Be Your Own Therapist
Which activities are most important to you? Once you answer, try the strategies below to see which ones work for you for each activity.
Use Personal Strengths
How can you build on your strengths and minimize your limitations? For example, if you have the strength of helping children enjoy reading, you could exercise that strength by reading to your grandchildren, by listening to them as they read or by playing a reading game that stimulates both your imagination and theirs.
One of your strengths may be thinking skills. One thinking skill is imagining doing the activity before doing it. For example, imagining writing big can actually help you write big. Another thinking skill is speaking the steps out loud. When combing your hair, try saying hold and comb, to avoid dropping the comb.
Make sure you are exercising. Improving strength, balance and endurance through exercise supports your participation in all sorts of activities. Whether it is dancing or walking to a neighbors house, find an enjoyable way to exercise
Lastly, be positive. Think, I will do rather than Ill try to and you may be more successful.
Change the Environment
Adapt the Activity
Which activities do you enjoy and how can you adapt that activity to make sure you can still do it? For example, if you love baking, perhaps substitute complex recipes with simpler ones.
What Type Is Best
Understandably, many people ask for the best kind of exercise to help treat Parkinsons disease. Some people swear by dance classes or boxing. Others find tai chi and yoga helps their balance. Through our grassroots fundraising community Team Fox, people with Parkinsons run marathons or bike for their health and to raise money for research.
The best exercise is the one that your care team approves and that appeals to you, because youll stick with it. Your exercise routine will vary depending on your overall fitness level, but a good first step is to talk to your physician and have a thorough checkup before starting any activity. If your doctor agrees, one good way to start is with a physical therapist. This way, you can get an exercise prescription and work with an expert to determine what you can do safely.
Podcast: What Forms of Exercise Help Most?
Spoken by Lisa Shulman, MD, of the University of Maryland
What Is Parkinsons Disease
Parkinsons disease is a neurological disorder that causes problems with movement. These can include shaking, stiffness, and issues with walking, balance, and coordination.
Parkinsons disease can also lead to speech problems and side effects including depression, pain, and difficulty sleeping.
Parkinsons disease affects the cells of the area of the midbrain known as the substantia nigra. This part of the brain produces dopamine and relates to reward and movement. Parkinsons causes cells in the substantia nigra to die, which reduces dopamine levels and causes the onset of symptoms.
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Standard Protocol Approvals Registrations And Patient Consents
Each PPMI participating site received approval from the local ethics committee before study initiation, and written informed consent was obtained from all participants before participation. Our study strictly adheres to the publication policy in the PPMI study, and we have obtained permission for publishing our research by the Data & Publication Committee of the PPMI study.
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When To Find A Physical Therapist
Physical therapists can be helpful at all stages of PD. Movement impairments in the early stages of the disease may not be obvious. Talk to your doctor about getting a baseline physical therapy evaluation and then continue with periodic re-evaluations.
According to the Parkinsons Outcomes Project, the largest clinical study of Parkinsons disease through our Global Care Network, increasing physical activity to at least 2.5 hours a week can slow decline in quality of life. The Parkinsons Foundation has identified specific care approaches associated with better outcomes across people who seek expert care at our designated Centers of Excellence. Among others, best practices include early referral to physical therapy and encouragement of exercise as part of treatment.
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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, Id like company while an air-horn means theres 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
Q: Who Should Consider Undergoing Lsvt Loud
A: We at LSVT, strongly feel that nearly every person with PD could benefit from LSVT LOUD. We know that up to 90% of people with PD will experience reduced vocal loudness, monotone voice and imprecise articulation which can negatively impact communication and quality of life. We like to say, the earlier the better, but it is never too late. Early treatment may help people with PD regain any lost voice or speech function, reduce vocal fatigue, and increase confidence all while learning healthy, life-long vocal habits and practice. Even those who thought they didnt need speech therapy yet report their voice is stronger after LSVT, they are less fatigued when talking and have more confidence with communication.
For those with more impaired speech, LSVT LOUD can help them to regain vocal loudness and speech clarity. It can restore not only their ability to communicate, but also their sense of engagement that can be lost when a person is ignored or overlooked for not being heard or understood. Although people with advanced speech impairment may need reminders to use their loud voice, LSVT LOUD can improve the physical capacity of their speech motor system and help them communicate more effectively.
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Why Speech Is Affected
One key to understanding speech therapy is to understand the muscle functions and other physical aspects that affect our speech. In the case of Parkinsons and many other conditions, the problem is muscular and not related to intellectual disability. By focusing on gaining as much control over the muscles in the throat that control speech and strengthening those muscles as much as possible, the individual with Parkinsons can begin to reclaim their speaking abilities to a surprisingly large extent.
If you have Parkinsons and are having trouble communicating, we encourage you to look into the possibility of speech therapy with a qualified professional.
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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What Is The Cause
PD damages the nerves in the brain. It causes problems with movement and communication, including changes in speech. The exact way that PD causes speech and swallowing problems remains unclear.4,5
The nerve cells in the heavily damaged area of the brain produce dopamine. This is a chemical messenger that transmits signals to parts of the brain that help regulate smooth, purposeful movement.4
The muscles in the face, mouth, and throat also need to move to generate speech and help with swallowing. Doctors think that damage to dopamine-producing nerve cells leads to dysfunction in the movement of muscles involved in speech and swallowing, along with those in the trunk and limbs.4
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Q: Telehealth Has Expanded Recently Due To The Covid
A: Telehealth and LSVT LOUD have had a long relationship that started well before COVID-19. Much of the initial research into LSVT LOUD and telepractice began with our colleagues at the University of Queensland in Australia. These studies have documented that the outcomes of LVST LOUD delivered by telehealth are equivalent to treatment completed in-person. With COVID-19 there was a measurable increase in the number of speech therapists interested in telehealth options world-wide. We created multiple training webinars and information presentations to assist our LSVT LOUD clinicians with the transition to a telehealth world. We have also helped advocate for the expanded Medicare coverage of telehealth services that have been temporarily allowed for speech, physical and occupational therapies during the public health emergency. Telehealth and LSVT LOUD are very well suited! Patients can find eLOUD SLPs who are trained to provide LSVT LOUD via telehealth in our clinician directory.
The delivery of LSVT BIG via telehealth was not as advanced at the time of COVID. Therapists were quick to engage in this potential for solution for continued care of patients receiving LSVT BIG treatments. It has been exciting to see the innovation and we look forward to more systematic research and guidelines for offering LSVT BIG via telehealth in the future.
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Lee Silverman Voice Treatment
LSVT-LOUD is an intensive behavioral treatment program that requires sixteen therapy sessions in one month with a trained speech therapist. The primary goal is to help improve vocal loudness. As a result of therapy, improvements in speech clarity and breathing are often seen. DVDs are also sold for at-home treatment.
Q: One Of The Most Important Aspects Of Lsvt Is The Training Of Speech
A: You are correct training is at the heart of our organization. Because LSVT LOUD and LSVT BIG are evidence-based treatments, the goal of clinical training is not only to transfer science to clinical practice, but to ensure the quality of treatment matches the research .
LSVT Certification is available to speech, physical and occupational therapists, assistants, clinical fellows, and students enrolled in speech, physical and occupational therapy programs. LSVT Training and Certification Courses are offered in either two-day live in-person courses around the world or a 14-hour online course available in English. Both formats offer the same content, training and culminate in identical certification.
COVID-19 brought our live in-person training courses to a screeching halt in March 2020. While the LSVT LOUD and LSVT BIG Online Training and Certification Courses remained fully operational, training was limited to therapists who were comfortable with a self-paced, pre-recorded course and the English language. We have since made modifications to enable training in other languages, as well as virtual live training options.
We will remain virtual in 2021 for our live courses and continue to offer our very popular online courses as well. LSVT Certified Clinicians can be located through our LSVT Certified Clinician Directory.
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Q: Can You Tell Us About The Virtual Speech Therapist Under Development
A: The virtual speech therapist is an extension of our current LSVT Companion® technology. The LSVT Companion is an FDA-cleared medical device that assists in the delivery of LSVT LOUD sessions. The virtual therapist adds a more humanistic avatar to the existing platform to further engage clients during vocal practice.
There Are Two Popular Programs Offering Speech Therapy For Parkinsons Disease
The two most prevalent programs to help those with speech problems because of Parkinsons disease are LSVT Loud, The Lee Silverman voice treatment LOUD, and also Speak Out! Both of these are incredibly well researched.
All of our Better Speech pathologists are able to be certified in these programs and techniques so that we can offer it to our clients in whole or in part.
LSVT Loud speech therapy program for Parkinsons focuses more on actual articulation
- This program is a bit more structured
- Usually covered in four sessions at 60 minutes each week
- Homework assignments for practice
- Teaches clients to be loud and to communicate with projection.
Speak Out! speech therapy program for Parkinsons focuses on the intent of communication.
- This program has a little bit more flexibility
- Usually covered in three sessions of 45 minutes each week
- Homework assignments for practice
- Focuses on the intent or reason for the communication
Both of these programs include homework assignments to practice outside, which is really fantastic when but then you get to also take those techniques, those tools, those things that you learn and implement them in your everyday life. That way you can then be more functional in your communication, and start to enjoy communicating with those around you.
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The Lee Silverman Voice Treatment
The Lee Silverman Voice Treatment LOUD is the first speech treatment for PD proven to significantly improve speech after one month of treatment.
LSVT® Guidelines
- Must be administered four days a week for four consecutive weeks.
- On therapy days, perform LSVT exercises one other time during the day. On non-therapy days, perform LSVT exercises two times a day.
- Once you complete the four-week LSVT therapy, perform LSVT exercises daily to maintain your improved voice.
- Schedule six-month LSVT re-evaluations with your specialist to monitor your voice.
- If available in your area, participate in a speech group whose focus is on thinking loud.
- A Digital Sound Level Meter can help you monitor voice volume. Place the meter at arm distance to perform the measurement. Normal conversational volume ranges between 68-74dB.
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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An Example Of Speech Therapy
For a taste of what speech therapy may be like, consider taking a look at our special DVD of speech exercises for people with Parkinsons. Recorded by speech-language pathologist Mary Spremulli, Voice Aerobics is a fun and easy speech workout that lasts a full hour.
The DVD was originally intended as an after-therapy program for people with Parkinsons, and it focuses on posture, breathing and improving voice volume. While individual needs may vary greatly with speech therapy, this DVD is great for anyone seeking to rekindle the strength of their voice, speak with more volume and be understood.
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.
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How Can I Maintain And Enhance My Speech