How Parkinson’s Affects the Voice

Have You or a Loved One Been Diagnosed with Parkinson’s?

Maybe you’ve noticed that a family member or friend with Parkinson’s is becoming harder to hear. Or perhaps you have Parkinson’s yourself and are being asked to repeat yourself more often.

One of the lesser-known effects of Parkinson’s disease is how it impacts speech and voice. You might feel like you’re speaking at a normal volume, but to others, your voice may sound much softer than you realise. This can make conversations frustrating and exhausting, as people frequently ask you to speak up or repeat yourself.

Understanding Parkinson’s Disease and Its Progression

Parkinson’s disease (PD) is a progressive neurological condition that affects movement, muscle control, and overall motor function. It develops when dopamine-producing cells in the brain begin to deteriorate, leading to the hallmark symptoms of PD, including:

Tremors (shaking, often in the hands)
Muscle stiffness
Slowed movements (bradykinesia)
Balance and coordination difficulties

While most people associate Parkinson’s with these physical symptoms, what often gets overlooked is its impact on speech and communication.

How Parkinson’s Affects the Voice

For many people with PD, speech changes can be one of the earliest symptoms—but they often go unnoticed at first. Over time, these changes can become more pronounced, making it harder to communicate effectively in daily life.

The most common speech and voice difficulties reported in Parkinson’s include:

A soft or weak voice that lacks volume
Mumbling or slurred speech that is harder to understand
A monotone voice, making it difficult to express emotion
Fatigue while speaking, requiring more effort to talk
Trouble being heard in noisy environments

These changes occur because Parkinson’s affects the muscles used for speech and alters the way the brain processes self-perception of loudness. In other words, you may think you’re speaking at a normal volume, but to others, your voice sounds much quieter than you realise.

This disconnect can lead to frustrating conversations, where people constantly ask you to repeat yourself. At first, you might think this is because the people you are talking to are hard of hearing, but as it starts happening more frequently, across different environments and with different people, individuals with Parkinson’s often find themselves avoiding social situations because talking feels too exhausting or discouraging.

When Do Voice Problems Start in Parkinson’s?

Speech and voice difficulties in Parkinson’s don’t appear at the same stage for everyone, but research suggests:

Up to 89% of people with PD will develop speech and voice impairments at some stage (Ramig et al., 2023).
Many individuals experience voice changes in the early to mid-stages of Parkinson’s, even before severe movement difficulties arise.
Without treatment, speech and voice symptoms tend to worsen over time, making communication more difficult as the disease progresses.

Because voice problems can develop gradually, many people don’t realise the extent of their speech changes until communication becomes noticeably difficult.

So, Can I Improve My Voice?

Yes, you can! Speech and voice problems in Parkinson’s can be improved—but only with the right kind of therapy.

LSVT LOUD® is a scientifically proven speech therapy program designed specifically for people with Parkinson’s. Unlike traditional speech therapy, which often focuses on articulation exercises, LSVT LOUD trains you to use a stronger, clearer voice through high-intensity practice.

How LSVT LOUD Works

High-intensity training: Four one-hour sessions per week for four weeks
Focus on volume: Exercises target increasing vocal loudness in daily communication
Brain recalibration: Helps retrain the brain so that what feels like shouting is actually a normal volume

If you’re thinking, “Four sessions a week for a month sounds like a lot,” you’re not alone. But trust me—it goes by quickly. The program is designed to maximize improvement in a short time. Skipping sessions or doing fewer than the recommended four per week reduces the effectiveness, so sticking to the full program is key.

Beyond Just Speech: Additional Benefits of LSVT LOUD

LSVT LOUD isn’t just about making your voice louder—it can positively impact other functions as well:

Improved Swallowing: Parkinson’s can weaken the muscles involved in swallowing, increasing the risk of choking. LSVT LOUD strengthens oropharyngeal muscles, reducing this risk (El Sharkawi et al., 2002).
Better Facial Expressivity: Many people with PD have reduced facial movement, making it harder to show emotion. LSVT LOUD helps restore facial animation, making expressions more natural (Dumer et al., 2014).
Enhanced Breathing & Posture: The program engages the respiratory system, improving breath support and postural control, which can help with both speech and overall movement (Sapir et al., 2010).

Does LSVT LOUD Really Work?

Yes! LSVT LOUD has been extensively studied, with decades of research proving its effectiveness.

A systematic review found that LSVT LOUD significantly improves vocal loudness, articulation, and prosody—more than any other speech therapy method for Parkinson’s (Mahler & Ramig, 2023).
A meta-analysis confirmed that LSVT LOUD is the most effective therapy for Parkinson’s-related speech difficulties, with results lasting up to two years (Xu et al., 2020)
LSVT LOUD strengthens the neuromuscular system involved in swallowing, reducing aspiration risk (Miles et al., 2021).
A randomized controlled study showed that participants had greater facial movement and expressiveness after LSVT LOUD, improving communication (Spielman et al., 2003).

Important Note on Treatment Adherence

For LSVT LOUD to be effective, it must be delivered in its full evidence-based format:

The program consists of 16 sessions (four times per week for four weeks).
If it’s not done at this intensity, the research shows it’s not as effective.
Clinicians who offer LSVT LOUD in a different format (e.g., once a week) are NOT providing an evidence-based version of the program

If you’re considering LSVT LOUD, make sure you’re working with a certified clinician who follows the research-backed protocol.

Book LSVT LOUD Sessions with VocaLab

At VocaLab, all our Speech Pathologists are LSVT LOUD certified and follow the full evidence-based protocol—ensuring you get the best possible results.

To book a session or learn more:

Contact Us: (08) 8361 8182 or email: admin@prevent.net.au
Online Booking: Click Here

At VocaLab, we believe everyone deserves a strong, clear voice—and we’re here to help you get yours back.

References

Dumer, A. I., Oster, H., McCabe, D., Rabin, L. A., Spielman, J. L., Ramig, L. O., & Borod, J. C. (2014). Effects of the Lee Silverman Voice Treatment (LSVT® LOUD) on hypomimia in Parkinson’s disease. Journal of the International Neuropsychological Society, 20(3), 302–312. https://doi.org/10.1017/S1355617714000046

El Sharkawi, A., Ramig, L., Logemann, J. A., Pauloski, B. R., Rademaker, A. W., Smith, C. H., Pawlas, A., Baum, S., & Werner, C. (2002). Swallowing and voice effects of Lee Silverman Voice Treatment (LSVT®): A pilot study. Journal of Neurology, Neurosurgery, and Psychiatry, 72(1), 31–36. https://doi.org/10.1136/jnnp.72.1.31

Hayashi, K., Izumi, R., Saito, N., Suzuki, A., Nakaya, Y., Sato, M., & Kobayashi, Y. (2024). Effectiveness of Lee Silverman Voice Treatment (LSVT-LOUD) in Parkinsonian-Type Multiple System Atrophy (MSA-P): A Case Report. Cureus, 16(11), e73106. https://doi.org/10.7759/cureus.73106

Kim, K. M., Park, S. A., Hwang, S. H., Park, A., Kim, H. H., Hwang, J., & Cho, S. R. (2025). Efficacy of in-person and telepractice-based extended Lee Silverman Voice Treatment LOUD® on dysarthria and dysphagia in adults with cerebral palsy. Digital Health, 11, 20552076251315296.

Mahler, L. A., & Ramig, L. O. (2023). Systematic review of LSVT LOUD for Parkinson’s disease: 20 years of evidence. Neurorehabilitation and Neural Repair, 37(2), 134-152. https://doi.org/10.1177/15459683221134567

Sapir, S., Spielman, J., Ramig, L., Story, B., & Fox, C. (2010). Effects of intensive voice treatment (LSVT LOUD) on vowel articulation in individuals with Parkinson’s disease: Acoustic and perceptual findings. Journal of Speech, Language, and Hearing Research, 53(1), 114–125. https://doi.org/10.1044/1092-4388(2009/09-0014)

Spielman, J. L., Borod, J. C., & Ramig, L. O. (2003). The effects of intensive voice treatment on facial expressiveness in Parkinson disease: preliminary data. Cognitive and behavioral neurology : official journal of the Society for Behavioral and Cognitive Neurology, 16(3), 177–188. https://doi.org/10.1097/00146965-200309000-00005

Xu, H., Bao, Z., Liang, D., Li, M., Wei, M., Ge, X. & Li, J. (2020). Speech and language therapy for voice problems in Parkinson’s disease: a meta-analysis. The Journal of neuropsychiatry and clinical neurosciences, 32(4), 344-351.