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Singing and PD

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Hi Dr Mahler,

I know that PD can interfere with singing. I mean, Linda Ronstadt had to give up touring due to not being able to reach higher notes. In my case, just in the last month I notice I cannot sing as well...have difficulty holding a note. Most of it seems to be a "phlegm ball" in the back of my throat that I just can't clear.

Now I know that it is allergy season, and things are REALLY bad here in Florida right now, but this seems to be even more than just that. Is there something with mucus and PD.

Any suggestions would be GREATLY appreciated, as I'm suppose to perform at a gathering in 2 weeks. Thanks, Bob

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Nearly 90% of people with PD will develop speech disorders during the course of the disease, which can have a negative impact on functional communication contributing to decreased quality of life for people with PD and their families.  Speech disorders associated with PD are most commonly characterized by one or a combination of the following speech impairments; reduced vocal loudness; a breathy or harsh voice quality; imprecise consonants and distorted vowels; and reduced voice pitch inflections or monotone voice collectively called hypokinetic dysarthria. 


Voice and speech deficits in people with PD include reduced vocal fold adduction and asymmetrical patterns of vocal fold vibration; reduced neural drive to laryngeal muscles; poor reciprocal suppression of laryngeal and respiratory muscles; and a reduction in respiratory muscle activation patterns, all of which contribute to the perceptual feature of significantly decreased loudness in people with PD. 


Origin of speech disorders in people with PD

Over the last 25 years we have learned a lot about the neuroscience of PD, which has led to an increased understanding of the underlying neurophysiology associated with changes in voice and speech.  It is well established that the symptoms of PD are associated with alterations in basal ganglia circuitry due to a decrease in dopamine that affects motor and sensory systems   Recent research suggests that these changes begin before the onset of PD symptoms and therefore, before the diagnosis of PD by a neurologist. Therefore, it is recommended that patients receive treatment at diagnosis or soon after to obtain the maximum benefit from the treatment for the greatest possible length of time.


Pharmacological and neurosurgical approaches for people with PD have not demonstrated as consistent or significant impact on voice and speech disorders in people with PD.  Therefore, a behavioral speech intervention for people with PD is needed to effectively improve voice and speech disorders


Singing can be affected but there are treatments that can potentially improve not only speech but singing also.  Unfortunately, the opposite is not true.  Singing practice has not been shown to improve intelligibility in speaking.  I hope that you will get additional information from an evaluation with a speech-language pathologist to make appropriate treatment decisions.  In the meantime, try increasing your water intake because that may help with the phlegm and sensation of something in the back of your throat.  That can also be related to reflux so you may want to discuss that with your physician at your next visit.




Leslie Mahler, PhD, CCC-SLP

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