Speech Problems Of Parkinsons Disease
The most common speech problems experienced by people with PD involve reduced volume , reduced pitch range , and difficulty with the articulation of sounds or syllables . In essence, you cant speak as loudly as others, you find it more difficult to convey emotion when you do speak, and you find it difficult to form the words you are trying to pronounce.
You dont need me to tell you that this combination of factors makes speaking extremely frustrating. When you couple all of these voicing problems with the so-called masked faces of PD, the difficulty in expressing emotions via facial expression, it’s no wonder that people occasionally find it challenging to understand what you are trying to say.
It may be tempting to withdraw from conversations with others altogether, but that would be a mistake. You need to interact with others on a daily basis, no matter how frustrating it becomes this is critical for your mental health, and be assured that your loved ones want to interact with you. The good news is that there are treatments, such as voice exercises, that can dramatically improve the voicing problems associated with PD.
Parkinson’s Speech And Language Therapy
Speech and language therapy aims to help people communicate to the best of their ability by assessing and treating speech and other communication difficulties. Parkinson’s speech therapy also helps with eating, swallowing and drooling problems.
A speech and language therapist is a member of the multidisciplinary team, that is a group of professionals with different areas of expertise, who together will help you manage your Parkinsons.
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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How Can A Speech And Language Therapist Help With Swallowing Difficulties
If you notice any of the above difficulties, you should contact a speech therapist. He or she will assess eating and drinking difficulties and then suggest rehabilitative exercises, strategies, aids or specialist tools to help. Therapy may include:
- recommending techniques and postures for efficient and safe swallowing
- suggesting exercises to strengthen the muscles used for swallowing, to make the swallow more timely, complete and efficient
- suggesting strategies to reduce the risks of choking and aspiration
- providing advice on the consistency and texture of foods that are easier to swallow
- identifying specific areas of difficulty with saliva control for example poor posture, lip seal, tongue or swallowing problems. He or she can suggest exercises and also devices to achieve good lip seal or remind you to swallow frequently
- discussing with your doctor the use of anticholinergic medications or injections of botulinum toxin to reduce saliva production.
In severe cases an alternative method of eating and drinking may be discussed for example by a tube inserted directly into the stomach . See also Eating, swallowing and saliva control.
Seeing A Speech And Language Therapist
During the first session your speech and language therapist will talk to you to assess your difficulties. They will also take your medical history and may use some speech and language tests. At the end of the assessment the therapist will tell you:
- whether speech and language therapy will help you and if so how
- how regularly you will need to attend speech and language therapy sessions and for how long
Any strategies that a speech and language therapist may suggest will be tailored to your particular needs.
Many speech and language therapists use group work for people with Parkinsons. Working in groups can be a very effective way of reinforcing techniques learned in individual sessions and has many social and psychological benefits.
Referral procedures depend on the country in which you live and treatment may or may not be accessible through your countrys national health system.
See also: Communication and Parkinsons.
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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.
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.
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What Are The Common Reasons That Someone With Pd May See A Speech
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.
Behavioral Speech Therapy For Parkinson’s Disease
Behavioral speech therapy usually involves a series of voice exercises administered by a trained and certified speech therapist. These exercises include training in control of speech rate, stress/intonation, or expression of emotion, loudness, articulation, and breathing, so as to support the voice. Sometimes the therapist uses assistive instruments, such as delayed auditory feedback, voice amplification devices, or pacing boards.
Some investigators have claimed significant success with PD patients by using the so-called Lee Silverman Voice Treatment , an intensive program of voice exercises that targets vocal intensity, quality, and variation precisely the areas of difficulty for persons with PD.
The LSVT approach centers on a single therapeutic target at a time so that effort can be invested in achieving that target alone. A therapeutic target might be increasing vocal loudness or enhancing speech intelligibility. In pursuing these sorts of therapeutic targets, the patient is drilled on a series of voice exercises and is taught to be aware of sensory feedback from the voice, as well as to self-monitor voicing patterns and voice quality. The increased self-awareness of voice allows for the correction of errors and for faster progress toward the target.
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Q: What Does An Lsvt Big Session Consist Of
A:LSVT BIG treatment sessions completely mirror LSVT LOUD sessions as described above. The only difference is the focus of the LSVT BIG exercises involve the whole-body across both daily exercises and functional movement activities. Goals and functional activities are personalized for each person, but all built around Think BIG! as a guiding principle. LSVT BIG retrains people with PD on how normal movement should feel.
Speech And Language Problems
It has been estimated that speech problems may affect around 90% of people with Parkinsons. Difficulties may arise at any time, the main ones being:
- weak voice or reduced voice volume, resulting in the need to repeat oneself
- hoarse voice and limited intonation resulting in a monotonous voice
- slurred or unsteady speech
- speaking too fast or too slow
- difficulty speaking clearly whilst doing other things as speech may require more concentration than before
- stuttering or difficulties getting started
- forgetting what you were trying to say or losing your train of thought in a conversation
- difficulty following a conversation involving several or more people.
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Speaking Effectively A Strategic Guide For Speaking And Swallowing
Booklet includes self-evaluations and caregiver surveys to determine at what point professional help is needed. Professional examinations are described along with recommendations for both home and professional intervention to improve speech, make eating easier and safer, and reduce drooling. Maintaining communication to reduce isolation is encouraged.
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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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:
What Is The Role Of Speech Therapy In The Treatment Of Parkinson Disease
Medications and surgery cannot effectively treat the laryngeal manifestations of Parkinson disease. For this reason, speech therapy plays a key role in the disease’s vocal treatment regimen. Speech therapy is effective in treating the laryngeal manifestations of Parkinson disease, but despite the significant number of patients with vocal symptoms, only an estimated 3-4% of patients with Parkinson disease undergo speech therapy.
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How Can Listeners Help People Who Have Difficulty Speaking And Communicating
Here are some ways friends and family of people with Parkinsons disease can ease speaking and communication difficulties:
- Talk to the person with Parkinsons disease face-to-face only, and look at the person as he or she is speaking.
- Ask questions that require a simple “yes” or “no” answer.
- Repeat the part of the sentence that you understood.
- Ask the person to repeat what he or she said, to speak more slowly or spell out the words you did not understand.
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For Our Readers Who May Be Curious About What To Expect During A Speech Therapy Session Can You Describe A Typical Speech Therapy Session For Pd
A session can vary quite a bit from patient to patient, as we tailor treatment to the persons specific issues. SLP therapy sessions are only provided after a detailed evaluation is completed and a treatment plan is developed. It is best to see an SLP who has experience with PD and uses evidence-based techniques when developing an individualized plan for the person with PD.
One of the gold standard treatments for communication impairments associated with PD is called LSVT LOUD®. LSVT LOUD® has strong evidence associated with it, and it requires that the SLP be specifically trained and LSVT-certified. To preserve treatment fidelity and ensure best outcomes, the sessions must be four times per week for four weeks , with each session lasting one hour. The initial part of the session involves specific voice exercises focusing on loudness and pitch range. The last half of the session focuses on functional communication activities that carry over this normalized volume and voice range into everyday speech in everyday situations.
There is another evidence-based approach also utilized to treat the soft voice associated with PD and this is called the SpeechVive. This device is worn in the ear to introduce babble noise which causes the person with PD to increase their speaking volume automatically. This device also requires that the SLP be specifically trained for its use. The sessions involve an initial calibration of the device with subsequent follow-ups scheduled.
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.
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.
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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