradation and loss of dignity. He chose to die on his own terms, without further loss of his basic abilities to function as a full human being.”
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What to do? Find a speech therapist who understands Parkinson’s, and join a choral group if possible. On your own you can create a playlist of songs that you like and that you can sing to (in other words, they’re in the right key for you), then sing out, Louise! Practice singing more and more loudly, and see if you can take fewer breaths to draw out your phrasing.
Here’s an example of a song on YouTube that’s perfect for my pitch range and in general is a lot of fun for me. It’s “The Wells Fargo Wagon” from the 1962 movie “The Music Man.”
(Note: You may have to click the “Watch on YouTube” button in the lower left corner to see the video,)
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One more suggestion: grab a few of your Parkie friends and family, and head for the nearest karaoke bar! Beer’s on me!
Thanks Bruce