How Parkinson's Impacts Speech

Part 1: Seven Things I've Learned from Working with People with Parkinson's Disease. A Speech Pathologist's Perspective.

By Sophie Walsh, Senior Speech Pathologist

Over the years, I’ve had the privilege of working closely with people living with Parkinson’s disease. While every person’s journey is different, some common themes have emerged - some that surprise even the people living with them. These insights are based on real conversations, shared frustrations, unexpected breakthroughs, and a lot of mutual learning. Here are reflections that stick with me:

1. “My wife/husband (or dog) is going deaf!”

If I had a dollar for every time someone with Parkinson's said this to me, I'd be writing this from a yacht! One of the lesser-known features of Parkinson's is the way it affects self-monitoring (your ability to feel what is happening with your body), especially of voice. Many people are genuinely surprised to learn they're speaking more softly than usual.

This isn't just a matter of perception - it comes down to changes in the brain's messaging system. Parkinson's affects an area of the brain called the basal ganglia, which helps coordinate the muscles in the body, including those involved in speech. This part of the brain relies on a chemical called dopamine (a brain chemical that helps produce smooth, automatic movement) to send clear signals. In Parkinson's, dopamine levels drop, so these signals change. Movements become smaller, or “dampened,” including the voice, and the brain's ability to register its own movements - like how loud or expressive a voice is - becomes less reliable. What feels like a normal speaking volume on the inside is often coming out much quieter to everyone else.

It's not stubbornness or denial - it's a genuine disconnect between how things feel and how they actually sound. The encouraging part: once people become aware of it, they can make real changes.

2. “It feels like I’m shouting!” – Why the effort feels bigger than the outcome

Because of the altered self-monitoring and perception of volume, people with Parkinson’s often don’t feel like they need to speak louder. Individuals often have to practise consciously putting in extra effort to produce speech that is within a “normal” volume range. What might feel like shouting, is actually just reaching a typical conversational volume. Maintaining that level of effort consistently is understandably tiring, though it can become a learned skill.

Encouragingly with structured practice and repetition, the brain can often adapt. Evidence-based voice therapy programs like LSVT LOUD® or SPEAK OUT!® assist people to "recalibrate" their internal volume and strengthen their voice through practice. They are designed specifically to help retrain the brain and body to accept that stronger effort is the new normal. These programs are grounded in the principles of motor learning, and they show measurable improvements in voice strength, clarity, and confidence.

Stay tuned for Part 2 of our chat with Speech Pathologist Sophie Walsh.