Communication & Tremor

How might Tremor affect communication?

Tremor can cause a number of communication difficulties: speech, facial expressions, handwriting and body language are affected in many people. This obviously has a profound impact on how a person with Tremor interacts with everyone from family members to complete strangers.

• How tremor affects communication
• What treatment is available?
• How can I help myself?

How tremor affects communication

The ways in which Tremor can cause communication difficulties include:

• handwriting: people complain their writing becomes hard to read. It becomes small, cramped and ‘spidery’. Whilst writing starts at normally, it tends to reduce in size as the page progresses. This is known as micrographia and is caused by tremor and a lack of co-ordination
• speech: it may be slurred or become monotonous with limited variation or expression in the voice, as well as a lack of volume. Some people find that as they talk, their speech becomes faster and incomprehensible. Using the telephone and communicating in social situations where there is a lot of people or noise can be difficult
• facial movement and body language: both can become slow or even diminished. Facial expressions, such as smiling or frowning, may become difficult to make. Body language often lacks spontaneity, and gestures, such as nodding, may be missing. By contrast, abnormal involuntary movements - known as dyskinesias - may make it difficult to control the face and mouth sufficiently to speak or otherwise communicate.

These difficulties can impact considerably on quality of life and can contribute to a very misleading picture of the affected person, resulting in assumptions being made about them - often which are erroneous and very distressing. For example, people may assume that, rather than having Tremor, the person is drunk or unintelligent. Moreover, the ability to communicate may fluctuate during the day, depending on the medication schedule and whether the individual is ‘on’ or ‘off’. Such fluctuations can be very confusing to others.

A lack of self-expression can dent your confidence to interact with others. In some people, this could lead to depression, so it is important that family and friends are aware of your difficulties and encourage you to continue socialising.

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What treatment is available?

Adjusting medication can sometimes improve communication problems. Discuss this with your doctor before making any changes yourself.

A speech and language therapist may also be able to help. With speech and non-verbal, physical communication. They can offer advice on:

• exercises and techniques to improve breathing, posture and communication
• equipment and special tools, such as amplifiers, to overcome verbal problems, such as speed, or quietness of voice
• specific help with situations that you have problems with
• alternative means of communication, if speech is impossible.

An occupational therapist can advise on ways to help with handwriting. They can recommend special equipment and tools, such as:

• thick/padded or felt tip pens
• weighted cuffs
• clipboards or a dycem mat (non-slip) to stop paper from slipping
• computers or typewriters.

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How can I help myself?

Speech

• If you are in a situation where you find communication difficult, as hard as it may be, try to remain as calm and relaxed - stress will only make your symptoms worse
• Make sure you are sitting or standing comfortably, in as upright a position as possible. Voice quality can be affected by a stooped posture
• Keep your sentences short and enunciate clearly. This may take practice
• If someone doesn’t understand you, think of an alternative way to communicate what you are trying to say, rather than endlessly repeating yourself
• Don’t talk over noise
• Don’t try to talk to someone in another room to you
• Imagine that you are in a bigger room than you really are as this will make you speak louder
• There are various gadgets and adapted telephones that make talking on the phone easier – the speech and language therapist or occupational therapist can advise further
• You can use a computer to create small cards with information about tremor so that if you are unable to communicate when you are out you can use these cards.

Handwriting

• Try using a tape recorder if your speech is unaffected. A tape recorder will verbalise things you want to write, or you may find a computer helpful
• Pick a time of the day when you are ‘on’ and symptoms are most controlled. This will reduce the effect of the tremor that makes writing tricky. This may not always be practical or possible, but writing can prove far less frustrating if timed well
• It may also help to stop writing after each line and then relax, breathe deeply and stretch the arms widely before continuing
• Signing cheques or other documents may be frustrating when your signature is not consistent. Talk to your bank in case they have a solution. If you do have to write a cheque, it is worth asking the bank or shopkeeper to fill in the details so all you have to do is sign. You can also shorten your signature so that it is easier to write – but make sure your amended signature is the one registered with your bank. In some instances carrying a form of identification with a photo, such as a passport, can be useful, or some banks may be able to issue a bank card with photo. In some countries rubber stamp signatures are acceptable, but this is not the case everywhere.

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We would like to acknowledge the use of information taken from the European Parkinson’s Disease Association website  www.rewritetomorrow.eu.com/