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Robert F. Kennedy Jr.’s voice affected by spasmodic dysphonia: Know about this rare condition

American politician Robert F. Kennedy Jr. has spasmodic dysphonia, a rare neurological condition. Check out how this affects his ability to communicate effectively.
Robert F. Kennedy Jr.
Robert F. Kennedy Jr. has a rare health condition. Image courtesy: Robert F. Kennedy Jr./Instagram
Published On: 3 Feb 2025, 05:00 pm IST
Dr Vivek Barun
Medically Reviewed by

American politician Robert F. Kennedy Jr. once had a very strong voice. But last month when he appeared during the Senate confirmation hearing for his nomination to the US Secretary of Health and Human Services, the tremble in his voice was hard to miss. The 71-year-old has been vocal about suffering from spasmodic dysphonia, which has impacted his voice since he was in his 40s. It is a rare neurological disorder that affects the muscles in the voice box. People with this disorder may have a shaky voice or not be able to speak at all. There is no cure for it, but there are treatment options to manage the symptoms.

Robert F. Kennedy Jr. on his voice

Even though many people pointed out the change in the voice of Robert F. Kennedy Jr. when he answered questions last month, he has never shied away from talking about his health condition. In a 2023 interview, Robert F. Kennedy Jr. had said that he had a “very strong voice” until he was 46 years old. At that time, he was into public speaking, but then his voice started trembling. Robert F. Kennedy Jr. said, “I didn’t know what was wrong with it. But when I would go on TV, people would write me letters and say, ‘You have spasmodic dysphonia.’”

Robert F. Kennedy Jr.
Robert F. Kennedy Jr. on his change in voice. Image courtesy: Robert F. Kennedy Jr./Instagram

What is spasmodic dysphonia?

Robert F. Kennedy Jr. attributed his raspy voice spasmodic dysphonia, which is a type of dystonia, a movement disorder, marked by involuntary contractions of muscles. “In spasmodic dysphonia, the contractions are of the muscles of the larynx or the voice box, and this leads to interruptions in speech that cause the voice to sound strained, and shaky,” explains neurology and epilepsy expert Dr Vivek Barun.

As noticed during Robert F. Kennedy Jr.’s appearance, the disorder affects a person’s ability to communicate effectively. It causes voice breaks while speaking and can make the voice sound strained, or breathy. The voice breaks can occur once every few sentences, but in severe cases, spasms may happen on each and every word, as per the US National Institute on Deafness and Other Communication Disorders. It is a rare disease affecting 3.5 to 7 individuals in 100,000 people, as per research published in Auris Nasus Larynx in 2023.

What are the causes of spasmodic dysphonia?

“It is believed that this illness is related to dysfunction in the basal ganglia, part of the brain that coordinates the muscle movements,” says the expert. It causes breaks in the voice that are irregular, and strained speech along with difficulty in vocal control.

Genetic predisposition is assumed to be the cause, given that this disorder sometimes runs in families. “Some cases of spasmodic dysphonia have also been associated with other neurological diseases, such as Parkinson’s disease or multiple sclerosis, which can affect motor function,” says Dr Barun.

What are the types of spasmodic dysphonia?

There are mainly three types of spasmodic dysphonia:

1. Adductor Spasmodic Dysphonia (AdSD)

“This is the most common form of spasmodic dysphonia, characterised by the over-adduction of the vocal cords while speaking,” says the expert. The vocal cords stiffen and press together too tightly, and the voice gets strained, choked, or strangled. The voice often breaks frequently, which makes speech effortful and tiresome. The tension in the vocal cords disrupts normal phonation and often cuts words or syllables off abruptly.

2. Abductor Spasmodic Dysphonia (AbSD)

In this less common variant, the vocal cords spasm involuntarily in the opposite way. They are too open (abduction) during speech, so the voice sounds to be very weak, and whisper-like. People with AbSD may sound as if they are losing their voice in the middle of saying something.

3. Mixed Spasmodic Dysphonia

“This is a rare form of SD where symptoms are mixed, which includes both AdSD and AbSD,” says the expert. Vocal cords alternate between excessive closing and opening. People with this form may experience unpredictable voice quality with periods of strained and breathy speech. So, it is extremely challenging to maintain vocal consistency and leads to major communication challenges.

Spasmodic dysphonia
Know the symptoms of disorder that has left an impact on the voice of Robert F. Kennedy Jr. Image courtesy: Shutterstock

What are the symptoms of spasmodic dysphonia?

We have noticed one of its symptoms during Robert F. Kennedy Jr.’s recent appearance. Here’s are the signs of this disorder:

  • Problems in speech due to involuntary muscle spasms that disrupt a normally natural flow of speech. In adductor spasmodic dysphonia, the vocal cord closes a little too tightly, making the voice strained, or choked. Effortful speech may be present, and there is a possibility of voice breaks.
  • In abductor spasmodic dysphonia, the vocal cords remain open, and the voice sounds breathy or weak with voice breaks that come and go.
  • In mixed spasmodic dysphonia, exhibiting both patterns, there is an inconsistent mix of strained and breathy voice qualities.

“Symptoms of this disorder worsen in scenarios involving stress, for example, speaking in public,” says Dr Barun. They may improve in relaxed moments.

How to diagnose spasmodic dysphonia?

A complete evaluation by doctors is done to diagnose spasmodic dysphonia. “This involves a detailed medical history, a physical examination, and tests for the assessment of vocal function,” says the expert.

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  • Fiberoptic nasolaryngoscopy, a diagnostic tool is often used. A thin, flexible tube containing a light and camera is inserted through the nose to view the vocal cords as they move with speech. It can identify involuntary spasms and vocal cords problems.
  • Another technique is stroboscopy, which gives proper view of the vibrations of the vocal fold.
  • Acoustic analysis and aerodynamic testing assess voice quality and airflow, and help distinguish spasmodic dysphonia from other voice disorders.

How to treat spasmodic dysphonia?

This disorder that currently does not have a definitive cure, but has treatments that help control the symptoms, says the expert.

  • Botulinum toxin (Botox) injections: The most common way to treat the illness is by using these injections. They are injected into the laryngeal muscle to reduce the involuntary muscle spasms, as per research published in The Journal of Neuroscience: The Official Journal Of The Society for Neuroscience in 2011. “These injections usually bring relief for three to four months before needing further treatment,” says Dr Barun.
  • Voice therapy: Another important treatment approach is voice therapy, particularly in combination with Botox injections. Speech-language pathologists assist people with this disorder in the use of techniques to enhance breath support, minimise strain on the vocal cords, and optimise the function of the voice. “It does not treat spasmodic dysphonia, but people can learn better control over their voice,” says the expert.
  • Surgery: For more severe spasms, people can go for SLAD-R and recurrent laryngeal nerve resection. “The aim of these surgical interventions is to alter the way the nerves signal. They are done in an attempt to minimise spasms,” says the expert.

The raspy voice of Robert F. Kennedy Jr. has put the spotlight on spasmodic dysphonia, which has a major impact on the voice. While there is no cure, treatment may help to reduce the involuntary muscle spasms in the voice box.

Related FAQs

Is spasmodic dysphonia a symptom of Parkinson's?

Spasmodic dysphonia is not considered a direct Parkinson's disease symptom, but there is a link between these two conditions causing voice disturbances. Spasmodic dysphonia is considered a neurological voice disorder due to spasms caused in the vocal cords, giving a voice break or strained strangled voice with breathy speech. On the other hand, Parkinson's disease can affect speech through a condition known as hypokinetic dysarthria. This is when the voice becomes soft and monotone, the speech is not clear, and articulation becomes difficult.

What is the difference between dysphonia and spasmodic dysphonia?

Dysphonia and spasmodic dysphonia are both voice disorders, but they do differ in respect to their causes and symptoms. Dysphonia is a term that refers to difficulty in producing vocal sounds in speech and is caused by a variety of different things, including nodules on the vocal cords, polyps, muscle tension dysphonia, neurological disease, or trauma. Spasmodic dysphonia is a form of specific neurological disorder affecting the laryngeal muscles for speech. It causes involuntary spasms of the vocal cords because of an impaired basal ganglion.

Is spasmodic dysphonia life threatening?

Spasmodic dysphonia is not life threatening, but it does cause a significant restriction in the individual's ability to communicate, severely affecting their quality of life. This neurological voice disorder causes spasms in the laryngeal muscles, leading to breaks in speech, strained voice, or breathy speech patterns.

Disclaimer: At Health Shots, we are committed to providing accurate, reliable, and authentic information to support your health and well-being. However, the content on this website is intended solely for informational purposes and should not be considered a substitute for professional medical advice, diagnosis, or treatment. Always consult a qualified healthcare provider for personalised advice regarding your specific medical condition or concerns.

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About The Author
Natalia Ningthoujam
Natalia Ningthoujam

Natalia Ningthoujam has written on various subjects - from music to films and fashion to lifestyle - as a journalist in her career that started in 2010. After getting stories from the crime scene, police headquarters, and conducting interviews with celebrities, she is now writing on health and wellness which has become her focus area.

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