Parkinson’s Disease And Speech Therapy

Parkinson’s Voice Project Practice Videos

Four Speak Out! practice videos, each with a different Parkinson’s Voice Project speech language pathologist .

Cost: $34.99/month or $349.99/year, first month free

Online post speech therapy maintenance with a speech language pathologist trained in either LSVT LOUD or Speak OUT!

Includes 15+ voice practice sessions per week as well as facial exercises, articulation practice, and more.

Publisher: LSVT Global, Inc. Cost: $28 for DVD or download $15/year streaming

Speech exercises for people with Parkinson’s Disease and other neurological conditions. Available in English and Cantonese.

If I Have Speech And Voice Problems How Can I Maintain And Improve My Communication

Some tips to improve communication include:

• Choose a quiet, low-noise space. Turn off televisions, radios and other devices that create noise.
• Make sure your listener can see your face. Look at the person while you are talking. A well-lit room improves face-to-face conversation, increasing the ability to be understood.
• Use short phrases. Say one or two words or syllables per breath.
• Plan periods of vocal rest before planned conversations or phone calls. Know that fatigue significantly affects your ability to speak. Techniques that work in the morning might not work later in the day.
• Keep your throat hydrated. Drink plenty of water. Dont drink caffeinated or alcoholic beverages. Use a humidifier if the air in your home is dry.
• Keep an upright posture, straight chin, slightly lifted neck to improve airflow from lungs to your vocal cords.
• If you are soft spoken and your voice has become low, consider using an amplifier.

If some people have difficulty understanding you, these additional strategies might help:

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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What Type Of Healthcare Professional Helps People With Speech Problems From Parkinsons Disease

If you have speech and voice problems, see a speech-language therapist. Your primary healthcare provider can help you find a therapist in your local area. Some speech-language pathologists have specialized training that focuses on training people with Parkinsons disease to amplify their voice. This is called the Lee Silverman Voice Treatment.

Speech-language therapists are specifically trained to diagnose and treat speech, language and swallowing disorders. If you have Parkinsons disease, a speech-language pathologist can help you:

• Maintain as many communication skills as possible. Teach you techniques to conserve energy, including using nonverbal communication skills.
• Introduce you to assistive devices and techniques to help improve your communication.
• Recommend exercises to help you improve muscle strength and movements needed to improve your speech and communication options.

Q: Can You Give An Overview Of How An Lsvt Loud Session Is Conducted

A:LSVT LOUD is an intensive, one-on-one treatment delivered over one months time, with four one-hour sessions per week for four weeks in a row, and with daily homework and carryover exercises.:

The first 30 minutes of a session focuses on voice exercises, which are the foundation for improving vocal loudness and effort. The second 30 minutes of the session are spent on transferring this vocal loudness into functional speaking activities. LSVT LOUD keeps people highly engaged, not only with frequent treatment sessions but also daily assignments for practicing newly learned skills at home and in their communities. Further, LSVT LOUD individualizes treatment exercises to each persons interests and personal goals for improving communication.

As needed, we add progressive challenges with speaking activities, such as dual motor tasks or a cognitive challenge. For example, we can work on typing and talking on the phone for someone who frequently does this at work. For others it might be keeping a loud voice while playing/shuffling cards. Whatever is a specific, meaningful goal and communication activity for a given person, we can work on it in therapy.

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Speak Up For Parkinson’s

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.

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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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.

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, “I’d like company,” while an air horn might mean there’s 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.

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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.

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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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Design And Data Collection

A pre-interview was held with each patient to gather personal background details, including medical, musical, and social history, and subsequently, pre- , post- , and 6-month follow-up tests were administered. Based on previous studies, we designed the ITSP-PD to include six 50-minute music therapy sessions provided by a certified music therapist over a period of two weeks . All data collection and music therapy sessions were performed in the hospital or in the patients homes. All tests and sessions were video recorded with the written consent of each patient.

The Hoehn and Yahr staging scale , Unified Parkinsons Disease Rating Scale for speech , and the Levodopa Equivalent Daily Dosage were also assessed by a neurologist .

We evaluated three main aspects of the participants vocal and emotional state: vocal attributes, depression, and patient responses during the sessions. To evaluate depression, we used the Geriatric Depression Scale . The total GDS score ranges from 0 to 30, where a score over 10 indicates depressive symptoms . The Maximum Phonation Time , the Voice Handicap Index , and the Voice-Related Quality of Life were assessed during the pre-, post-, and follow-up tests.

Additionally, behavioral observations, use of voice, and interactions using physical, linguistic, emotional, and musical responses were reported by a researcher. The descriptive observations and subjective analysis of each session for each patient were recorded.

Do Swallowing Problems In People With Parkinsons Disease Also Affect Speech

Swallowing problems are a common problem in people with Parkinsons disease. They can occur at any stage of the disease, can change throughout the disease course and often get worse as symptoms progress. Let your healthcare provider and/or speech-language pathologist know as you notice you are having swallowing problems. Symptoms of swallowing problems include drooling, choking, coughing, difficulty taking pills, taking a long time to eat, weight loss and dehydration. The most serious complication of a swallowing problem–and the reason why you should see your provider right away– is aspiration. Aspiration is when food or liquid goes into your windpipe , then passes down into your lungs, which can lead to aspiration pneumonia.

Although swallowing problems may not directly affect your speech, swallowing problems and voice and speech problems often occur at the same time.

A note from Cleveland Clinic

Voice and speech difficulties are common problems in people with Parkinsons disease, especially as the disease worsens. These problems affect your ability to communicate in the work setting and with family and friends which affects the quality of your life. Fortunately a speech-language pathologist can develop an effective treatment program to help improve your ability to communicate.

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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.

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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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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How Can A Speech And Language Therapist Help

If you are concerned about your speech, communication or swallowing you should first talk with your doctor. He or she will be able to refer you to a speech and language specialist if appropriate. By talking to you early on, the speech and language therapist will be able to put in place strategies to enhance your communication and therefore quality of life before difficulties have any significant impact. Early intervention may even be able to prevent or delay other problems so even if you are not experiencing problems or have doubts on whether you are or not, then speak to a speech therapist as finding out more will help with the management of current or future symptoms. You may also be provided with maintenance exercises used to retain your current skills.

Speech and language therapy will focus on maintaining adequate volume of speech by working on breathing and voice to produce clear pronunciation . It will work on the muscles in your mouth and throat and how you create words, phrases and sentences. It will also make you aware of your facial expression and other non-verbal skills. In short it will preserve your communication skills.

A speech and language therapist will also discuss other factors such as:

Note: ParkinsonNet provides evidence based guidelines in English for healthcare professionals.

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Q: You Were Involved In The Development Of Lsvt Big Why And How Was That Program Developed

A: The development of LSVT BIG evolved from a collaboration with physical therapists and our LSVT team. We were intrigued to see if the same concepts that we discovered to be the keys in successfully improving speech in people with PD could be applied to movement. These concepts include: 1) increasing amplitude of motor output to address soft voice , 2) retraining sensory perception of normal loudness , and 3) training in a mode consistent with neuroplasticity-driven principles of intensity, complexity, saliency, and task specificity. The results of the initial work were promising and in 2010, Dr. Georg Ebersbach and his colleagues in Germany published the first randomized controlled trial showing LSVT BIG had a positive impact on motor function in people with PD as compared to two alternative approaches .

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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Building Stronger Caregiving Partnerships Through Better Communication

In this one-hour talk, the speaker explains that diminished communication significantly impacts the social, emotional and physical burdens of caregiving. The fourth speaker at the Parkinsons Foundation Caregiver Summit, Angela Roberts, PhD, explains how changes in speech, cognition and hearing due to Parkinsons disease affects communication. She then offers specific strategies for optimizing communication.