The Power of Intentional Speech in Parkinson’s

Communication is one of the most fundamental aspects of being human, yet for many living with Parkinson's, the simple act of speaking can become a significant challenge. Recent webinars featuring Julia Lidgard, a speech-language pathologist from the University of Utah, and Samantha Elandary, the founder of the Parkinson’s Voice Project, have shed light on a transformative approach to maintaining speech and swallowing function. Their message is clear: while up to 90% of people with the condition will eventually face speech difficulties, these challenges do not have to be inevitable or permanent. By moving from automatic speech to intentional speech, individuals can regain their voices and protect their quality of life for decades. The Science of Two Motor Systems The core philosophy behind the SPEAK OUT!® program rests on the understanding that humans possess two distinct motor systems. The first is the automatic motor system, which handles activities we do without thinking, such as walking, talking, and swallowing. This system is heavily dependent on dopamine, the very neurotransmitter that becomes depleted in people with Parkinson's. As dopamine levels drop, these automatic actions become smaller, quieter, and less reliable. This explains why someone might shuffle while walking or mumble while speaking without even realising it has happened. However, we also possess an intentional motor system. This system acts like a "backup generator" because it is not as dependent on dopamine. When you purposefully think about an action—such as stepping over a crack in the pavement or projecting your voice to the back of a large room—you bypass the faulty automatic system and engage the intentional one. The SPEAK OUT! program teaches people to treat every word as a deliberate, voluntary act. By doing so, they can often achieve a voice that sounds entirely normal, clear, and resonant. Recognising the Early Warning Signs Early intervention is arguably the most critical factor in long-term success. The first signs of speech changes are often subtle and easily overlooked. A person might notice a slightly raspy or hoarse voice that doesn't actually hurt, or they might find that family members are frequently asking them to repeat themselves. Because of a common sensory deficit associated with the condition, many people feel they are speaking at a normal volume when they are actually much quieter than they realise. The statistics regarding delay are sobering. Research indicates that without treatment, many may lose the ability to speak or swallow effectively in the final years of life, and a significant percentage of deaths in people with the condition are attributed to aspiration pneumonia caused by swallowing difficulties. Starting therapy early, when a voice is still relatively strong, makes it much easier to maintain that function. For instance, if a person’s volume has only dropped slightly, therapy can often bring them back to a normal conversational range of 72-78 decibels. If they wait until their voice is very faint, reaching that normal threshold becomes much harder. A Lifetime Commitment to Intentional Living The SPEAK OUT! program is not a short-term "fix" but a lifelong strategy. It begins with a comprehensive evaluation and an educational phase that includes a 27-minute video explaining the transition from automatic to intentional living. This is followed by eight individual therapy sessions, typically conducted twice a week for four weeks. These sessions are intensive but brief, lasting only 30 minutes to ensure the person remains fully engaged and energised. Following the initial individual sessions, participants transition into weekly group classes. These classes provide a supportive environment where people can practice their exercises together, share experiences, and stay motivated. Because Parkinson's is a progressive condition, the program includes mandatory "refreshers" every six months. These re-evaluations help catch any slight regressions early, ensuring that the person’s "normal way of working" remains intentional and effective. Practical Exercises and Comprehensive Benefits During sessions, participants engage in a variety of exercises designed to strengthen the vocal cords and improve breath support. These include "warm-ups" like the "May-Me-My-Mo-Moo" syllables, sustained vowel sounds, and pitch glides that prevent the voice from becoming a monotone "robot" sound. Because cognitive health is also a priority, sessions include exercises such as spelling words backwards or identifying the functions of objects to keep the mind sharp. Beyond the voice itself, the benefits of speaking with intent extend to swallowing. By focusing on the physical act of swallowing—thinking of the Adam's apple moving up and down—individuals can significantly reduce drooling and improve their ability to eat safely. The ultimate goal is to apply this "intent" to all areas of life, from walking with purpose to buttoning a shirt with focus. Accessibility and Resources One of the most remarkable aspects of the Parkinson’s Voice Project is its commitment to accessibility. Through collaborations with university research centers, the program is often provided at no cost to the participant, with no insurance billing involved. Much of the therapy is now conducted virtually, allowing people to participate from the comfort of their homes. For those seeking to start immediately, the Parkinson’s Voice Project website offers a free e-library with digital booklets and daily practice videos that are updated five days a week. Living with Parkinson's requires a proactive approach to maintaining the skills that many take for granted. By embracing the principle of intent, people can ensure that their voices remain heard and their ability to communicate with loved ones is preserved for the long term.