V Management Of Dysphagia
Because lack of awareness of swallowing difficulty as well as silent aspiration are not uncommon in PD, it is critical to monitor weight and provide counseling regarding signs and symptoms of swallowing difficulty even to individuals who report no swallowing difficulties.2 For patients with documented swallowing difficulty, regular evaluation should help to anticipate problems and put strategies in place to reduce the likelihood of malnutrition, dehydration, and pulmonary problems.
Treating Speech And Language Problems In Parkinsons Disease
Potential treatments for speech and language problems of PD include medication, behavioral therapies, and surgery. The most recent assessments of these therapies suggest, however, that surgery is not effective for speech problems, although it may improve some of the severe motor problems of PD. In addition, there are no medication therapies that are effective when used alone.
Treating the basic motor problems of PD optimally appears to be a prerequisite for improving speech problems. That is, if the PD motor problems are untreated, the speech problems do not respond well to behavioral treatments. PD medication is, therefore, necessary but not sufficient. In short, the optimal treatment strategy for speech and language problems of PD appears to be a combination of PD medication plus some form of behavioral speech therapy.
Diagnosis Of Parkinsons Disease
There are currently no blood or laboratory tests to diagnose non-genetic cases of Parkinsons. Doctors usually diagnose the disease by taking a persons medical history and performing a neurological examination. If symptoms improve after starting to take medication, its another indicator that the person has Parkinsons.
A number of disorders can cause symptoms similar to those of Parkinsons disease. People with Parkinsons-like symptoms that result from other causes, such as multiple system atrophy and dementia with Lewy bodies, are sometimes said to have parkinsonism. While these disorders initially may be misdiagnosed as Parkinsons, certain medical tests, as well as response to drug treatment, may help to better evaluate the cause. Many other diseases have similar features but require different treatments, so it is important to get an accurate diagnosis as soon as possible.
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Study Selection And Characteristics
A total of 391 records were identified through database searches and other sources. Among these records, six duplicated records were removed, 304 records were excluded because speech or language treatment was not used as the intervention strategy, 57 records were excluded because full-text checking indicated that they were not RCTs, and 14 records were excluded because treatment outcomes were not fully available. A total of 10 studies were included in this meta-analysis .
FIGURE 1. Flow diagram of studies considered for the meta-analysisa
a RCTs=randomized controlled trials.
TABLE 1.Characteristics of 10 randomized controlled trials included in the meta-analysis
Social Impact Of Voice Problems
Low-volume voice and other Parkinsons-related speech impairment can have a significant impact on members social lives. Has anyone else noticed that friends you have had for years no longer call or ask you to do anything? We never hear from people whom we thought were close friends. It is very isolating and hurtful. We wonder if it is because my husbands speech isnt very good, one MyParkinsonsTeam member shared.
Another member added, When my facial expression is frozen and I cant turn my head and have trouble with speech, people think I am ignoring them.
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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.
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Parkinsonnet Care Providers Reduce Complications In Parkinsons Disease
People with Parkinsons disease have fewer complications when treated by ParkinsonNet physiotherapists, occupational therapists and speech therapists. A combination of specialist care by these four disciplines also leads to the greatest reduction in complications. This is evident from new research by the Radboudumc among more than 51,000 people with parkinsons. Never before have these results emerged for speech therapy and the combination of care.
One in a hundred people over the age of 55 will develop Parkinsons disease. Although medications reduce symptoms of the disease, they cannot prevent certain complications. Examples include a broken bone from a fall or pneumonia from swallowing problems. For this reason, among others, people with parkinsons also receive paramedical care, such as physical or exercise therapy, speech therapy and occupational therapy. PhD student Amir Talebi and research leader Sirwan Darweesh of the Radboudumc Neurology Department investigated whether it makes a difference whether specialized paramedics or non-specialized practitioners provide this care.
Fewer complications
More than the sum of its parts
About the publication
This research was published in Movement Disorders: Specialized versus Generic Allied Health Therapy and the Risk of Parkinsons Disease Complications. A.H. Talebi, J.H.L. Ypinga, N.M. De Vries, J. Nonnekes, M. Munneke, B.R. Bloem, T. Heskes, Y.B. Shlomo, S.K.L. Darweesh. DOI: .
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Compensatory And Therapeutic Swallowing Techniques
Compensatory strategies control the flow of food and help to eliminate symptoms, but do not alter the swallow physiology. Compensatory strategies used in the treatment of PD to be discussed include postural changes, increasing sensory input, and altering food consistencies. Eating while upright with the chin tucked to the chest or the head tilted forward at a 45 degree angle may be helpful for patients with a delay in triggering the pharyngeal swallow, reduced tongue base retraction, or reduced airway entrance closure or protection.43 Increasing sensory input may benefit patients who are delayed in triggering the pharyngeal swallow. Foods that help to increase sensory input include highly seasoned food, cold foods, sour foods, and possibly carbonated beverages. Altering food consistencies or elimination of consistencies from the diet should be explored only after other compensatory strategies have been examined.43 In general, thick viscous consistencies will be difficult for patients with PD to swallow who experience reduced tongue base retraction and pharyngeal contraction. Emphasizing foods that are moist and form a cohesive bolus has been suggested for patients with poor pharyngeal contraction, and blenderized food that requires minimal chewing may be necessary for patients with severe dysphagia.2 Similarly, thin liquids are typically the most difficult consistency for patients with reduced laryngeal closure.
About This Neurotech Research News
Abstract
Online internal speech decoding from single neurons in a human participant
Speech brain-machine interfaces translate brain signals into words or audio outputs, enabling communication for people having lost their speech abilities due to diseases or injury.
While important advances in vocalized, attempted, and mimed speech decoding have been achieved, results for internal speech decoding are sparse, and have yet to achieve high functionality. Notably, it is still unclear from which brain areas internal speech can be decoded.
In this work, a tetraplegic participant with implanted microelectrode arrays located in the supramarginal gyrus and primary somatosensory cortex performed internal and vocalized speech of six words and two pseudowords.
We found robust internal speech decoding from SMG single neuron activity, achieving up to 91% classification accuracy during an online task .
Evidence of shared neural representations between internal speech, word reading, and vocalized speech processes were found. SMG represented words in different languages as well as pseudowords, providing evidence for phonetic encoding.
Furthermore, our decoder achieved high classification with multiple internal speech strategies . Activity in S1 was modulated by vocalized but not internal speech, suggesting no articulator movements of the vocal tract occurred during internal speech production.
This works represents the first proof-of-concept for a high-performance internal speech BMI.
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What Are Common Causes Of Parkinsons
About 90% of people with Parkinsons will experience speech difficulty. A common characteristic of Parkinsons is smaller movements. Besides smaller walking and smaller writing, people with Parkinsons tend to use smaller movements when speaking. In other words, they take a smaller breath, move their vocal folds in a smaller way, and produce small movements of the lips and tongue. Even their facial movements are smaller. With these small movements, people with Parkinsons are not using their speech muscles to full capacity. As a result, the speech mechanism becomes weak and uncoordinated. If left untreated, speech challenges can develop into life-threatening swallowing complications.
The early symptoms of a speech disorder associated with Parkinsons are:
- Inconsistent production of the voice
Speech And Swallowing In Pd
People with Parkinsons may notice changes in or difficulty chewing, eating, speaking or swallowing. These changes are more likely, and tend to worsen, as PD progresses and the muscles in the face, mouth and throat that are used in speaking and swallowing are affected. Here are some resources to understand speech and swallowing issues in PD, how speech-language pathologists determine the extent of the changes, and what can be done to compensate or make swallowing safer to prevent aspiration.
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Risk Of Bias In Included Studies
See Table 2 and Figure 2 for summary of the methodological quality of the trials. It is impossible to blind patients and treating therapists in trials comparing the efficacy of two types of speech and language therapy. This leaves such trials open to performance and attrition bias. Blinded assessors were used for all included trials, so detection bias is unlikely in these studies.
Risk of bias summary: review authors judgements about each risk of bias item for each included study.
Randomisation method and concealment of allocation
Eligiblity criteria
Patient numbers
We found only six randomised controlled trials comparing two methods of speech and language therapy for speech disorders in a total of 159 Parkinsons patients . With such a small number of patients examined, it is possible that there was bias in the selection of patients, therefore, the applicability of the data to the general population with PD is questionable. The lack of power due to the small number of patients also increases the risk of a false negative result.
Similarity at baseline
Description of speech and language therapy methods
Drug therapy
How Is Sleep Apnea Treated
A continuous positive airway pressure machine, a machine that blows air into your airway at a pressure that is sufficient to keep the airway open during sleep, is the most consistently effective treatment for obstructive sleep apnea. The CPAP machine is connected by a tube to a face mask worn when sleeping through the night. It controls pressure in ones throat to prevent the walls of the throat from collapsing, creating better sleep quality. CPAP should be worn for the entire night and for naps.
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Speech And Communication Problems
Speech and communication problems are common for people with Parkinsons.
They can include problems with your voice, body language, making conversations and small handwriting. But with the right help and support there are lots of ways you can improve any symptoms.
Changes in the brain in people with Parkinsons mean that your movements become smaller and less forceful than before. This can lead to problems with your speech and communication.
Issues may relate to making sure your voice is loud enough, making your pronunciation clear enough and getting the right tone to your voice.
Problems creating movements that are powerful enough can also affect chewing and safe swallowing. Because of this you may find mealtimes more difficult, with an increased risk of food going down the wrong way.
Find out more: see our information on eating, swallowing and saliva control.
Other communication issues in people with Parkinsons are linked to the way you think. Brain changes mean you may not be able to process thoughts as quickly as you need to.
This includes difficulty finding the right words you need or understanding what other people mean straight away. It also includes problems getting your thoughts together quickly enough to respond to someone in the flow of a conversation. In particular, this can happen when you have to do several different things at once .
Language Problems Of Parkinsons Disease
Besides the frustrating speech and voicing problems of PD, there may also be language problems. These language problems very likely make the speech problems more difficult to deal with, so it is important to identify these language difficulties when they appear.
Speech is about expressing ideas via the use of language. Language is a cognitive ability that can be present even when you cannot speak. In the case of people with PD, they may exhibit word-finding difficulties and grammatical difficulties. They tend, for example, to use simplified sentence structures with an increase in the ratio of open-class items to closed-class items , as well as an increase in the frequency and duration of hesitations and pauses.
When listening to others speak, it’s sometimes hard for persons with PD to understand the others language, if they use complicated sentences to express their ideas. Thus, in both the production of language and comprehension of language, people with PD sometimes experience significant difficulties.
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Speech And Voice Disorders In Parkinsons
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.
Communication Strategies For Optimal Success
In this 1-hour webinar speech language pathologist Angela Roberts reviews the changes in speech, facial expressions, cognition, voice and hearing caused by PD that can interfere with communication and meaningful connection with others. These changes impact the social, emotional, physical and practical aspects of living with PD. Communication strategies for optimizing successful conversation are shared. Registration is required, but it is free.
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As A Result Of Her Research Dr Cynthia Fox Helped Develop An Effective Approach To Speech Therapy Treatments For Parkinsons Disease
Dr. Cynthia Fox is the co-founder and Chief Executive Officer at LSVT Global, which oversees the LSVT LOUD and LSVT BIG programs. The mission of LSVT Global is to continue to develop and advance these programs, as well as to train speech, physical and occupational therapists around the world in these techniques so that they can positively impact the lives of their patients. Dr. Fox began her work with LSVT more than twenty years ago, conducting efficacy research on the voice techniques for PD. She subsequently worked closely on the development of the LSVT BIG program. She has numerous publications in these areas of research and has presented extensively around the world. Dr. Fox continues to serve as faculty for LSVT LOUD and LSVT BIG training and certification courses.
I had the privilege of talking with Dr. Fox about LSVT LOUD and LSVT BIG.
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.
What Causes Parkinson Disease
As is the case with many other neurodegenerative disorders, the vast majority of Parkinson disease cases occur spontaneously with no known genetic inheritance from generation to generation. These so-called sporadic cases make up more than 90% of all cases of PD. However, inherited forms of PD have been identified of both the dominant and the recessive type. With both early and late age onset forms, the various gene defects responsible have pointed to selected biochemical pathways that could serve as key targets for future therapeutic intervention. One area of particular interest is the role played by oxidative damage in the substantia nigra as a causal factor in PD.
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Dysarthria Management Beyond The Individual: Group Therapy Approaches
Group treatment is also often implemented in university clinics and beyond, with the aim of improving speech communication in PD in a larger, supportive setting. De Angelis et al investigated the effects of 13 group therapy sessions on voice variables in 20 individuals with PD.50 Treatment focused on increasing phonatory function through the implementation of a high-effort program based on pushing exercises during phonation, as well as overarticulation techniques to maximize articulatory precision. Positive changes following speech treatment were reported, indicating greater laryngeal efficiency. Specifically, the study reported an increase in maximum phonation times and vocal intensity, a decrease in s/z ratio measures and a reduction in self-perceived deviant vocal characteristics . An improvement in speech intelligibility was also found as measured by participants self-evaluations, suggesting promise for such group treatment.