Speech Therapy For Parkinson’s Disease: A Helpful Guide For SLPs

While there’s no cure for Parkinson’s disease, there’s plenty that speech therapy can do to help improve your patients’ quality of life.

This article covers the basics of speech therapy for Parkinson’s disease. You’ll learn common symptoms, plus how to assess and treat:

• Swallowing
• Cognition
• Voice
• Dysarthria
• Drooling

Your First Patient With Parkinson’s Disease: What To Expect

Parkinson’s disease (PD) is a progressive neurological movement disorder that can cause motor speech, swallowing, voice, language, and cognitive deficits. 

The number of people with Parkinson’s disease has doubled over the past 25 years. It’s now the second most common neurodegenerative disorder in the world (World Health Organization, 2023; Cosentino et al., 2022).

How your patient presents will depend on how advanced the disease is, co-existing medical conditions, the presence of cognitive deficits, care partner support, and others.

Here are common speech therapy-related symptoms in patients with Parkinson’s disease.

Common Symptoms of Parkinson’s Disease

Dysphagia: Swallowing impairments may involve the oral, pharyngeal, and/or esophageal phases. 

Hypokinetic Dysarthria​:

• Monotone pitch
• Reduced loudness
• Hoarseness
• Rapid speech rate
• Phoneme repetition
• Imprecise articulation
• Monotone speech pattern (Atalar et al., 2023)

Cognitive Deficits:

• 25% of people with PD have mild cognitive decline (Aarsland et al., 2010)
• 27% of people with PD will have dementia at 10 years of disease duration, 50% at 15 years, and 74% at 20 years (Gallagher et al., 2024)

Other Common Symptoms: 

• Respiratory dysfunction
• Asymmetric resting tremor​ 
• Bradykinesia​ or slow movement
• Rigidity​ of the body, face, and limbs
• Difficulties sleeping
• Gait disturbances
• Masked facial expressions (hypomimia)

Speech Therapy For Parkinson’s Disease

Speech Therapy Assessments For Parkinson’s Disease

Here are some FREE speech therapy assessment resources for Parkinson’s disease. See our Complete Guide to Adult Speech Therapy Assessments for more ideas.

Swallowing Assessment Resources:

• MASA scoring sheet
• Yale Swallow Protocol
• EAT-10
• ROMP-saliva (appendix 10)

Voice Assessment Resources:

• Praat Software
• CAPE-V
• Voice Assessment Norms
• Voice Handicap Index

Speech & Communication Assessment Resources:

• Max phonation time norms
• DDK rates norms
• Rainbow Passage
• Cookie Theft Picture

When deciding what areas to assess, consider your patient’s previous level of functioning, premorbid conditions (e.g. dementia), care partner support, and personal goals.

Focus your assessments on what you believe are the main deficits affecting your patient’s overall quality of life and safety, then go from there.

Dysphagia In Parkinson’s Disease

Dysphagia is very common in PD. It can affect the oral, pharyngeal, and esophageal phases. 

Assessing Dysphagia in PD

If your patient has a swallowing evaluation order or their chart review had dysphagia red flags (i.e. pneumonia secondary to aspiration), complete a full clinical swallow evaluation.

You may also complete a 3-ounce water test and oral motor examination. If there are signs of dysphagia, proceed with the full clinical swallow evaluation.

When appropriate, also recommend an instrumental swallowing assessment.

Treating Dysphagia in PD

The goal of dysphagia treatment is to improve the safety and efficiency of swallowing. Whenever possible, use the results of an instrumental assessment to guide your dysphagia treatment in patients with PD (Schindler et al., 2021).

There are plenty of evidence-based swallowing treatments for patients with Parkinson’s disease, including:

• Oral care! Useful for any patient
• Patient/care-partner education
• Swallowing exercises
• Compensatory strategies, like:
  • Diet modifications, swallowing maneuvers, chin-down posture with thin liquids, postural adaptations, increased sensory input, etc.
• Respiratory muscle strength training, like EMST
• Intensive voice treatments, like LSVT LOUD® (Winiker and Kertscher, 2023)
• Intensive skill training therapy (Athukorala et al. 2014)

(Schindler et al., 2021)

Learn more about Parkinson’s Disease Dysphagia Treatments.

Voice Disorders In Parkinson’s Disease

If you notice signs of a voice disorder during your chart review, screening, or patient interview, complete a voice assessment.

Evidence-based voice treatments include:

• SPEAK OUT!®
• LSVT LOUD®
• Compensatory strategies
  • Choose a quiet space and improve lighting, use a personal amplifier, stay hydrated, use AAC
• Respiratory training, including EMST, IMST, or incentive spirometer (van de Wetering-van Dongen et al., 2020)

Dysarthria in Parkinson’s Disease

Patients with PD often present with hypokinetic dysarthria. Common symptoms include less volume, monoloudness, mono-pitch, breathiness, and harsh voice.

Assessing Dysarthria in PD

If your patient has signs of motor-speech deficits, complete an oral motor exam and full motor speech examination (e.g., DDK rate, automatic speech tasks, and maximum phonation time; Kalf & de Swart et al., 2011).

Any of the speech subsystems may be affected by hypokinetic dysarthria, including phonation, articulation, respiration, resonance, and prosody. If indicated, assess them all carefully (Atalar et al., 2023).

Treating Dysarthria in PD

Evidence-based dysarthria treatments for Parkinson’s disease by subsystems include:

• Articulation
  • Cueing and biofeedback
  • Practicing a hierarchy of speech sounds
  • Pacing (pacing board)
  • Clear speech strategies
  • Writing keywords, first letter, and other AAC
• Phonation
  • Breath control exercises
  • LSVT LOUD
  • SPEAK OUT!
• Respiration
  • Respiratory muscle strength training (EMST and IMST)
  • Postural adjustments
  • Diaphragmatic breathing
  • Building breath control
• Prosody
  • Sentence stress
  • Contrastive stress
• Resonance
  • Refer out as needed
  • Biofeedback
  • Forward focus
• Other Compensatory Strategies
  • AAC
  • Environmental modifications
    • Improve lighting, make sure you can see each other’s faces, using FaceTime and WhatsApp instead of phone calls
  • Personal amplifier

Cognitive Deficits in Parkinson’s Disease

Assessing Cognitive Deficits in Parkinson’s Disease

Early in the disease progression, 1 in 4 people with Parkinson’s disease experience mild cognitive decline. Most people with PD go on to develop dementia.

Complete a cognitive screen or, if indicated, a cognitive assessment.

Treating Cognitive Deficits in Parkinson’s Disease

Cognitive rehabilitation is an evidence-based treatment for mild cognitive decline in PD (Calleo et al., 2012). Depending on their deficits, you may treat attention, problem-solving, memory, and/or executive functioning.

See our shop for cognitive rehabilitation activities, worksheets, and materials.

Treat dementia with strategies like spaced retrieval, external memory aids, and environmental modifications. For more treatment ideas, read Dementia Treatment in Speech Therapy.

Drooling & Saliva Management

Drooling is also common in patients with PD.

Assessing Drooling in Parkinson’s Disease

This may be because decreased swallow frequency and oropharyngeal bradykinesia (slowness of movement) cause saliva to pool in the mouth. Then a stopped, open-mouth posture leads to drooling.

The Radboud Oral Motor Inventory for Parkinson’s disease (ROMP) was developed specifically for Parkinson’s disease and is available for clinicians to use with their patients.

You can access it in the Guidelines for Speech-Language Therapy in Parkinson’s Disease (scroll down to the Appendix).

Treating Drooling in Parkinson’s Disease

First, ensure that your patient has the cognitive skills, motor skills, motivation, and/or family support for these interventions to be successful.

Speech therapy drooling treatments for PD include:

• Cues to swallow (i.e., verbal cues, an app like Swallow Prompt)
• Encourage them to use an upright, head-neutral posture
• Refer to physical therapy as needed to improve posture and strength and for a wheelchair assessment (e.g. to add neck support)
• Chew gum if the patient can safely manage the bolus (South et al., 2010)
• Refer to their doctor for medical intervention (like Botox, drops, medications)
• Lip closure exercises if decreased strength is causing an open mouth (EMST, strengthening exercises)

Read How To Assess And Treat Drooling In Parkinson’s Disease for more details.

References

• Argolo, N., et al. (2013). Do swallowing exercises improve swallowing dynamic and quality of life in Parkinson’s disease?. NeuroRehabilitation, 32(4), 949–955. https://doi.org/10.3233/NRE-130918
• Aarsland, D., Bronnick, K., Williams-Gray, C., Weintraub, D., Marder, K., Kulisevsky, J., Burn, D., Barone, P., Pagonabarraga, J., Allcock, L., Santangelo, G., Foltynie, T., Janvin, C., Larsen, J. P., Barker, R. A., & Emre, M. (2010). Mild cognitive impairment in Parkinson disease: a multicenter pooled analysis. Neurology, 75(12), 1062–1069. https://doi.org/10.1212/WNL.0b013e3181f39d0e
• Atalar, M. S., Oguz, O., & Genc, G. (2023). Hypokinetic Dysarthria in Parkinson’s Disease: A Narrative Review. Sisli Etfal Hastanesi tip bulteni, 57(2), 163–170. https://doi.org/10.14744/SEMB.2023.29560
• Athukorala, R. P., Jones, R. D., Sella, O., & Huckabee, M. L. (2014). Skill training for swallowing rehabilitation in patients with Parkinson’s disease. Archives of physical medicine and rehabilitation, 95(7), 1374–1382. https://doi.org/10.1016/j.apmr.2014.03.001
• Cosentino, G., Avenali, M., Schindler, A., Pizzorni, N., Montomoli, C., Abbruzzese, G., Antonini, A., Barbiera, F., Benazzo, M., Benarroch, E. E., Bertino, G., Cereda, E., Clavè, P., Cortelli, P., Eleopra, R., Ferrari, C., Hamdy, S., Huckabee, M. L., Lopiano, L., Marchese Ragona, R., … Alfonsi, E. (2022). A multinational consensus on dysphagia in Parkinson’s disease: screening, diagnosis and prognostic value. Journal of neurology, 269(3), 1335–1352. https://doi.org/10.1007/s00415-021-10739-8
• Calleo, J., Burrows, C., Levin, H., Marsh, L., Lai, E., & York, M. K. (2012). Cognitive Rehabilitation for Executive Dysfunction in Parkinson′s Disease: Application and Current Directions. Parkinson’s Disease, 2012(1), 512892. https://doi.org/10.1155/2012/512892
• Gallagher, J., Gochanour, C., Caspell-Garcia, C., Dobkin, R. D., Aarsland, D., Alcalay, R. N., Barrett, M. J., Chahine, L., Chen-Plotkin, A. S., Coffey, C. S., Dahodwala, N., Eberling, J. L., Espay, A. J., Leverenz, J. B., Litvan, I., Mamikonyan, E., Morley, J., Richard, I. H., Rosenthal, L., Siderowf, A. D., … Parkinson’s Progression Markers Initiative (2024). Long-Term Dementia Risk in Parkinson Disease. Neurology, 103(5), e209699. https://doi.org/10.1212/WNL.0000000000209699
• Kalf, J. G. et al. (2011). Guidelines for Speech-Language Therapy in Parkinson’s Disease. ParkinsonNet. Retrieved December 2024, from
• Schindler, A., Pizzorni, N., Cereda, E., Cosentino, G., Avenali, M., Montomoli, C., Abbruzzese, G., Antonini, A., Barbiera, F., Benazzo, M., Benarroch, E., Bertino, G., Clavè, P., Cortelli, P., Eleopra, R., Ferrari, C., Hamdy, S., Huckabee, M. L., Lopiano, L., Marchese-Ragona, R., … Alfonsi, E. (2021). Consensus on the treatment of dysphagia in Parkinson’s disease. Journal of the neurological sciences, 430, 120008. https://doi.org/10.1016/j.jns.2021.120008
• South, A. R., Somers, S. M., & Jog, M. S. (2010). Gum chewing improves swallow frequency and latency in Parkinson patients: a preliminary study. Neurology, 74(15), 1198–1202. https://doi.org/10.1212/WNL.0b013e3181d9002b
• van de Wetering-van Dongen, V. A., Kalf, J. G., van der Wees, P. J., Bloem, B. R., & Nijkrake, M. J. (2020). The Effects of Respiratory Training in Parkinson’s Disease: A Systematic Review. Journal of Parkinson’s disease, 10(4), 1315–1333. https://doi.org/10.3233/JPD-202223
• Winiker, K., & Kertscher, B. (2023). Behavioural interventions for swallowing in subjects with Parkinson’s disease: A mixed methods systematic review. International Journal of Language & Communication Disorders, 58(4), 1375-1404. https://doi.org/10.1111/1460-6984.12865
• World Health Organization. (2023). Parkinson’s disease. Retrieved January 2025 from https://www.who.int/news-room/fact-sheets/detail/parkinson-disease