Parkinson’s is a neurodegenerative disease that affects muscle movement and the central nervous system. Among the functions it affects, there are two of vital importance: communication and swallowing. These two areas are worked on through speech therapy, the language area being fundamental in Parkinson’s, so that the patient can communicate and not see his quality of life deteriorated.

Parkinson’s disease

Parkinson’s is a neurodegenerative disease that was discovered in 1817 by the physician James Parkinson. And, in 1997, the World Health Organization (WHO) established April 11 as World Parkinson’s Day.

Through a chronic process, Parkinson’s degenerates and destroys dopaminergic neurons, which are responsible for transmitting dopamine, necessary for muscle movement and the central nervous system. This implies neuronal cell death from the brainstem to the cerebral cortex. As a result, the person sees different functions altered: sensorimotor control, balance, gait, autonomic function, mood, cognition, communication (language in Parkinson’s and facial expression) and swallowing (the passage of food or other substances from the mouth to the stomach).

The disease affects each person differently. There are different pharmacological treatments and palliative treatments to control muscular symptoms, which are dealt with by physiotherapy professionals; and symptoms at the communication level, which are treated from the area of speech therapy, specifically language in Parkinson’s disease. The aim of both therapies is to improve the patient’s quality of life.

How does Parkinson’s affect speech?

Up to 90% of people with Parkinson’s have speech and voice disorders at some point during the course of the disease. Therefore, language in Parkinson’s is affected. The most common symptoms include reduced voice intensity, monotonia, hoarseness, broken voice and imprecise articulation. The cause of these symptoms is not known exactly. Their origin may be related to the stiffness, slowness and poor range of motion characteristic of the disease.

These people may not be aware that their voice is becoming weaker and their speech increasingly unpredictable and more difficult to understand, having a language in Parkinson’s more imprecise and indecipherable. All this has a negative impact on them and affects their communication at work, family and social environment.

Therefore, an evaluation of the symptoms by a speech therapist is necessary in order to start rehabilitation as soon as possible.

What does speech therapy in Parkinson’s disease consist of?

Speech therapy in Parkinson’s disease works in two fundamental areas: language in Parkinson’s disease, with the aim of improving the communication of those affected; and swallowing techniques.

Techniques to improve language in Parkinson’s disease

On the one hand, fundamentally, people with Parkinson’s learn techniques to be better understood when they speak, since language in Parkinson’s is impaired by the disease. These techniques to improve language in Parkinson’s are: relaxation, breathing, utterance and articulation exercises, and form the basis of speech therapy intervention.

• Vocal cord relaxation training avoids voice overload and fatigue. In this way, the patient can make full use of his or her voice, thus improving speech in Parkinson’s disease.
• Breathing exercises stimulate and raise awareness of the respiratory cycle of phonation (nasal-buccal, buccal-nasal). This allows maintaining vocal hygiene and prevents slight language impairment in Parkinson’s disease.
• Emission exercises are those with which we re-educate the voice to emit it in the right tone. In this way, we reduce vocal cord fatigue and improve speech in Parkinson’s disease.
• Phoneme articulation exercises are aimed at the re-education of articulation of some phonemes and reduce the loss of tonicity that affects language in Parkinson’s disease. In this way, we improve pronunciation and, therefore, the patient’s communication with others.

Swallowing problems and techniques

They are also given information and taught techniques for safe feeding, avoiding false feeding routes that can lead to pneumonia, malnutrition and dehydration. For these difficulties are common and can appear at different stages of the disease, varying in their course, with difficulties worsening as symptoms progress. Symptoms include: choking, coughing, drooling, difficulty taking pills, increased time spent eating, weight loss and pneumonia.

Language in Parkinson’s

Language in Parkinson’s is not only affected at the functional level and worsens the patient’s verbal communication with others, but also affects non-verbal communication, that which is manifested through gestures, expressions or body movements.

Facial expression

It is very common that these people show difficulty in their facial expression, also called hyponymia or poker face. As time goes by, they begin to show difficulty in moving the muscles of the face, greatly reducing gesticulation and blinking.

Facial expression is a fundamental element in communication, since it conveys the feelings of the person speaking with respect to his or her speech. When this element fails, communication deteriorates, since the intention of the speaker is not deduced by his facial gestures and makes it difficult to understand the language in Parkinson’s disease.

Myofunctional therapy

In speech therapy rehabilitation, facial expression will be worked on to improve language comprehension in Parkinson’s disease, through myofunctional therapy.

This therapy is a discipline that is responsible for preventing, assessing, diagnosing and correcting orofacial dysfunctions that can interfere both in the production of speech and on the structure of the teeth and jaw relationships.

The main goals of myofunctional therapy, in the area of speech in Parkinson’s disease, are to reduce speech loss and to preserve facial muscle tone. In this way, communication is altered as little as possible and the quality of life of the Parkinson’s patient is preserved or improved, since language is a fundamental part of our life.

The intervention can be active, with voluntary participation of the patient, or passive, without it. This reeducation is mainly based on specific exercise, by means of praxias, massages, mechanical stimulation, postural control, etc. Its purpose is to achieve an orofacial muscular balance that allows adequate neuromotor patterns of behavior of the orofacial system.

Conclusions

Language in Parkinson’s disease is one of the functions that is altered and it is important to carry out a treatment, both preventive and reeducation, so that the patient has an acceptable quality of life. On the other hand, preventing the loss of tone in the facial muscles in combination with therapy aimed at correct swallowing not only improves quality of life, but also prevents other symptoms and diseases derived from incorrect swallowing, which can affect the patient’s life expectancy.

Consequently, we can affirm that speech therapy not only improves the patient’s quality of life, but can also extend it.