Speech Therapy Parkinson’s Disease

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.

How Does Speech And Language Therapy Help Parkinsons Disease

Speech and language therapy can be very helpful to someone who has Parkinsons disease. Speech and language therapists will investigate swallowing, facial expression, and body language as well as language and speech. It is thought that up to half of Parkinsons patients will at some point have difficulty with communication and speech.

Speech therapy may also improve patient’s confidence in communicating with others which may in turn increase social and work opportunities.

What problems caused by Parkinsons disease can speech and language therapy help with?

Speech and language therapy can help with a number of problems which are caused by Parkinsons. Each persons treatment will be different, however, generally people will have the same sort of difficulties relating to speech, language and swallowing. This is because as the condition gets worse the control of the muscles will deteriorate and can include the tongue, larynx, pharynx and vocal cords.

Our speech and language therapists can help individuals who have Parkinsons disease with attention and listening problems, communication problems, swallowing difficulties, voice and speech problems.

Ways To Improve Speech In Parkinsons Disease

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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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How We Can Help People Who Have Parkinsons Disease

Parkinsons disease is a neurological disorder and is progressive, meaning it gets worse over time. People who have Parkinsons are lacking in the chemical dopamine as some of the nerve cells situated in the brain have died.

Speech and language therapy can help people who suffer from Parkinsons disease by offering support and solutions to communication and swallowing problems.

If I Have Parkinsons Disease What Kind Of Speech And Voice Problems May I Experience

If you have Parkinsons disease, some of the voice and speech difficulties seen include:

• Softened voice. Reduced volume to your voice.
• Speaking in an unchanging pitch .
• Having a hoarse or strained quality to your voice.
• Having a breathiness to your voice. Breathiness in the quality of your voice that is easily heard by your listeners. It takes more effort and energy to speak. You run out of gas as you speak.
• Trouble clearly and easily pronouncing letters and words.
• Tremor in your voice.
• Using short rushes of speech.
• Loss of your facial expression.

If you have Parkinsons disease, you may not be aware of the problems with your spoken communication. Changes in the quality of your voice may be the first sign of speech problems followed by the inability to have fluid speech and clear and distinct speech sounds. Speech problems that are severe enough to reduce your ability to be easily understood usually do not occur until later in the course of Parkinsons disease.

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Whenever We Speak Our Brain Must

Remember all the vocabulary and organise it into the correct order to make sentences.

Remember all the muscle positions for the body parts and systems needed to say the words.

Send messages to the muscles to make the required movements.

Receive messages back from the nerve sensors in the body parts and systems which have moved.

Receive messages back from our ears telling us that are mouths are making the correct sounds for what we want to say.

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.

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What Alternative Communication Devices And Tips Can Help With My Voice And Speech Problems

If you have difficulty speaking, are frustrated and stressed by your inability to communicate or tire from the efforts to speak, consider the following devices and methods to be better understood:

• Amplification: This could be a portable personal amplifier or a telephone amplifier that can be used to increase vocal loudness in soft-spoken people. The amplifier also decreases voice fatigue.
• TTY telephone relay system: This is a telephone equipped with a keyboard so speech can be typed and read by a relay operator to the listener. Either the whole message can be typed or just the words that are not understood.
• Low-technology devices: Paper-based books and boards, alphabet boards and typing devices are examples of low technology assistive methods.
• High-technology electronic speech enhancers, communication devices: Computers with voice synthesizers and speech generating devices are available. Talk to a speech-language pathologist about the available high technology devices best suitable for your needs.

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.

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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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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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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.

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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Does Parkinsons Cause Loss Of Speech How Does Parkinsons Affect Speech

Difficulties with speech and voice production are very common among those affected by Parkinsons disease. Difficulty with effectively producing speech is known as dysarthria and affects as many as 75-90% of Parkinsons disease across the globe.

Parkinsons disease affects nerves and muscles that are essential for effectively producing speech. This disease most notably affects the:

• Frequent Use of Short Rushes of Speech

Many people with Parkinsons disease are not immediately aware of the problems with their spoken communication. Changes in the quality of their voice may be the first sign of speech problems followed by difficulty producing fluid speech and clear and distinct speech sounds. Speech production problems that are severe enough to reduce the clarity of speech and the ability of others to understand the individual dont typically occur until later in the progression of Parkinsons disease. Slurred speech occurs as a result of loss of muscle tone and the decreased ability to effectively coordinate the movements and required muscle strength to produce clear and fluid speech.

Data Collection And Analysis

The review authors independently assessed the studies identified by the search strategy. We resolved disagreements about inclusions by discussion.

We contacted the authors of trials in the cases where further trial information was required for full analysis. We assessed full papers for methodological quality by recording the method of randomisation, concealment of allocation and blinding of assessors to treatment group, whether an intentiontotreat analysis was used and the number of patients lost to followup.

Two review authors independently abstracted eligible data onto standardised forms, checked for accuracy and amalgamated the information. We resolved disagreements about inclusions by discussion.

We combined the results of each trial using standard metaanalytic methods to estimate an overall effect for one type of speech and language therapy intervention versus another.

var diff = var pre + var post 2r

where var diff is the variance of the change score var pre is the variance of the baseline score var post is the variance of the final score and r is the correlation between the pre and post treatment scores. We assumed a correlation coefficient of 0.5, which is a conservative estimate, to reduce the chance of false positive results .

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What Can A Person With Parkinsons Disease Do To Help Improve Their Speech And Language

• Work with their doctor or consultant to optimise drug treatment. In addition to benefiting other symptoms of PD this will facilitate getting maximum benefit from any behavioural treatment.
• Pay attention to any problems with drooling or swallowing and try to resolve these problems. If needed seek specialist help from a Speech and Language Therapist.
• Get advice from a Speech and Language Therapist about exercises that will improve speech and do them! Have regular check-ups so that specific exercise programmes can be given as changes occur in speech.
• Discuss with the doctor, consultant or Speech and Language Therapist if LSVT may be beneficial to treating specific problems experienced with Speech and Language.
• Be aware that fatigue significantly affects speaking ability. Techniques that work in the morning may not work later in the day. Plan periods of vocal rest before planned conversations or phone calls.
• If the person with PD enjoys singing, they should consider joining a choir as this may help improve speech and language.

When speaking:

What Are The Symptoms Of Parkinsons Disease

Parkinsons Disease has Four Primary Symptoms:

• Tremors in the Hands, Legs, Jaw, Arms, or Head
• Muscle Stiffness and Muscle Contractions that Persist for a Long time
• Slowness when Moving
• Impaired Balance and Reduced Coordination

Other symptoms include:

• Depression and other Changes in Emotions
• Difficulties related to Chewing, Swallowing and Speaking
• Elimination or Urinary Problems
• Constipation
• Skin Problems

In most cases, the early symptoms of Parkinsons disease are subtle and develop gradually. For instance, an individual in the early stages of the disease might experience a mild tremor in their hand or may struggle to get up out of a chair. Or they may notice that their speaking voice has become extremely soft, or that their handwriting is looking less neat or legible. Loved ones may also notice the early subtle signs of Parkinsons disease before the individual does. They may notice an absence of facial expressions or animation when they are speaking. They may also notice a difference in the individuals gait, or the movements of their hands, arms, and legs.

In many cases, the symptoms of Parkinsons disease begin to emerge on one side of the body or even one limb. As the disease progresses, both sides of the body are eventually affected. It is relatively common, however, for the symptoms to be more pronounced on one side of the body, even when both sides are affected.

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Benefits Of Speech Therapy For Parkinsons Disease

Posted on: April 8, 2021

After someone is diagnosed with , they are frequently referred to physical therapy to address the physical impairments associated with this disease. Parkinsons disease does not just impact physical impairments but can also affect speech, swallowing and cognition. A speech-language pathologist specializes in evaluation function and providing treatment in the areas of communication and swallowing across the lifespan .

As Parkinsons disease evolves, changes in speech production and swallow function are expected to occur. Speech changes associated with Parkinsons disease is called hypokinetic dysarthriacharacterized by decreased volume, hoarse vocal quality, monotone and short rushes of speech. Patients often state they feel frustrated because their spouses or family members can no longer hear them or frequently have to repeat themselves. who has a certification in Speak Out!® like the experts at Sheltering Arms. It is a program designed specifically for Parkinsons disease to target speech and cognition that provides a maintenance program to continue with skills learned during the course of treatment.

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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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.

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.

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