Neurologic & Neurodegenerative Disorders

Neurologic voice disorders occur when there is damage to either the central or peripheral nervous system.  Neurodegenerative disorders are progressive and incurable.  Over time, nerve cells weaken or die.  There are many neurodegenerative diseases that can impact the voice.

Neurodegenerative disorders occur when nerve cells in the brain or peripheral nervous system lose function over time and ultimately die. The risk of becoming affected by a neurodegenerative disease increases dramatically with age. More individuals are living longer, which may mean that more people may be affected by neurodegenerative diseases in the coming decades. There is a critical need to improve our understanding of the causes of neurodegenerative diseases and to develop new approaches to treatment and prevention.  

• Parkinson Disease is a common neurodegenerative disease affecting the voice.  Individuals with Parkinson often present with very quiet voices.  How quickly the individual speaks and clarity of their articulation can also be affected.

• ALS, also known as amyotrophic lateral sclerosis or Lou Gehrig's disease, presents differently for many people.  About one fourth of all ALS cases start with symptoms that affect voice, speech, and swallowing.  Individuals with ALS frequently demonstrate weak, breathy, rough voice, increased nasality, increased slurring, and slow rate of speech.  When respiratory muscles become involved, individuals with ALS generally require a ventilator to continue breathing.
• Myasthenia gravis is a disease involving muscle fatigue and weakness, but is not considered neurodegenerative, as individuals don’t typically worsen over time.  While the voice may sound normal when a person first begins to speak, it begins to sound weak and breathy with use since the muscles fatigue quickly.  Other voice symptoms can include quiet voice, monotone voice, increased nasality, and tremor.
• Huntington's disease is an inherited disorder.  It differs from several other neurodegenerative diseases in that it produces abnormal, jerky movements, called chorea, instead of weakening or increasing flaccidity of muscles.  Individuals with Huntington's disease often have hoarse or rough sounding voice, fluctuations in pitch and volume, choking stoppages to the voice, slowed articulation, and difficulty coordinating breathing for voice.

Speech-Language Pathology Evaluation & Therapy

Our Speech-Language Pathologists, who have specialty training and expertise in voice disorders, assessment and treatment, will complete a personalized assessment of your voice. Assessment may include:

• A detailed history collection
• Laryngeal Function Studies consisting of computerized voice analysis and airway measures
• Behavioral voice and communication analysis
• Stimulability trials
• Pre-treatment video recording
• Dysphagia/swallowing screening
• Cognitive screening

Prior to the initiation of voice therapy, a laryngeal examination must be completed in order to identify the etiology of your individual voice problem and determine the most appropriate course of treatment.

If you are recommended for voice therapy, your therapy program may include some or all of the following techniques:

• Strengthen and re-balance laryngeal and pharyngeal musculature, including the muscles, joints and ligaments used in voice production
• Create a healthy motor pattern and balance pressures to achieve the ideal configuration of your vocal folds for voice use
• Parkinson's disease is frequently treated using a structured therapy program which encourages individuals to be intentional in their voicing and speech. This leads to improved volume, rate of speech, intonation, facial movement, and articulation.
• Individuals with neurodegenerative disorders may work with a speech therapist to complete voice banking, learn to use AAC devices (alternative and augmentative communication), or to address swallowing concerns.

Additional Information

The American Speech-Language Hearing Association – Speech Disorders

Myasthenia Gravis

National Institute on Neurologic Disorders & Stroke – Myasthenia Gravis Fact Sheet

Huntington’s Disease

Huntington’s Disease Society of America: https://hdsa.org/

National Institute on Neurologic Disorders & Stroke – Huntington’s Disease Information Page

Amyotrophic Lateral Sclerosis (ALS)

ALS Association: https://www.als.org/

National Institute on Neurologic Disorders & Stroke – ALS Fact Sheet

The Muscular Dystrophy Association – ALS

Parkinson Disease

Parkinson Foundation: https://www.parkinson.org/

National Institute on Aging – Parkinson's Disease

Parkinson Voice Project: https://www.parkinsonvoiceproject.org/