Parkinson’s Disease and the Voice

About Dr. Reena Gupta

Dr. Reena Gupta is the Director of the Division of Voice and Laryngology at OHNI. Dr. Gupta has devoted her practice to the care of patients with voice problems. She is board certified in otolaryngology and laryngology and fellowship trained in laryngology, specializing in the care of the professional voice.

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parkinsons disease voiceBritish actor, Bob Hoskins, just announced his retirement from acting after being diagnosed with Parkinson’s Disease.  The progressive neurologic disorder was brought into the spotlight some time ago when famed actor Michael J. Fox was diagnosed.  His persistence in seeking treatment and willingness to use his name to advocate for research dollars has increased public awareness of this exceedingly difficult disease.  But why has one actor chosen to go into retirement while the other has continued to act, appearing on numerous television shows even as his disease has progressed? What are the characteristics of Parkinson’s that make an acting career so difficult?

What is Parkinson’s Disease?

Parkinson’s Disease is a nervous system (brain and nerves) disorder.  Nerve cells in the brain that make a chemical, dopamine, are slowly destroyed in Parkinson’s patients.  Dopamine is critical as a “messenger” molecule; the brain sends signals to nerves using dopamine.  When dopamine-producing cells are destroyed, the message is unable to be sent, resulting in muscles not moving correctly, or at all.  Loss of muscle movement results in atrophy (thinning and weakening) of the muscles.

All muscles are affected, including those involved in walking, speaking, swallowing, facial animation, hand coordination, etc.

What are symptoms of Parkinson’s Disease?

Because of the effect on muscles, the symptoms are related to the action of muscles.  These include:

  • Difficulty swallowing
  • Drooling
  • Problems with balance and walking
  • No expression in the face (like you are wearing a mask)
  • Difficulty with movement (starting to move, continuing to move, speed of  movement)
  • Loss of fine coordination (eating, feeding yourself, etc)
  • Tremors (movement of the hands, legs, tongue, etc)
  • Slowed, quieter speech; monotone voice
  • Stooped position

There are also known psychological effects including anxiety and depression but it is important to note that cognitively patients are usually normal.  This means that although expressing themselves may be hard due to difficulty coordinating tongue, voice, and mouth muscles, they are as intelligent as they were before the disease affected them.

Why can some people still act, and others can’t?

The disease affects every patient differently. Some are affected severely and quickly, others more slowly and mildly.  However, actors and singers will have a particularly difficult time negotiating career demands with the effects of Parkinson’s Disease.  Indeed, watching Michael J Fox acting on Scrubs or Spin City, you can see how the tremors and lack of muscle control is present.

He works very well with these symptoms, developing characters who move frequently and are “high-energy,” thereby concealing and incorporating his symptoms into a role.  It is a testament to his skill; however, it is likely very taxing and stressful.  Therefore it understandable when other actors, such as Hoskins, elect to lead their lives away from the camera.

Even more challenging, perhaps, is how difficult it becomes to modulate the voice. Parkinson’s Disease usually leads to a monotone voice and any actor can testify to the fact that this is a career-ender.  Often, voice therapy can decrease the severity of this symptom but, again, it is a taxing and difficult task to work against your body.  Finally, the difficulty in controlling facial muscles of expression make a career in acting, that relies on facial expression, that much more difficult.

What is the treatment of Parkinson’s Disease?

Unfortunately, there is no cure for Parkinson’s Disease.  However, many medications do exist that can decrease symptoms. For those who find voice symptoms disabling, which is almost all Parkinson’s patients at some point, voice therapy using a special technique is helpful.  This technique is called Lee Silverman Voice Treatment.

Because Parkinson’s Disease usually affects the older patient, some voice symptoms can be lessened with a vocal injection.  The reason for this is all people (including those without Parkinson’s) suffer from vocal atrophy, or thinning of vocal muscles, as they age.  Some people have this later in life (or never), others earlier. Thinning of the vocal folds makes projection difficult.  Parkinson’s patients, who have trouble with projection anyway, are therefore fighting two problems: their disease and the atrophy (when you get the vocal atrophy text up, which is attached to the same email, can you link to it here?) of their vocal folds.  An injection into the vocal folds to bulk them up may lessen symptoms.

Read patient stories about Dr. Reena Gupta from The Division of Voice at the Osborne Head and Neck Institute.

To learn more about Dr. Reena Gupta, click here.