Key Takeaways 

  • Parkinson’s can affect the muscles used to speak and swallow, not just the arms and legs. These changes are different for everyone. They can start earlier or later than other symptoms and move at their own pace. 
  • Many people with Parkinson’s feel they are speaking loudly enough when others can barely hear them. This comes from changes in how the brain gives feedback, not from lack of effort. Speech therapy designed for Parkinson’s can help people relearn what a normal voice feels like. 
  • Swallowing difficulties are worth taking seriously because they can raise the risk of aspiration pneumonia, a lung infection that can lead to a hospital stay. A speech-language pathologist can assess your risk, and everyday habits such as good oral care can help lower it. 
  • If your symptoms change while you’re waiting to see a specialist, ask your doctor to update the clinic. Many clinics decide who gets seen first based on need, so a clear update may help you get seen sooner. 
  • Questions from the community on soft voices, tiring speech, stuttering and swallowing, were answered live by speech-language pathologist Jasmine Cload of Speak Strong. 

Some people living with Parkinson’s describe a strange feeling: it seems like the whole world around them is going deaf. Friends lean in. Family members ask them to repeat themselves. But to the person speaking, their voice sounds perfectly normal. 

As Jasmine Cload, a speech-language pathologist in British Columbia who specializes in movement disorders, explained during a recent Parkinson Canada Tulip Talk, that experience has a clear cause, and it can be treated. Jasmine is the founder of Speak Strong, a virtual clinic serving people with Parkinson’s across BC. She is a certified provider of LSVT LOUD® and SPEAK OUT!®, two speech therapy programs designed for Parkinson’s. 

In this piece, we explore why Parkinson’s can change your voice and your swallowing, what you can do about it, and questions from the community that Jasmine answered live: on tiring speech, on a loved one who won’t seek help, and on stuttering. 

Why Parkinson’s can make your voice small 

Most people think of Parkinson’s as affecting the arms and legs: movements that are slower, stiffer or shaky. Jasmine explained that the same changes can affect the muscles of the face, mouth, throat and chest that we use to speak. The result can be a voice that is softer, hoarser, or more mumbled than before. 

Your health care team may call this hypokinetic dysarthria. You don’t need to memorize the term, but it helps to recognize it. In Jasmine’s words: “Parkinson’s is trying to take your movements, your speech, your swallowing, and make it small. In speech pathology, we want to do the opposite.” 

Why you might not notice it yourself. When we speak, the brain listens to our own voice and adjusts it without us thinking about it. With Parkinson’s, that internal feedback becomes less accurate. Many people genuinely feel they are speaking loudly enough when they are not. Jasmine was clear that when this softening happens it’s not a choice – it’s part of Parkinson’s. For care partners, that means a quiet voice isn’t the person trying to be quiet. Their brain just isn’t telling them how soft they sound. 

Relearning what “normal” feels like. Over months or years, a softer voice slowly becomes the new normal. So the same effort that once would have made you shout may now only bring you back to a normal volume. Speech therapy designed for Parkinson’s helps people recalibrate, so a voice that feels too loud to them sounds normal to others. This is different from traditional speech therapy, which often aims to make speech more automatic. With Parkinson’s, the goal is the opposite: more awareness and more control. That’s why Jasmine recommends finding a speech-language pathologist with training specific to Parkinson’s. 

Try this at home. Jasmine suggested a simple way to hear yourself the way others do: 

  1. Use your phone or computer to record a video of yourself reading out loud for two to three minutes. 
  1. Watch it with the sound off. Notice how your face and body move. 
  1. Turn the sound on, but turn your screen away. Just listen to your voice. 
  1. Watch the video with the sound on. 
  1. Record the same passage again, this time using a bigger “stage voice,” as if people at the back of a room need to hear you. Compare the two. 

Many people are surprised by how much their voice has changed, and by how much better the bigger voice sounds. 

What about singing? Singing in a choir is a wonderful way to connect and use your voice. But Jasmine noted that a strong singing voice doesn’t always carry over to everyday conversation. Her advice: keep singing if it brings you joy, and combine it with speech therapy to keep a strong speaking voice. 

A note for care partners. Communication is a two-way street. Asking “What would you like to drink?” leaves all the work to the other person. Asking “Would you like tea, coffee or water?” makes it easier, because they can answer in one word. Small changes in how you ask questions can lighten what Jasmine calls the “communication burden.” 

Swallowing safely 

The muscles we use to speak are the same ones we use to chew and swallow food, drinks, pills and our own saliva. So if speech has changed, swallowing may have changed too. Jasmine explained that it’s common to have more trouble with certain textures, at certain times of day, or when feeling anxious. That’s why a speech-language pathologist can help with both. 

Why it matters. Swallowing problems can lead to aspiration pneumonia. This is not the contagious, viral kind of pneumonia. It happens when food, liquid or saliva goes down the wrong way into the lungs and causes an infection. Research shows why this matters. A study of 339 hospital stays among people with Parkinson’s at one U.S. centre found that falls or fractures and lung problems were the two most common reasons for being admitted. Some of those lung-related admissions were caused by aspiration pneumonia. In about 2 out of every 100 hospital stays, people also developed aspiration pneumonia while in hospital, and in most of those cases swallowing checks were done only after it happened.1 A second review found that people with Parkinson’s are more than three times as likely as people without Parkinson’s to develop aspiration pneumonia. That review also notes that aspiration pneumonia leads to longer hospital stays.2 

Everyone has things go down the wrong way from time to time. Whether that turns into an infection depends on three main factors, according to Jasmine: 

Aspiration: whether food, liquid or saliva gets into the lungs, in one big choking episode or in small amounts over time 

Overall health: how well your body can fight infection, which is shaped by things like exercise, sleep, nutrition and lung health 

Oral care: how clean your mouth is 

The surprising one: brushing your teeth. When something goes down the wrong way, it carries bacteria from your mouth into your lungs. Jasmine explained that keeping your mouth clean can significantly lower the risk of infection, even for people who do have choking episodes. Her tip: if you’re worried about swallowing, brush your teeth before meals, not only after. 

Finding the right textures. There’s no single “safe” diet. Sauces and gravies can make food easier to swallow for some people. For others, mixing liquid with solid food is exactly what makes swallowing harder. A speech-language pathologist can identify which textures are best for you. A dietitian can help you adapt your favourite meals, and make sure softer foods still give you enough energy, since many people lose weight without noticing. 

Getting seen sooner. Many outpatient clinics, including speech, physiotherapy and occupational therapy, place people on their waitlist based on how urgent their needs seem. If your symptoms change while you wait, ask your doctor to send an update to the clinic. Be specific about how the change affects your life. For example, being worried your voice is too soft to call 911 is important information that can move you up the list. 

Questions from the community 

The webcast’s Q&A brought in questions from people living with Parkinson’s and the people caring for them, answered live by Jasmine. Watch the full video or listen to Part 1 or Part 2 of the podcast to hear them all. In the meantime, here are three that might resonate with you: 

“Speaking has become exhausting for me. What exercises can help me speak clearly and strongly, or even sing?” 

Jasmine explained that fatigue can be part of living with Parkinson’s, and your speech-language pathologist may want to work with your neurologist or doctor on it. But she also described a common cycle: speaking feels tiring, so we speak less, so the muscles get weaker, so speaking feels even harder. Her advice is to break that cycle. Look for times of day when your medication is working well, and use them to talk. “Even if you only have five minutes of good, clear, strong communication, I’d rather you do that than nothing.” 

“I know someone who needs help with their voice, but they resist getting it. What can I do?” 

First, Jasmine wanted the person who asked to know that this experience is common. Parkinson’s involves lower levels of dopamine, a brain chemical that helps with movement but also with feeling motivated and rewarded. That can make routines, appointments and home exercises feel much harder to start. “It’s not a reflection of their personality,” she said. Her approach is to make the first step small enough: watching a webinar together, learning what a speech-language pathologist does, or trying the recording exercise as a pair. Recording a short conversation between two people can help, since the difference in volume is easier to hear side by side. 

“Is stuttering part of Parkinson’s? Can anxiety make it worse?” 

It can be. Jasmine explained that Parkinson’s can make it hard to start a movement, like taking a first step when walking. The same thing can happen with the muscles used for speech, so it feels like getting stuck on a word. “It’s still us in there, but it’s hard to get our muscles to cooperate.” Like many Parkinson’s symptoms, it can get worse with anxiety, stress or when medication is wearing off. Speech therapy can help many people, and a speech-language pathologist may adjust the approach for someone who stuttered as a child. 

Other strong answers from the live audience covered drooling and dry mouth, how to change food textures, and how Parkinson-specific programs like LSVT LOUD® differ from regular speech therapy. 

Carrying it forward 

If your voice or swallowing has changed, you don’t have to wait until it gets worse to ask for help. A speech-language pathologist with training in Parkinson’s can assess where you are today and give you tools to protect your voice and your safety. Parkinson Canada’s Support & Information Team can help you find services, education and support in your area. 

Phone: 1-888-664-1974 Email: support@parkinson.ca 

Helpful Parkinson Canada resources 

References 

  1. Martinez-Ramirez, D., Almeida, L., Giugni, J. C., Ahmed, B., Higuchi, M.-a., Little, C. S., Chapman, J. P., Mignacca, C., Wagle Shukla, A., Hess, C. W., Wheeler Hegland, K., & Okun, M. S. (2015). Rate of aspiration pneumonia in hospitalized Parkinson’s disease patients: A cross-sectional study. BMC Neurology, 15, 104. https://doi.org/10.1186/s12883-015-0362-9 
  1. Chua, W. Y., Wang, J. D. J., Chan, C. K. M., Chan, L.-L., & Tan, E.-K. (2024). Risk of aspiration pneumonia and hospital mortality in Parkinson disease: A systematic review and meta-analysis. European Journal of Neurology, 31(12), e16449. https://doi.org/10.1111/ene.16449