Wednesday, June 19, 2024

Guidelines For Speech-language Therapy In Parkinson’s Disease

Managing Swallowing Changes In Psp Cbd And Msa

Helping Parkinson’s Patients Speak Clearly

In this one hour and fifteen-minute webinar speech language pathologist Julie Hicks has just one slide specific to PSP, CBD, and MSA. The rest of her presentation provides general information about working with a SLP, what swallowing evaluation looks like, and what treatment might involve. In the question-and-answer time Julie talks about when to see an SLP, the use of feeding tubes, practical tips families can use to help people slow down and control impulsivity while eating, and how to find an SLP with experience treating those with parkinsonism disorders.

Overall Completeness And Applicability Of Evidence

Outcome measures

It can be argued that intelligibility is the most critical outcome to be measured in speech and language therapy trials. If this global measure does not improve then it is irrelevant to the patient how many other objective speech quality measures improve they still cannot be understood. All included trials assessed intelligibility and almost all results were not statistically significant. The exception to this was the perceptual ratings of speech recordings overlaid with babble noise for which LSVTLOUD gave a greater improvement than LSVTARTIC . The noninferiority of online delivery of LSVT was supported by the intelligibility results of Constantinescu 2011, who reported no statistically significant difference between the improvements in both acoustic and perceptual measures for this group and the facetoface delivery group.

The prosodic abnormality score, which assesses volume, pitch, tone, intonation, vocal quality , rate and rhythm, does not appear to have been independently assessed for validity.

Adverse events were not reported by any of the trials included in this review. Although the risk associated with speech and language therapy is low, patients could be affected by vocal strain or abuse during high effort exercises.

Speech and language therapy methodology

Speech and language therapy terminology

If A Person With Pd Finds His/herself In A Loud Room Trying To Have A Conversation What Are Some Tips To Keep In Mind

Many people have difficulty conversing in noisy rooms, and it can be so frustrating that people start avoiding social situations or dont attempt to engage with others. In these situations, it is particularly important to be aware of your speaking volume. In addition to this, try these simple things:

  • Make sure that you have the visual attention of your listener so that they know you are trying to communicate with them.
  • Stand closer to the person whom you are talking to or ask if you can step out to a quieter area.
  • Make sure that you are standing in good lighting this will enable the other person to see your lips and expressions.
  • Check in with your listener, Can you hear me okay?
  • Be clear about the topic of conversation. If your listener knows the topic, it will help them predict what words you might be apt to use.
  • If you are misunderstood, try to rephrase your message using alternate words and shorter sentences.
  • Use gestures and any other nonverbal communication to supplement your words.

Tips and Takeaways

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Try To Help The Person With Pd By Not:

  • Forcing them to speak or to see people they do not want to.
  • Talking for them unless necessary.
  • Interrupting when they are trying to say something.
  • Insisting that the person pronounces each word perfectly.
  • Becoming irritated when the person cannot communicate.
  • Isolating the person with PD:
  • Trying to get them to talk while they are walking.

How To Find A Speech Therapist

Parkinsonism &  Related Disorders

Tell your doctor If you are experiencing any changes in your speech or voice. Ask for a referral and a prescription for a speech evaluation and treatment. If you have not noticed changes in your speech, but a spouse, care partner or friend has: pay attention to their comments. The sooner you get a speech evaluation and start speech therapy, the better.

Speech therapists work in many settings, including hospitals, outpatient rehabilitation centers and private practice offices. To locate one in your area, contact the American Speech-Language-Hearing Association at, or find a therapist certified in the Lee Silverman Voice Treatment by visiting

Ideally, you should see a speech therapist face-toface for a complete voice and speech evaluation and treatment. However, if a speech therapist is not available in your area, LSVT LOUD the most researched voice treatment for people with PD is virtually offered in select states. The speech therapist interacts with you in your home or office live through your computer screen.

Learn more about speech and Parkinsons by reading our free book Speech and Swallowing. Order online at or by calling our Helpline at 1-800-4PD-INFO .

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Rehabilitation For Speech And Swallowing

Research has shown there are benefits for PD patients who take part in high intensity exercise. This is true for the muscles involved in speech and swallowing as well.

There are a few evidence-based rehabilitative treatment methods that have proven effective. Working with a speech language pathologist, patients may choose from:

All treatment options require intense effort and ongoing practice during treatment as well as after. A therapist will also recommend periodic “tune-up” therapy sessions to maintain the strong clear voice and participation in maintenance groups.

Can Anything Be Done To Treat Speech And Language Problems Seen In Parkinsons Disease

Yes. Sadly, although the majority of people with PD experience some type of speech problems, less than 5% get treatment for those speech problems.

This is unfortunate, as research shows that effective treatments are available for some of the speech, voice and language problems of PD.

Medication, speech and language therapy and brain surgery have all been evaluated as potential treatments for speech and language problems of PD.

The various types of brain surgery used in the treatment of PD over the last 30 years or so have generally not been shown to have a beneficial effect. In many cases surgery has caused deterioration in speech and language in PD.

Parkinsons medications by themselves are not effective in improving problems with speech. They can however help by improving the volume and clarity of speech and body language while the medication is working . The converse of this is that when the medication is not working the voice may be quiet and difficult to understand. This can be frustrating, but there are ways to adjust life around on/off periods. For further information regarding the on/off syndrome please see the Parkinsons Associations Information Sheet on the On/Off Motor Fluctuations in Parkinsons Disease.

Speech problems in PD do not respond well to speech and language therapy if the mobility problems and tremor of the person with PD are left untreated.

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Speech And Language Problems Of Parkinsons Disease

In Parkinsons disease the nerve cells that produce dopamine, the chemical which transmits signals to other nerve cells in the brain to produce movement, are lost in PD. By the time clinical symptoms of PD occur a high number of the cells producing dopamine have already died . The remaining dopamine producing cells will continue to die over time. Given the movement control and messaging required within the brain to facilitate speech and language, it is not surprising that problems with speech and significant difficulties in using and understanding written and spoken language are seen in PD. Just as PD progresses over time, problems with speech and language will also worsen as the disease progresses.

Many people with PD have problems speaking when they first develop the condition and almost all patients with PD will experience problems with their speech and voice at some stage.

Subtle changes may happen early, with the persons voice becoming softer and flat in tone, making it hard to hear. The severity of the changes to speech can vary from one patient to the next.

In fact, some patients may have their speech severely affected, while others may only have slight effects on their speech. In advanced stages of PD, speech may become unintelligible for some people.

Lets Talk About Talking With Parkinsons Disease

How does speech therapy help Parkinson’s patients?

Communication issues can become a problem for people living with Parkinsons disease . Recently APDA published a new booklet entitled Make Your Voice Heard! Healthy Communication and Parkinsons Disease which can be downloaded from our website for free or ordered by mail at no cost to you. Lisa Sommers, MA, CCC-SLP Clinic Director and Clinical Assistant Professor, in the Department of Communication Disorders at University of Massachusetts Amherst, is a Speech-Language Pathologist and an expert in speech and communication issues for people with PD and was one of the authors of this extremely informative publication. She is also an advisor to our APDA Massachusetts Chapter. Recently, I was able to talk with Ms. Sommers about the value of speech therapy for people with PD at all stages of the condition and what someone with PD might expect from a visit with an SLP.

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Training And Coaching Of Trial Therapists

Before the start of the trial, participating speech therapists follow a 2-day training in which they are informed about the study procedures and the PERSPECTIVE intervention protocol, including delivering online treatment. During the study period, speech therapists will be coached online by one of two experts to ensure that every patient receives optimal speech therapy. These experts have been responsible for the education of speech therapists in ParkinsonNet and the development of the voice trainer. Coaching of speech therapists takes place in a group video call with the coach, speech therapist, and patient during three online treatment sessions , in which the coach provides live feedback to the speech therapist.

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Speak Up For Parkinsons

This free app allows the patient/client to video-record themselves saying words or phrases, reading aloud or having a conversation. It has a volume target zone which turns green when the person is loud enough to reach it. The downside of this app is that you really do have to speak very loud to reach the green target zone. However, it is good for encouraging increased vocal effort and the video-recording can be used for client feedback on articulation, intelligibility and facial movement.

What Are The Common Reasons That Someone With Pd May See A Speech

Please access free hypnosis audio program for reduction of tremors at ...

Often people with PD are referred to an SLP by their physician when they begin to have difficulty communicating or swallowing. Unfortunately, by the time people receive an evaluation from a SLP they have likely been experiencing subtle symptoms for quite a while. People with PD as well as their family members and friends often start being aware of communication issues when the person with PDs voice becomes too soft to communicate effectively. The communication symptoms begin very gradually, so they may first experience difficulty projecting their voice in a noisy environment, or when ordering at a drive-thru window. Over time they begin to experience more and more issues being heard and understood by others. Some people may gradually develop some imprecise/slurred speech and/or a hoarse or breathy voice quality. Communication can also be negatively impacted by changes in nonverbal communication, such as reduced facial expression and speaking with a monotone inflection.

Swallowing issues are often not detected until the person with PD is coughing significantly during meals or struggling to chew and swallow food safely and efficiently. The changes in swallowing can also happen so gradually that people assume symptoms are just related to aging or some other external factor, when in reality, these changes are directly related to the sensory and motor issues associated with PD.

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What Emergency Type Devices Should A Person With Parkinsons Disease With Speech And Voice Problems Have At Hand

To preparing for emergencies:

  • Use an intercom system or baby monitor to alert others that there is an emergency.
  • Use bells or buzzers if you are not able to speak. Use codes that signify urgency. For example, a tinkling bell might mean, Id like company, while an air horn might mean theres an emergency.
  • Carry a cell phone that is equipped with pre-programmed numbers. Preprogram all of your telephones so they can automatically dial the necessary emergency number.
  • Sign up for a Life Call button service if you spend time alone. Pressing a button on a device usually worn on the wrist or around neck signals a service company that alerts loved ones and/or your local emergency service.

What Is Nonverbal Communication

Nonverbal communication, also called augmentative and alternative communication , is a method of communicating without spoken words.

When communication needs cannot be met through speech, the following techniques can help:

  • Make the best use out of what speaking ability is left.
  • Use expressions and gestures to communicate.

Non-verbal communication can help people with speech difficulties actually speak better by:

  • Reducing the frustration and stress of being unable to communicate.
  • Alleviating the pressure to speak.
  • Allowing the person to be more relaxed and come across in a more understandable manner.

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If I Have Parkinsons Disease What Kind Of Speech And Voice Problems May I Experience

If you have Parkinsons disease, some of the voice and speech difficulties seen include:

  • Softened voice. Reduced volume to your voice.
  • Speaking in an unchanging pitch .
  • Having a hoarse or strained quality to your voice.
  • Having a breathiness to your voice. Breathiness in the quality of your voice that is easily heard by your listeners. It takes more effort and energy to speak. You run out of gas as you speak.
  • Trouble clearly and easily pronouncing letters and words.
  • Tremor in your voice.
  • Using short rushes of speech.
  • Loss of your facial expression.

If you have Parkinsons disease, you may not be aware of the problems with your spoken communication. Changes in the quality of your voice may be the first sign of speech problems followed by the inability to have fluid speech and clear and distinct speech sounds. Speech problems that are severe enough to reduce your ability to be easily understood usually do not occur until later in the course of Parkinsons disease.

If The Person With Pd Is Having Difficulty With Use Of Language:

Occupational Therapy & Parkinsons Disease
  • Use short sentences and stress key words
  • Do not ask complex questions.
  • Make sure they can see and hear you.
  • Use body language and facial expression. Note: In some communities and with some I individuals this can be interpreted in different ways, and so may not be appropriate.
  • Vary the tone of your voice.
  • Do not embarrass them by making them join in a group if they do not want to.
  • If verbal communication is becoming overtly challenging, consider using a speech aid to help. A Speech and Language Therapist will advise on this.

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What If I Have An Emergency How Will I Communicate

  • Use an intercom system or baby monitor to alert others that there is an emergency.
  • Use bells or buzzers if you are not able to speak. Use “codes” that signify urgency. For example, a tinkling bell may mean, “I’d like company” while an air-horn means there’s an emergency.
  • Carry a portable phone that is equipped with pre-programmed numbers.
  • Pre-program all of your telephones so they can automatically dial the necessary emergency number.
  • Consider a “life call” button if you spend time alone.

Show Sources

How Can Someone With Parkinsons Disease Access Speech And Language Therapy

A doctor or consultant can provide a referral to a Speech and Language Therapist working in the HSE. However, there is unfortunately a shortage of qualified Speech and Language Therapists working in the HSE in Ireland.

Self-referral to see a private Speech and Language Therapist is also possible. The Irish Association of Speech and Language Therapists in Private Practice site can help find a private practitioner in specific area. Their website is available at: www.

Many Speech and Language Therapists working in the HSE or in private practice are trained to administer the Lee Silverman Voice Therapy. Details of Speech and Language Therapists trained in LSVT around the world can be obtained from the LSVT Global website on

If a person with PD decides to seek private treatment they will have to pay for the treatment. However, there may be some reimbursement for speech and language therapy under private health insurance schemes. People with PD will need to check their individual policy for specific reimbursement entitlements. Tax relief may be obtained on speech and language therapy fees .

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Ways To Improve Speech In Parkinsons Disease

5 min read

Parkinsons disease is a neurodegenerative disorder that affects the motor neurons. As it progresses, the person with PD may become harder to understand as their voice becomes softer or hoarse. Their face may become more masked or expressionless, and their voice may sound monotone with less emotion. They may speak faster , mumble, or repeat . Together these symptoms are known as hypokinetic dysarthria.

A speech-language pathologist is a specialist in communication disorders and can help a person with PD to speak more clearly and confidently. Here are 9 ways an SLP can help:

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Speech And Voice Disorders In Parkinsons

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There are several reasons people with PD have reduced loudness and a monotone, breathy voice. One reason is directly related to the disordered motor system that accompanies PD, including rigidity, slowness of movement and tremor. For example, the poor muscle activation that leads to bradykinesia and hypokinesia in the limbs can translate to the muscles involved in speech. These problems with muscle activation can result in reduced movements of the respiratory system , larynx and articulation .

Another cause of speech and voice impairment in PD is a change in sensory processing that is related to speech. It is believed that people with PD may not be aware that their speech is getting softer and more difficult to understand. When people in this situation are asked to bring their voice to normal loudness, they often feel as though they are shouting, even though they are perceived by listeners to be speaking normally

Another cause of this condition is that people with PD may have a problem with cueing themselves to produce speech with adequate loudness. Individuals with PD can respond to an external cue , but their ability to cue themselves internally to use a louder voice is impaired. These problems can be frustrating both for the person and for the family.

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