A voice that gets quieter, or speech that slurs so it doesn’t carry, is called hypophonia. It is a common symptom — about 75% of people with Parkinson’s are known to experience it at some point as the disease progresses.
Why does the voice get quieter?
The bradykinesia and rigidityBradykinesia is a general slowing of movement; rigidity is stiffness in the limbs. Both are hallmark motor symptoms of Parkinson's disease.Learn more that make your arms and legs move slowly and weakly show up in the muscles that produce your voice as well. The vocal cords don’t close fully, giving the voice a breathy sound, and the breath support you need to speak weakens too. Slowness in the arms and legs is visible from the outside, but the voice isn’t — so both you and the people around you often notice it later than you otherwise would.
Why it is hard to notice yourself
The muscles that make your voice are affected and weaken like any other motor symptom, but the problem is that most people feel they are speaking at about their usual volume. This is understood to happen because the brain isn’t accurately registering how loud the voice actually is. So when family members say “I can’t hear you,” it can sting — but the odds are good that your voice really has gotten quieter.
What you can try right away
- Make eye contact and talk face to face. Facing someone lets them read your mouth as well, which makes getting through much easier.
- Speak in short sentences and pause fully between them. If you try to say a lot on one breath, your voice gets quieter the further you get.
- Talk in places with less background noise. Just turning off the TV or radio helps.
- Consciously think “speak loudly” as you talk. You have to speak much louder than it feels like you are, just to reach your normal volume.
There is professional voice therapy too
LSVT LOUDThe most widely used professional voice therapy program for the voice and speech problems of Parkinson's disease. It runs 16 sessions over four weeks, and the effect has been reported to last up to two years.Learn more is the most widely used professional treatment program for voice problems in Parkinson’s. It runs four times a week for four weeks, 16 sessions in total, and focuses on one thing only — producing a loud voice. Yet that focus has been reported to improve intonation and articulation accuracy as well, with the effect lasting up to two years. It is now available remotely too.
Singing can help as well
Short of professional therapy, there is research suggesting that singing regularly helps your breathing capacity and your voice. Singing uses the respiratory and vocal systems together while being enjoyable enough to keep up — so if you take it further into something like a choir, an activity you do with other people, it can help emotionally too.
You can use assistive devices
If your symptoms are severe, a voice amplifier — worn on the body or clipped to your clothes — is another option. Because it raises your volume immediately, it is particularly useful at medical appointments and in conversations with several people.
Tell the people around you in advance
If the situation where someone keeps asking “What?” repeats itself, both sides tire of it quickly. Letting your family and the people you see often know in advance that a quieter voice is a symptom of the disease makes it easier for everyone to keep the conversation going without strain.
This article is not a substitute for medical diagnosis or treatment. If you are worried about changes to your voice, consider asking your care team for a referral to a speech therapist.
