context: Dysarthria (difficulty speaking) and dysphagia (difficulty swallowing) can be severely limiting symptoms of Parkinson's disease. Both can be helped by seeing a speech pathologist or speech therapist. In particular, the Lee Silverman Voice Therapy Program, has demonstrated significant value for people with Parkinson's. Ask your doctor about a referral to a speech pathologist experienced in administering the Lee Silverman Voice Therapy program. Speech-language pathologists can help people with Parkinson's disease maintain as many communication skills as possible. They also teach techniques that conserve energy, including non-verbal communication skills. Speech-language pathologists are also available to: Recommend appropriate communication technologies that will help with daily activities. Treat all types of speech, language, and communication problems. Evaluate swallowing function and recommend changes as necessary. Choose an environment with reduced noise. It can be tiring to try to "talk over" the television or radio. Speak slowly. Be certain your listener can see your face. Look at the person while you are talking. A well-lit room enhances face-to-face conversation, increasing understanding. Use short phrases. Say one or two words or syllables per breath. Over-articulate your speech by prolonging the vowels and exaggerating the consonants. Choose a comfortable posture and position that provide support during long and stressful conversations. Be aware that exercises intended to strengthen weakening muscles may be counter-productive. Always ask your speech therapist which exercises are right for you. Plan periods of vocal rest before planned conversations or phone calls. Know that fatigue significantly affects your speaking ability. Techniques that work in the morning may not work later in the day. If you are soft spoken and your voice has become low, consider using an amplifier. If some people have difficulty understanding you, the following strategies may help: If you are able to write without difficulty, always carry a paper and pen as a backup so you can write down what you are trying to say. If writing is difficult, use an alphabet board to point or scan to the first letter of the words that are spoken. Spell words out loud or on an alphabet board if they are not understood. Establish the topic before speaking. Use telegraphic speech. Leave out unnecessary words to communicate the meaning of the topic. Nonverbal communication, also called augmentative and alternative communication ( AAC), is a method of communicating without spoken words. When communication needs cannot be met through speech, the following techniques can help: Make the best use out of what speaking ability is left. Use expressions and gestures to communicate. Non-verbal communication can help people with speech difficulties actually speak better by: Reducing the frustration and stress of being unable to communicate. Alleviating the pressure to speak. Allowing the person to be more relaxed and come across in a more understandable manner. Here's a sample of the devices that are available to help people with Parkinson's disease communicate more clearly. Palatal lift. A dental apparatus that is similar to a retainer. It lifts the soft palate and stops air from escaping out of the nose during speech. Amplification. A personal amplifier can be used to increase the volume of the voice. The amplifier also decreases voice fatigue. TTY telephone relay system. A telephone equipped with a keyboard so speech can be typed and read by a relay operator to the listener. Either the whole message can be typed or just the words that are not understood can be typed. Low technology devices. Notebooks and language boards can be used as an alternative communication techniques. High technology electronic speech enhancers, communication devices. Computers with voice synthesizers and dedicated communication devices are available. If you are interested in purchasing an electronic communication aid discuss this with your speech therapist before contacting sales representatives for these devices. Use an intercom system or baby monitor to alert others that there is an emergency. Use bells or buzzers if you are not able to speak. Use "codes" that signify urgency. For example, a tinkling bell may mean, " I'd like company" while an air-horn means there's an emergency. Carry a portable phone that is equipped with pre-programmed numbers. Pre-program all of your telephones so they can automatically dial the necessary emergency number(s). Consider a "life call" button if you spend time alone.