John M. Dean: Parkinson’s Speech Therapy for Real Life

Could you tell us a little about your professional background and what inspired you to become a speech-language pathologist, especially with a focus on people with Parkinson’s?

I was originally a professional musician and played the double bass with great passion. Unfortunately, a serious hand injury ended that career. While teaching, I began singing vocal lines for my students and became more aware of my own voice. By a fortunate coincidence, I was referred to a renowned expert in speech therapy for Parkinson’s — and that sparked my interest. I realized that my musical ear and technical understanding gave me an excellent foundation for training as a speech-language pathologist. So I began studying speech-language therapy, worked with digital tools, and specialized in Parkinson’s early on.

In a care facility, I noticed how many residents suffered from Parkinson’s disease. That was the trigger for me to set up interdisciplinary Parkinson’s teams. I later met my wife Josefa Domingos – she is a physiotherapist – and together we developed a comprehensive training concept. Today we live in Lisbon (Portugal) and work with Parkinson’s patients worldwide – and I am grateful that I chose this path.

How did you start offering online training for people with Parkinson’s? What challenges came with moving therapy online, and why is this format especially well suited to speech therapy?

Online training began for very practical reasons: in-person courses are effective, but they are limited by geography and logistics. Many people simply cannot travel to us. With the rise of digital tools — especially during the pandemic — we were able to continue developing our courses. Zoom suddenly became part of everyday life.

We began to offer regular interactive courses in which cameras and microphones are deliberately left switched on. This enables direct feedback and individual adjustments. Today, we offer nine online training sessions per week. My focus is on language exercises and communication, while Josefa takes on movement training and dual-task exercises. Online formats not only create access – they also promote motivation, structure and social interaction.

You work in North America, the United Kingdom, and Europe. Have you noticed regional differences in Parkinson’s care, especially when it comes to exercise and support?

Yes, the differences are clear. The Netherlands has developed an impressive model with ParkinsonNet: nationwide care delivered by connected, specialized professionals. Similar approaches have existed in Germany, but the structure of the healthcare system makes nationwide implementation more difficult. In the United States, this kind of model usually works only within large healthcare systems.

Exercise culture also varies from region to region. In Colorado, for example, physical activity is deeply woven into everyday life — people are happy to meet for a hike. In Portugal, that is less common, which means we have to be more creative in helping people get moving. What matters is this: the path may differ, but the goal is the same — an active, independent way of life.

What role do technology and digital tools play in your work with people with Parkinson’s? How do you see the future of digital applications in Parkinson’s care?

Technology has long been an integral part of my work. It helps us make training sessions more flexible, document progress, and support assessment. I find the voice especially exciting as a biometric measure. It can offer clues about motor and cognitive changes — an approach I am researching with colleagues.

Digital tools such as wearables, apps, and automated speech analysis make it possible to develop a much more nuanced picture of the course of the disease. What matters is that these technologies are not complicated, but intuitive to use. That way, they can help close gaps in care, including in regions with limited access to specialists.

Based on your experience, how effective can speech therapy exercises delivered through an app be, and what should people with Parkinson’s keep in mind when using them?

Apps can be a valuable addition to therapy, especially when they are simple, motivating, and flexible. A good app should provide individualized feedback, make progress visible, and ideally make practice feel a little enjoyable. People with Parkinson’s often experience apathy or low motivation — an app that is too complex will quickly go unused.

That is why we have placed such strong emphasis on user-friendly design in our online courses. The exercises are clearly structured, and there is no complicated navigation. The barrier to getting started is low — and that is exactly what many people need. Of course, an app does not replace personal contact, but it can help people build regular practice into their daily lives.

In your view, what are the most common misconceptions about Parkinson’s?

One of the biggest misconceptions is that Parkinson’s is automatically associated with cognitive impairment. Many people see someone with visible motor symptoms and wrongly assume that their thinking is also severely affected. Unfortunately, this leads to stigma — in daily life, at work, and even in medical settings. I know many people with Parkinson’s who continue to work at a highly skilled level, in international companies or with complex technology. These abilities do not suddenly disappear.

Many people with Parkinson’s also struggle with a sense of isolation. When the voice becomes softer or facial expression decreases, social interaction changes — and that is often not recognized enough. It is so important to provide support early, rather than waiting until the person has already withdrawn.

Parkinson’s can also affect speech and communication. How do you see the connection between physical therapy and speech therapy in this area?

For me, that connection is central. Communication is almost never a purely cognitive task; it is embedded in movement and everyday activities. We speak while walking, cooking, and shopping. In therapy, we therefore often use what are known as dual-task exercises, training speech and movement at the same time. One example would be a voice projection exercise while moving or responding to visual cues.

This combination is practical and effective because it reflects real life. After all, what good is a strong voice in a quiet therapy room if it is not available when someone needs it in daily life? That is why we place great emphasis on embedding exercises in realistic contexts. Speech is not separate from life — it is right in the middle of it.

What role does speech therapy play overall in Parkinson’s care?

Speech therapy is an important part of Parkinson’s care, but it often does not receive enough attention. About 90% of patients develop changes in speech or voice over the course of the disease. These changes can have a major impact on quality of life because they make communication more difficult in daily life, at work, and within the family. Unfortunately, many people only begin therapy once the limitations have already become very noticeable.

Starting early would be ideal. Even in the early stages, targeted exercises can strengthen the voice, improve articulation, and — just as importantly — build confidence. When people no longer feel comfortable speaking loudly, they often begin to withdraw. In this sense, speech therapy is not only functional; it also has an emotional impact.

What challenges do you see around motivation? How can people with Parkinson’s be encouraged to practice regularly?

That is a very important question. Many people with Parkinson’s experience apathy or low motivation. This is not a matter of willpower, but often a direct consequence of neurobiological changes. Dopamine deficiency, as well as reduced levels of other neurotransmitters such as serotonin or norepinephrine, can have a strong effect on motivation.

That is why the barrier to practice needs to be as low as possible. The goal is to create habits that can be easily integrated into daily life. Short sessions, visible progress, and positive feedback all help. In our app and our courses, we make sure people can feel a sense of success after the very first session. When someone realizes, “This works,” motivation begins to come from within.

What specific exercises or techniques do you recommend for improving voice and communication in people with Parkinson’s?

The LSVT LOUD method is very well researched and has proven effective in many cases. It is based on increasing speaking volume, which can have a positive effect on articulation, vocal strength, and even body language. We combine these approaches with cognitive elements, such as responding to visual or auditory cues.

This creates exercises that train not only the voice, but also the interaction between attention, response, and speech. The goal is not only to make the voice stronger, but above all to make it usable in everyday life. A strong, clear voice that holds up in real conversations is crucial for quality of life.

Which developments in research give you particular hope, especially when it comes to treatment and day-to-day self-management?

I find the use of voice as a biomarker especially exciting. In research, we are working on using artificial intelligence and machine learning to analyze changes in the voice and draw conclusions about motor and cognitive symptoms. This can help detect Parkinson’s earlier and monitor its progression more precisely. So it is not only about diagnosis; it is also about fine-tuning therapy.

There are also wearables that capture movement patterns and video-based analyses using computer vision. Together, these technologies create a more layered picture of a person’s health status. They also make it easier to understand individual responses to medication or exercises. The possibilities are enormous, especially for personalized, flexible care.

How do you see the future of Parkinson’s care in the digital age, especially when it comes to platforms and virtual programs?

I am convinced that digital care will play a crucial role. Even today, virtual programs give many people access to specialized therapy, including in rural areas or countries with limited care. That is an enormous step forward.

At the same time, digital platforms make it possible to tailor therapy content to individual needs. For example, someone who can train only at certain times of day needs a program that fits flexibly into daily life. Online programs also help participants connect with one another. Many of our participants feel part of a community. That strengthens not only motivation, but also emotional well-being.

What do you personally find most rewarding about working with people with Parkinson’s?

I consider it a great privilege to work with this patient group. Many people bring tremendous commitment — they want to stay active, shape their lives, and give something back. That impresses me again and again. Often, they are people who have been curious, eager to learn, and responsible throughout their lives — and who remain that way after the diagnosis.

What makes me especially happy is that in speech therapy, we often see progress quickly. When someone is heard more clearly after just a few sessions, speaks with more confidence, or feels more secure, that is the most rewarding feedback I can receive. This immediate impact, combined with long-term support, is what makes my work so meaningful.

How do you bring a holistic approach into your work — physically as well as mentally?

Our work is based on an interdisciplinary approach. Speech therapy, movement, motivation, and psychosocial support are closely connected. My wife, Josefa, is an expert in movement therapy for Parkinson’s. Together, we design courses that combine physical and speech-based exercises. We make sure they remain varied and grounded in real life.

The emotional component also plays an important role. Many people with Parkinson’s experience uncertainty, anxiety, or withdrawal. That is why it is important to us to create a positive, supportive atmosphere, both in therapy and in the digital space. When people feel comfortable, they are more open to change.

What advice would you give speech-language pathologists who want to work more intensively with people with Parkinson’s?

First: familiarize yourself with the basics of the disease – neurological, functional and psychosocial. Then I recommend networking across disciplines. The International Parkinson and Movement Disorder Society (MDS ) offers excellent training and access to the latest research findings. I myself lead the Allied Health Professionals group there, in which therapists from all over the world work together.

Practice is also important: connect with experienced colleagues, observe sessions, and exchange ideas. And above all, listen carefully to your patients. They are the ones who know best what truly helps in everyday life.

You are chair of the Allied Health Professionals Special Interest Group and co-chair of the Web Editorial Board of the International Parkinson and Movement Disorder Society. What goals and priorities do these organizations pursue?

The MDS was founded to advance knowledge about movement disorders such as Parkinson’s worldwide. Our focus is on research, education, and connecting healthcare professionals. What has changed in recent years is that we are increasingly including the perspectives of patients and families. This is an important step toward making care truly patient-centered.

Another priority is collaboration with start-ups that are developing digital or technical solutions. Many of these innovations come directly from the Parkinson’s community, and we see it as our role to give them a platform. In the long term, we want to create a global network that connects expertise, research, and practical support — and makes a real difference in people’s lives.

Thank you very much for the interview, and all the best for the future.