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.
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. 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.
“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.
There are mainly three types of spasmodic dysphonia:
“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.
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.
“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.
We have noticed one of its symptoms during Robert F. Kennedy Jr.’s recent appearance. Here’s are the signs of this disorder:
“Symptoms of this disorder worsen in scenarios involving stress, for example, speaking in public,” says Dr Barun. They may improve in relaxed moments.
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.
This disorder that currently does not have a definitive cure, but has treatments that help control the symptoms, 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.
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.
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.
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.
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