Search Methods For Identification Of Studies
1. The review is based on the search strategy of the Movement Disorders Group and also the following more general search strategy:
a. Dysarthria OR speech OR speak OR intelligibility OR dysprosody OR hypophonia OR monotonicity OR phonate b. near ) OR silverman OR LSVT c. Parkinson OR Parkinson’s disease OR Parkinsonism d. OR
See Appendix 1 for sample search . This strategy was adapted for each electronic database.
We identified relevant trials by electronic searches of general biomedical and science databases: The Cochrane Controlled Trials Register searched without date limiters, CENTRAL and PubMed , EMBASE , CINAHL , ISISCI rehabilitation databases: AMED , MANTIS , REHABDATA , REHADAT, GEROLIT English language databases of foreign language research and third world publications: Pascal , LILACS , MedCarib , Journal@rchive , AIM , IMEMR and handsearching of appropriate conference proceedings Relevant trials were included on the Group’s specialised register of randomised controlled trials.
2. We also searched The CenterWatch Clinical Trials listing service, controlled_trials.com, ClinicalTrials.gov, CRISP, PEDro, NIDRR and NRR for relevant trials.
3. The reference lists of located trials and review articles.
Further details on this search strategy are available in the Group’s module within The Cochrane Library . This includes explanations of the acronyms, sources and web sites.
Therapy Programmes For People With Parkinsons
Your speech and language therapist may be trained in one of the following treatment programmes which are specifically designed for voice and speech therapy in people with Parkinson’s.
Lee Silverman Voice Treatment is an intensive treatment programme involving several individual sessions over the course of one month together with home practice. The main focus is volume of voice. LSVT helps people to recognise whether their voice is quiet while working to produce a loud, good quality voice.
Most people can benefit from LSVT and it can be adjusted to individual communication needs and environments. Speech and Language Therapists need to undergo a two-day training in order to deliver the LSVT.
For more information and to find a trained clinician see www.lsvtglobal.com.
SPEAK OUT! by the Parkinson Voice Project is also an intensive treatment programme emphasising speaking with intent and converting speech from an automatic function to an intentional act. It also provides a Parkinsons Information Session. Therapy is intensive over a number of sessions together with home practise.
For more information and also to view the speech practise videos see www.parkinsonvoiceproject.org.
Spoeech An ‘active Cognitive Event’
Dr Lindsey Collins-Praino, Associate Professor of Medical Science at Adelaide University, said different speech therapy programs focused on different things.
She said the Lee Silverman Voice Treatment, for instance, was based more around sensory and perceptual approach, raising the intensity of voice, while the Parkinson’s Voice Project had a cognitive focus.
“Its all about intention of speech, helping people to not see speech as automatic but an active cognitive event,” Dr Collins-Praino said.
She said it could be beneficial to take a multifold approach because about 80 per cent of people with Parkinson’s experienced cognitive impairments.
Estimates are 80 to 90 per cent of people with Parkinson’s experience speech impairments but only between 3 and 4 per cent of patients sought treatment to address the issue, Dr Lindsey Collins-Praino said.
“Your voice is a muscle just like the muscles of your body and you need to also work that as well,” Dr Collins-Praino said.
“Just like with any form of exercise, you get out of it what you put into it.
“To just participate in the program and expect it to be a one-stop fix is probably not realistic it will certainly have benefits in the short term but… it will likely involve a lasting commitment to ongoing exercises.”
She said there were preliminary studies suggesting that as the disease got worse it became more difficult for speech therapy to have benefits.
“That’s why early intervention is so important,” she said.
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Speech Therapy For Parkinsons Disease
Parkinsons disease affects not only movement but also muscles in the face, mouth and throat that are used to speak. This may cause a persons voice to change, as well as dysarthria, or difficulty in speaking, and dysphagia, or difficulty in swallowing. Speech may become slurred, mumbled or rapid, and the voice softer. For some, it may be difficult to breathe, find words or participate in fast-paced conversations.
These problems may be referred to a speech and language therapist who is trained in all forms of communication, including non-verbal communication such as facial expressions or body language. Such therapists can teach techniques and offer tips for better communication.
It is important to begin speech therapy as soon as possible and continue it on a regular basis.
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Low Intensity Focused Ultrasound To Help Deliver Therapies
While high intensity FUS is a treatment for PD as described above, low intensity FUS can be used in an entirely different way to help treat PD. This type of FUS may allow for disruption of the blood brain barrier. The blood brain barrier refers to the cells that line the blood vessels within the brain which keep foreign substances, such as toxins and microbes, in the bloodstream and out of the brain.
Normally, this mechanism is advantageous and protects the brain. However, the blood brain barrier may also keep out molecules that could help to treat brain diseases. Therefore, disrupting the blood brain barrier could allow for penetration of these molecules into particular areas of the brain. A whole variety of different molecules such as antibodies, nerve growth factors and gene therapy may be able to take advantage of this approach. Further research is necessary to determine if this will be a useful method for drug delivery into the brain.
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Work With A Online Speech Therapist Today
The Parkinsons speech therapy exercises outlined above are a great place to start if you feel that your speech skills are starting to decline. But, youll see the greatest benefits if you also work with a specialized speech therapist.
When working with Great Speech, our team of therapists will help you make sure youre doing the exercises correctly. Theyll also be able to prescribe specific exercises that are better tailored to your particular needs to continue seeing results between sessions.
Great Speechs team of online speech pathologists provide speech therapy services for a wide range of people, including those related to Parkinsons disease.
Improving Speech & Movement Through Lee Silverman Voice Treatment Programs For Parkinsons Disease
People with Parkinsons disease often find that they have difficulty with their speech and their ability to be properly understood in conversation. Their voice may not be as loud, or their articulation as clear as it once was. They may speak in a monotone voice which does not convey the emotion that listeners expect to hear. When these communication issues are not addressed, problems can progress and significantly impact quality of life. People with PD may even limit their conversation with others, for fear of not being properly understood.
The Lee Silverman Voice Treatment was first developed as a speech therapy modality to help people with PD combat these issues. It aims to recalibrate the perception of loudness that a person with PD has of their voice, prompting participants to speak at a more normal volume.
More recently, the LSVT BIG® program was developed, applying similar principles to the size of movements that people with PD make. As PD progresses, movements tend to become smaller and smaller. LSVT BIG aims to recalibrate a persons perception of the size of their movements so that participants begin to move in larger, more intentional ways.
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Swallowing And Drooling Problems
Over time swallowing in people with PD may become more difficult, which can cause problems when eating or drinking. Treating swallowing difficulties is vital to prevent serious problems such as aspiration and choking. Difficulties may arise at any time, and may affect any of the three phases of swallowing: 1) when the food is being chewed in the mouth, 2) when the food is travelling from the mouth through the throat to the food pipe and 3) when the food is travelling down the oesophagus.
Common problems that we should look out for include:
- difficulty swallowing pills
- drooling or too little saliva
- coughing whilst eating or just after swallowing / eating
- a wet or gurgly voice after eating or drinking
- watery eyes or changes in breathing patterns after eating
- the feeling of something stuck in the throat
- food remaining in the mouth after swallowing
- difficulty chewing
- taking longer to finish a meal.
How To Find A Speech Therapist
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 www.asha.org, or find a therapist certified in the Lee Silverman Voice Treatment by visiting www.lsvtglobal.com.
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 Parkinson.org/Books or by calling our Helpline at 1-800-4PD-INFO .
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Zoom Voice Group For Pwp
Cost: $60 / 6 weeks
Class: voice exercise
Duration: 60 minutes
Classes run in 6 week sessions with a break in between. Class size is limited. Registrants must commit to all 6 weeks. You can register for the class with the instructor, speech language therapist, Jocelyn Lagier, on her website, by phone , or by using this form and mail her a check for tuition.
Speech And Language Therapy
Some people with Parkinsons have problems with their speech and communication. This information looks at what difficulties you may experience and how speech and language therapy can help.
Speech and language therapists specialise in all aspects of communication. This includes speech, using technology, and facial expression and body language.
They are part of the team of healthcare professionals who can help you manage your condition.
They will help with any swallowing and communication problems you may experience. For example, putting your thoughts into words, communicating your ideas to others and understanding what others are saying. They will be able to give you techniques or tips to help reduce problems and help you prevent them from happening.
In the early stages of Parkinsons, a speech and language therapist will focus on maintaining as much of your communication ability as possible.
They will develop strategies and exercises to help you with your volume and speed of speech, breathing, facial expressions and articulation .
A speech and language therapist will also ask about the different settings you communicate in, as they can play an important part in how your problems affect your everyday life.
They can help you, for example, if you work in a very noisy office where a soft or quiet voice is difficult to hear, or if you work in a very quiet environment that might not lend itself to speaking loudly.
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Effects Of Medication And Surgery On Speech
The effects of medication on speech vary from person to person but studies suggest that there is generally no significant effect of medication on speech.
Side effects of medication such as dyskinesia and motor fluctuations can make communication, eating and drinking more difficult though, so it is important to work with your doctor to adjust your medications to give you the best possible motor control.
Surgical treatments may lead to worsening speech. Therefore anyone considering surgery should discuss this risk thoroughly with an experienced specialist.
Recommendations For Caregivers And Family
Cognitive therapy may help by modifying the way caretakers communicate with a patient. Recommendations for caregivers, family and physicians include:
- Avoid complex syntax. Do not use embedded clauses such as, My car, which is very old, is in the shop. Sentences should be kept short when possible and pauses should be incorporated when long sentences are required.
- Avoid taxing word memory. Chunk information into smaller units whenever possible and wait for acknowledgment before proceeding. For example, phone numbers are not typically remembered in a long string of numbers, but rather 123-456-7890.
- Clearly delineate topics. Conversations should be structured so as to thoroughly discuss a single subject in a compartmentalized manner before shifting to a new and unrelated topic.
- Avoid reliance on emotional expressions. Do not rely on facial expressions to display emotions. Individuals with PD may have trouble recognizing emotional expressions such as a smile or a frown.
- Avoid using phrases with non-literal meaning. For instance, saying she hit the sheets instead of she went to bed can be confusing for the patient.
- Minimize distractions and background noise. A speaker should be oriented to face the listener. This will also help with understanding speech that may be impaired.
Visit our website for more information on our speech language pathology and rehabilitation programs.
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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.
If The Person With Pd Is Having Difficulty With Use Of Language:
- 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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Should Speech And Language Therapy Be Available To All People With Parkinsons Disease
The 2006 English and Welsh National Institute for Clinical Excellence Guideline for Parkinsons recommends that access to speech and language therapy should be available to everyone living with PD.
The earlier people with PD get access to a baseline speech evaluation and speech therapy, the more likely they are to improve their speech and voice and maintain effective communication over the course of their PD.
The available evidence suggests that these sorts of behavioural speech therapy regimens really work, so there is no reason for people with PD to keep having frustrating conversations with others who pretend they understand what is being said.
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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Treatment For Rem Sleep Disorder
Consider making environmental adjustments to protect the person with RBD and bed partner from injury. This may include padding the floor, creating a barrier between bed partners, or sleeping in separate beds or rooms.
Dysphagia & Parkinsons Disease
Dysphagia, or difficulty swallowing, will often occur at some point in the disease process. It is important to recognize these signs to ensure safety with meals and medications. Some signs of dysphagia may include, an increase in coughing or choking during meals, throat clearing or feeling foods get stuck in the throat after swallowing. It is important to further assess swallowing function with the assistance of an SLP to determine the safest and least restrictive diet recommendations and provide appropriate exercises to improve swallow function.
It is highly encouraged for patients to complete a formal assessment with an SLP who specializes in Parkinsons disease shortly after diagnosis in order to provide appropriate interventions to slow the progression of the disease and maintain independence.
Resources:
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