Sunday, December 10, 2023

Voice Therapy Exercises For Parkinson’s

Q: I Read With Interest A Recent Study In Which You Compared Lsvt Outcomes In People Speaking Different Languages Can You Summarize Your Results What Ramifications Does This Have For Reaching Communities Which Traditionally Did Not Have Easy Access To Lsvt

Parkinson’s Home Speech Therapy Workout

A: There are more than 50,000 LSVT LOUD and LSVT BIG Certified Clinicians representing 78 countries in the world. This has opened the opportunity for research in many different countries and languages. This is particularly interesting related to LSVT LOUD and the impact of language on treatment outcomes. We were curious to examine outcomes from published research studies across these different languages to understand if there is a differential effect of LSVT LOUD. Our hypothesis was that there would not be, given LSVT LOUD is geared towards the underlying neurological deficits in PD .

While all the studies looked at different aspects of speech, voice or communication, the outcomes were comparable to what has been published for English speakers across these measures. For example, Spanish speakers improved speech intelligibility, Cantonese speakers improved loudness and intonation, but not lexical tone, Quebecois French speakers increased vowel space area as did German speakers. Persian speakers improved self-perception of voice and Japanese speakers had short and long-term improvements in vocal loudness. As such, it appears that the benefits from this treatment may be universal regardless of language background. Prospective language comparison studies are needed to further clarify these findings.

We hosted a webinar on this topic that people might find interesting.

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.

What People Are Saying

Dear Mary, I had hoped to tell you how much I like your video. I do quite a bit of exercise so it is perfect for me. I will do it almost every morning.

I was out with some friends a few nights ago and someone said you have improved so much from a year ago and the other person said it is her voice which has improved the most. I thought you would like to know that because I am making real progress with you. I love how committed you are to helping people. You are indeed a wonderful person with all that you are doing, and your passion clearly shows.

I left my Songbird disc in Florida. Drat! I miss it and would like another. The one Im referring to is the one on which you play the piano. I call it The Fun One. It has glorious patterns which keep the beat as you change tempos.

Your voice aerobic tape and songbirds CD are great and I purchased them to share with any Parkinsons patients I work with now and may in the future. If they like it, I will have them order it.

October 9, 2012

January 2013

By the way I do really find The LOUD Crowd does keep my speaking with intent at top of mind and your creativity is just fantastic, and keeps me coming back for more each week

My dad has lots of exercise for Parkinsons DVDs but yours is the one he does everyday. My mom likes to join him because its a fun class and the exercises are easy and help lower her stress. Dad enjoys feeling part of your workout group. Thanks for your enthusiasm and sincere spirit.

Recommended Reading: Botox For Drooling In Parkinson’s

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.

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.

Read Also: Can You Have Parkinson’s Without Shaking

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.

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.

Also Check: How To Test For Early Onset Parkinson’s

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:

Pwpd Perspectives On Change In Speech And Voice

Speech Therapy Exercise for Parkinson’s Disease – Sustained Phonation

In terms of pwPD perspectives, impaired communication results in significant restrictions on daily living activities and social participation, and is strongly associated with reduced quality-of-life.2733 Perceived impact can be significant for the pwPD, even when listeners detect no apparent major issues with voice and speech.28,30,3436 PwPD describe their voice as too quiet, or volume fades fast over an utterance or in conversation they describe voice quality as hoarse, breathy, tremulous, and that they have difficulty initiating or sustaining utterances.37,38 Freezing of voice can be as troublesome as freezing of gait.27 Disturbance to speech prosody is also described as a strong feature.3941 PwPD report the frustrations of listeners seeming to misunderstand or miss the emotion they are aiming to convey, or the constant feeling that people believe them to be depressed, disinterested, and unmotivated when they are not.4244 Such impressions are reinforced by hypomimia.45,46 To listeners, articulation may sound distorted or sounds omitted and/or syllables and words slurred together, which may give the impression that the pwPD is speaking too fast. Listeners also describe sudden rushes of accelerated speech, maybe in an attempt to complete a sentence on insufficient breath.

These points offer a number of important implications for assessment and intervention, as discussed in the next section.

Recommended Reading: What Is The Prognosis For Parkinson’s Disease

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.

Speech And Voice Changes In Pd

Up to 90% of pwPD report changes to their speech and voice3,911 with around 50% experiencing deterioration which renders it difficult to make themselves understood to strangers.9

The underlying pathophysiological bases of voice, speech, and language changes in PD are complex. Voice quality changes, reduced loudness, loss of intonation variation, and imprecise articulation relate in part to rigidity and stiffness in the oral, laryngeal, and respiratory muscles.1215 However, stiffness and rigidity are insufficient to totally account for changes.

A crucial common denominator that appears to link impairment of articulatory movements, voice production, hand gestures accompanying speech, as well as many other non-communication related motor responses, concerns a failure to adequately scale the dynamics of movement to achieve the required range, force, and velocity, even though basic tone, power, and coordination are sufficient to do so.13,14 Further, pwPD exhibit reduced awareness of the extent and consequences of the under scaling. This appears associated with a deficit in central sensory processing.16,17 Thus, the pwPD is able to achieve adequate loudness, articulatory precision and emphasis when specifically asked to do soeven though increases in loudness may not match those that unaffected speakers make when asked to speak loudly.18,19 However, the pwPD may find it difficult to maintain these features during general conversation.

Recommended Reading: Does Weed Help With Parkinson’s

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.

Best Tips To Improve Voice Quality & Voice Exercises For Parkinsons Disease

LSVT BIG for persons with Parkinson

Parkinsons disease people face changes in their voice or speech. It is a significant problem, causing difficulties in communication and not able to pronounce words clearly. Today, we have discussed Voice exercises for Parkinsons disease.

Parkinsons disease has affected the speech of the patient in many ways. Speech may be garbled. Speech may become monotone, lacking the ups & downs of voice. The speech problem worsens as the disease advances.

Sometimes the person faces difficulty articulating the right words, causing speech to be slower. In this circumstance, speech therapists can be helpful for people with PD who face speech difficulties.

The best part of the Speech therapist, they can teach several techniques that make stronger the voice. One of the techniques of speech therapists is LSVT.

Don’t Miss: 1st Sign Of Parkinson’s

Few Techniques To Keep Speech & Voice Strong For Parkinsons People

Exercise No: 1

  • Sit or stand tall & then you inhale through your nose, feel your ribs and belly expand as you fill your lungs with air.
  • Continue to take several deep breaths from your diaphragm. The diaphragm is a large main muscle located at the base of the lungs and plays a vital role in the breathing process. Abdominal muscles help move your diaphragm.
  • Exhale gradually through your mouth as you are blowing out a candle.

Exercise No: 2

  • Take a deep breath and then push from your diaphragm as you say, AH for minimum of 15 seconds. You just feel that your voice fills the room. Now You push from your diaphragm & say each sound for at least 15 seconds.
  • Next step, first take a deep breath and then slide up and down your pitch range by first saying OH and then EE. Continue to alternate between these two sounds for 30 seconds.

Exercise No: 3

Exercise No: 4

  • Say Hi /Hello in a soft voice
  • Now say Hi /Hello in your COMFORTABLE LOUD voice.
  • Now take in a deep breath and say hi/hello in your LOUDEST VOICE.

Exercise No: 5

  • To improve your voice for speaking, you will need to exercise it on a regular schedule. Warm your voice before using it extensively, but also practice vocal exercises twice per day for the best results. Try setting aside 15 minutes to do vocal exercises when you wake up. Then do them again before you go to bed, such as while you are making dinner or taking a bath.

Exercise No: 6

Say the following longer sentences in a loud and clear voice

Exercise No: 7

Its Guided So Nothing To Remember Its Fun And Easy

Many people suffer from changes in their voice and speech, some as a result of Parkinsons Disease, stroke or neurological problems.

I am so glad I learned about Mary Spremullis speech therapy via telepractice. Without leaving my home which is miles away in another city, I can regularly take one on one speech therapy sessions virtually via Zoom. Marys voice therapy has improved my ability and confidence in speaking LOUDER with INTENT. My wife is much happier not having to frequently ask What did you say? Thanks Mary!

Jerry, Longboat Key, Fl

Read Also: Parkinson’s And Muscle Cramps

Physical Therapy For Parkinsons Disease

People with chronic conditions and movement disorders, such as early onset Parkinson’s disease, often find physical therapy can improve strength and flexibility and decrease pain and stiffness. Physical therapy is becoming an essential part of many Parkinson’s disease treatment plans. More and more studies show how beneficial exercise is to Parkinson’s patients to help slow the progression of the disease as well as aiding in physical and cognitive functions.

Its recommended that Parkinsons patients exercise a minimum of 150 minutes a week or 20 minutes a day. The activity can be something as simple as getting in and out of a chair, to as complex as an aerobics class. The exercise level should be catered to the patients needs.

Mercys physical therapists offer free exercise classes that combine skill-based exercises with aerobic exercises. Exercise is not just a temporary solution. Its a lifestyle change. If you have not exercised before, please consult your doctor before starting an exercise program.

Tips for Exercising:

  • Exercise with adequate intensity

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