SINGAPORE - Parkinson's disease not only robbed 61-year-old Mr Lim, who declined to reveal his full name, of his mobility, it also took away his ability to speak intelligibly.

As his disease progressed over the past 14 years, his voice became so soft that it was almost inaudible at times. Inevitably, it led to frequent communication breakdown between Mr Lim and his caregivers.

"He became withdrawn and preferred not to make conversation," said his wife, Mrs Lim, who looks after him with the help of a domestic helper. "This was, of course, very frustrating as he would sometimes just refuse to talk or tell us what he wants."

A debilitating neurodegenerative disorder that is rarely life-threatening, Parkinson's disease affects about three in 1,000 of the population here.

Tremors, slowness of movement, stiffness of the limbs and speech difficulties are typical symptoms of the disease, said Dr Louis Tan, a senior consultant neurologist at the National Neuroscience Institute.

"Parkinson's disease is a result of dopamine deficiency in the brain. Speech problems such as softer voice and slower speech are related to the overall slowing of motor control," explained Dr Tan. Dopamine is a neurotransmitter that supports critical brain functions.

Dr Tan estimated that almost all patients experience some form of speech problem as their disease progresses.

According to speech therapist Emily Guo, who runs a Parkinson's disease support group at National University Hospital (NUH), it is common for patients' voices to become softer until others cannot hear them. The support group was launched last week.

In addition, patients may also sound monotonous, hoarse, stutter, have vocal tremors or have problems articulating what they want. Often, the loss of intelligible speech can cause communication problems between patients and their families, said Dr Tan.

Ms Guo estimated that up to 90 per cent of the Parkinson's disease patients she sees end up paring down social activities because of their speech problems.

"Conversations with friends and families become less enjoyable. Some also experience strained relationships with their spouses due to difficulties in communication," she said.

In Mr Lim's case, he became increasingly withdrawn because his soft voice often resulted in him being ignored.

But the picture is not as bleak as it looks. According to Ms Guo, speech therapy can help.

"Speech therapy helps patients to improve on their loudness, articulation and speech intelligibility. Studies have also found that speech therapy enhances facial expression. Patients often then go on to have more confidence in speaking to their families and friends," said Ms Guo, who conducts speech therapy programmes for Parkinson's disease patients at NUH.

More importantly, therapy helps patients have more control over their disease. "We know Parkinson's disease is a degenerative disease but that doesn't mean that you can't do anything about it. Speech therapy can be empowering in that it teaches you what to do and patients take responsibility for their own communication," added Ms Guo.

Intensive speech therapy sessions - which run four times a week for a month at NUH - have since reaped tangible benefits for Mr Lim. He is now able to speak more clearly and loudly.

"It requires a lot of effort from my husband, who gets easily distracted because he has dementia, too. But at least we are now able to hear him fairly clearly and he is able to communicate his needs," said Mrs Lim.

And for that, the gruelling therapy sessions are well-worth his effort.

Need help?

Find in-depth information and share concerns with patients and caregivers whose lives are affected by Parkinson's disease at the following support groups.

Parkinson's Disease Society of Singapore NUH Support Group

- NUHPDGroup@gmail.com

Parkinson's Disease Support Group at National Neuroscience Institute (NNI) at Tan Tock Seng Hospital

- Neuroscience Specialists Outpatient Clinics (Level 1); Tel: 6357 7605

Parkinson's Disease Support Group at NNI at Singapore General Hospital

- NNI (SGH Campus), Rehabilitation Centre (Education Resource Room, Blk 1, Level 1); Tel: 8125 3543

- TODAY/ar