You Are Not As Loud As You Think

By Valeria Gary, M.A., CCC-SLP

Speech-Language Pathologist

Certified in LSVT-LOUD and SpeakOUT!

Do your loved ones have trouble hearing you even though you are sure you are speaking with a normal voice? Can your hard-of-hearing spouse hear everyone but you? Do you get tired of repeating yourself? Do people seem to encourage you to talk with an obnoxiously loud voice? If you have Parkinson’s, there’s a very good chance that you are not nearly as loud as you think.

There’s a neurological concept called “sensory gating,” and in this case it means that your brain is not giving you correct feedback about how loudly or softly you are speaking. Instead of going by what you hear, you’ll need to go by how much effort you put into your voice to determine if you are loud enough to be heard.

Voice therapy with a speech-language pathologist can help.  You already know about the role of intense exercise for people with Parkinson’s. The throat has muscles which also must be exercised with vigor. An extra benefit of exercising the muscles for voice is that the muscles for swallowing also get exercised (because speaking and swallowing share muscles).  Studies have shown that 90% of individuals who receive intense speech and voice therapy can show an improvement in their loudness and that 80% of them maintain that loudness for 12-24 months.

There are several ways in which a speech-language pathologist can help you to be able to be heard and understood the first time you say something. There are structured, intense, evidence-based programs designed specifically for people with Parkinson’s such as Lee Silverman Voice Therapy (LSVT-LOUD) and SpeakOUT!. The common goal of these methods is to improve the ability to speak clearly with a voice that is loud enough for others to hear.

If you and/or your loved ones have noticed that your voice is becoming harder to hear or that your speech is harder to understand, ask your primary physician or neurologist for a referral for a speech-language pathology evaluation. You may also need to see an Ear, Nose, and Throat doctor to ensure that other problems with your throat are not the cause of your voice difficulties. Do not try to “self-treat.” Improper use of the throat muscles can make the voice worse over time.

The evidence for maintaining communication (which is critical to quality of life) is very promising. Give your voice the same care that you give to the rest of your body.

For more information about LSVT, go to LSVT Global’s website:

Information about SpeakOUT! can be found on Parkinson Voice Project’s site:


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