Understanding Parkinson’s Off Periods

One aspect of PD that often goes underdiscussed is the concept of Parkinson’s off periods which can significantly affect speech and swallowing. In this article, we will explore what off periods are, how they can impact communication and swallowing function, and share some strategies to help you manage during periods when your Parkinson’s medication is not at peak efficiency.

Off periods, also known as “off times” or “off states,” refer to the periods when the effects of your Parkinson’s medication begin to wear off. During these times, you might experience a range of symptoms, such as increased tremors, stiffness, slowness of movement, and reduced coordination. You may even notice a worsening of non motor symptoms such as anxiety and fatigue. These off periods can also impact your ability to speak and swallow effectively. Swallowing issues are referred to medically as dysphagia.

How Parkinson’s Off Periods Affect Speech and Swallowing

1. Reduced Voice Volume: You might find yourself speaking even more softly during Parkinson’s off periods and notice that people are asking you to repeat yourself.
2. Slurred Speech: Muscle rigidity and decreased coordination can make articulation more effortful resulting in an increase in slurred speech.
3. Changes in Speech Fluency: Speech might feel slower and more effortful during off periods. Conversely, you may notice that speech becomes more rapid, cluttered and difficult to control, referred to as festinating speech.
4. Swallowing Difficulties: During Parkinson’s off periods you may notice increased difficulty with saliva management (drooling), chewing becoming more effortful and even reduced coordination of the muscles involved in triggering a swallow, which elevates risk of choking and aspiration.

Tips for Managing Changes to Speech & Swallowing During Off Periods

1. Know Your Schedule: Work with your healthcare provider to understand your medication schedule and when Parkinson’s off periods are most likely to occur. Try to schedule important conversations, phone calls, and meetings outside of these times to maximize your chances of successful communication.
2. Regular Voice Exercise: Consider working with a speech therapist who specializes in Parkinson’s disease. Both direct Parkinson’s voice therapy or a Parkinson specific voice exercise program can optimize your speech, voice and swallowing so that these “off periods” are less severe and more manageable.
3. Use Assistive Devices: If your communication is severely impacted during these off periods, there are various speech-enhancing devices and apps available that can help amplify your voice.
4. Stay Hydrated: Drinking plenty of water can help alleviate dry mouth, making swallowing and speaking more comfortable. Be cautious when drinking during off periods. Take very small, single sips and be sure to be sitting fully upright.
5. Eat Mindfully: Take your time to chew and swallow properly. During off periods, choose easier to swallow foods such as cream soups, pudding or soft, moist casseroles. Avoid mixed texture foods. Take very small sips of fluid. Even pills can be more difficult to swallow during off periods. Coat pills in applesauce or yogurt to help them go down more easily.
6. Being Kind to Yourself: While it’s essential to be aware of how off periods can affect your speech and swallowing, it’s equally important to be kind to yourself during these moments. Remember that everyone with Parkinson’s experiences these off periods.

Parkinson’s off periods can certainly exacerbate speech and swallowing issues. However, by understanding when they are most likely to occur and making appropriate adjustments, doing regular Parkinson specific voice exercises, and being kind to yourself, you can successfully navigate these challenging periods of the day.

Consult an Expert

As always, if you are experiencing significant swallowing difficulty, especially during Parkinson off periods, consult directly with a local speech language pathologist to schedule a clinical swallowing assessment.