As Parkinson’s disease advances, you might notice some challenges when communicating with your loved one. In this article, we provide some tips and strategies to communicate well during these more advanced stages.
The first and most important thing is to encourage your family member or friend to consider speech therapy when changes in communication are noticed. A speech-language pathologist can develop a program tailored to the person with PD's needs. Consider these other tips and strategies as well:
Get face-to-face when talking: Try to maintain no more than 3-6 feet. Minimize having conversations between rooms or across long distances. Make sure the lighting in the room is optimized so that you can see your partner's face and mouth movements clearly. Words, facial expressions, and gestures are easier to understand when you can see and hear them being produced.
Reduce background noise: Turn off the radio and TV, close car windows and shut doors to noisy areas.
Be aware that people with PD may not accurately express their emotions through facial expressions because of rigid facial muscles. This can be complicated by their quieter voices and sometimes difficult to understand words. Instead of assuming that your family member/friend does not understand your message or that you understood theirs correctly, check in and verify that the message was understood correctly.
Be patient. Allow ample time for the person with PD to communicate. Don't rush or force responses.
When necessary, "make room" in the conversation for the person with PD by opening the conversation for their turn or slowing down the pace of conversation. For example, "Tom and I were just talking about this yesterday and he had some great ideas... Tom, I'm sure Sarah would love to hear your thoughts."
Preserve dignity and personhood. Minimize talking for the person with PD or filling in their responses unless they ask you to do so, or you have asked (and received) their permission to respond for them.
In cases where cognitive decline is more severe:
Use shorter sentences with one idea per sentence when communicating with the person who has PD.
Use common vocabulary and words that are familiar to the person.
Ask questions that can be answered in a short sentence or with a "yes" or "no" response.
Alternatively, ask questions and then provide two or three options to help the person make their voice clear.
Use multi-modal supports, including writing down key words /short phrases that capture what you are trying to communicate: pictures and gestures help reinforce the message you are conveying.
Provide shorter chunks of information and allow extra time to process information. Resist slowing down your speech in an exaggerated way or overexaggerating your speech production, in some cases this can worsen communication.
Stay calm. Do not raise the loudness of your voice in an exaggerated way when repeating or rephrasing information. This can be emotionally upsetting for the person with cognitive impairment.
Addressing Communication Challenges
Parkinson's disease can impact communication in many ways. Most people with Parkinson's experience a soft voice volume and may be difficult to hear. Loss of automatic facial expression can be misinterpreted as boredom, anger, or sadness. Mood changes in Parkinson's such as apathy, depression, or anxiety can also affect communication. The following tips can make communication easier:
Try to have conversations one-on-one or in small groups. Smaller groups will be more willing to pause the conversation and wait for a comment than a large group.
Reduce or remove distractions like TV, radio, or music when speaking to the person with Parkinson's.
Be close to each other when you talk so its easier to hear. Avoid yelling from another room in the house.
Encourage the person with Parkinson's to take a deep breath before beginning to speak to enhance his or her vocal loudness.
Give the person with Parkinson's time to respond to participate in conversation. Just like slowness in movement, thought processes can be slowed by Parkinson's disease.
Do not make assumptions about how your loved one is feeling based on facial expression. Remember, you can't judge a book by its cover.
Recognize that mood changes such as depression, anxiety, and apathy can be symptoms of Parkinson's disease. If you notice these symptoms in your loved one, speak to his or her physician.
Seek a referral to a speech pathologist who is certified in the Lee Silverman Voice Treatment therapy (visit www.lsvtglobal.com) or who has attended a Parkinson's Foundation Allied Team Training for Parkinson's program.
Sources: Parkinson's Foundation. Page 55. Communication Challenges. Practical Pointers. Chapter 3. Caring and Coping. A Care Partner's Guide to Parkinson's Disease. "Booklet."