Why Does Parkinson’s Affect Speech

Speech Therapy Tacoma Is Proud To Offer

Together, the patient and speech-language pathologist complete speech, voice and cognitive exercises using a specialized workbook that the Parkinson Voice Project provides free of charge to every person with Parkinsons in the U.S. who is receiving SPEAK OUT®!

SPEAK OUT! emphasizes speaking with intent and converts speech from an automatic function to an intentional act. There are many benefits from learning to speak with INTENT, such as increased vocal loudness and speech clarity, increased facial expression, improved confidence and overall improved quality of communication.

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:

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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Lee Silverman Voice Technique

LSVT is a speech treatment that has been proven to significantly improve speech after one month. Results can last up to two years following treatment. The LSVT method is easy to learn and must be repeated four days a week for four consecutive weeks to be effective. After a four-week treatment period, LSVT exercises should be done daily to maintain the improvements achieved.

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.

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Medicines For Parkinson’s Disease

Medicines prescribed for Parkinson’s include:

• Drugs that increase the level of dopamine in the brain
• Drugs that affect other brain chemicals in the body
• Drugs that help control nonmotor symptoms

The main therapy for Parkinson’s is levodopa, also called L-dopa. Nerve cells use levodopa to make dopamine to replenish the brain’s dwindling supply. Usually, people take levodopa along with another medication called carbidopa. Carbidopa prevents or reduces some of the side effects of levodopa therapysuch as nausea, vomiting, low blood pressure, and restlessnessand reduces the amount of levodopa needed to improve symptoms.

People with Parkinson’s should never stop taking levodopa without telling their doctor. Suddenly stopping the drug may have serious side effects, such as being unable to move or having difficulty breathing.

Other medicines used to treat Parkinsons symptoms include:

• Dopamine agonists to mimic the role of dopamine in the brain
• MAO-B inhibitors to slow down an enzyme that breaks down dopamine in the brain
• COMT inhibitors to help break down dopamine
• Amantadine, an old antiviral drug, to reduce involuntary movements
• Anticholinergic drugs to reduce tremors and muscle rigidity

Compensatory And Therapeutic Swallowing Techniques

Compensatory strategies control the flow of food and help to eliminate symptoms, but do not alter the swallow physiology. Compensatory strategies used in the treatment of PD to be discussed include postural changes, increasing sensory input, and altering food consistencies. Eating while upright with the chin tucked to the chest or the head tilted forward at a 45 degree angle may be helpful for patients with a delay in triggering the pharyngeal swallow, reduced tongue base retraction, or reduced airway entrance closure or protection. Increasing sensory input may benefit patients who are delayed in triggering the pharyngeal swallow. Foods that help to increase sensory input include highly seasoned food, cold foods, sour foods, and possibly carbonated beverages. Altering food consistencies or elimination of consistencies from the diet should be explored only after other compensatory strategies have been examined. In general, thick viscous consistencies will be difficult for patients with PD to swallow who experience reduced tongue base retraction and pharyngeal contraction. Emphasizing foods that are moist and form a cohesive bolus has been suggested for patients with poor pharyngeal contraction, and blenderized food that requires minimal chewing may be necessary for patients with severe dysphagia. Similarly, thin liquids are typically the most difficult consistency for patients with reduced laryngeal closure.

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How Do I Know If I Have A Speech Or Voice Problem

• My voice makes it difficult for people to hear me.
• People have difficulty understanding me in a noisy room.
• My voice issues limit my personal and social life.
• I feel left out of conversations because of my voice.
• My voice problem causes me to lose income.
• I have to strain to produce voice.
• My voice clarity is unpredictable.
• My voice problem upsets me.
• My voice makes me feel handicapped.
• People ask, “What’s wrong with your voice?”

Tips For Coping With Speech Difficulties

• Exercise your voice by reading out loud or singing every day.
• Drink enough water, avoiding shouting and rest your voice when it is tired.
• Train your voice like an actorsit and stand with good posture, do exercises for articulation, breathing and projecting the voice.
• Get feedback from friends and family members about how others perceive your speech develop a cue or code word you can use in public to make you focus on speaking clearly.
• If you have soft speech, use tools such as a voice amplifier , placed on your shirt, and on the telephone . Ask an occupational therapist about other tools.
• Make eye contact with the person to whom you are speaking.
• Reduce background noise.
• Socialize in small groups or one-on-one.
• If you experience a facial masking, use feeling words to communicate your emotions . Use practice physical gestures to help convey emotions.
• Determine which times of day your speech is best. Plan social engagements around those times.

Even in the early stages of PD, many report that their voices are too soft, causing others to ask them to repeat themselves. Other people with PD may have a gruff or hoarse quality to their voice. Try these strategies:

Page reviewed by Dr. Chauncey Spears, Movement Disorders Fellow at the University of Florida, a Parkinsons Foundation Center of Excellence.

For more insights on this topic, listen to our podcast episodeImportance of Early Detection of Swallowing Disturbances or download our Speech and Swallowing book.

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Why Does Parkinsons Disease Cause A Mask

PD is a chronic, progressive disease that affects the nerves, especially the nerves that control muscle movement. There are at least 43 muscles in the face, which move in concert to create expressions ranging from happiness to anger and despair. Dopamine is the neurotransmitter that transmits the signal from the brain to the muscles to produce movement. When PD damages the nerve cells that produce dopamine, the motor symptoms and ability to control muscles are affected.4,5

What Causes Parkinson’s Disease

Parkinsons disease occurs when nerve cells in the basal ganglia, an area of the brain that controls movement, become impaired and/or die. Normally, these nerve cells, or neurons, produce an important brain chemical known as dopamine. When the neurons die or become impaired, they produce less dopamine, which causes the movement problems of Parkinson’s. Scientists still do not know what causes cells that produce dopamine to die.

People with Parkinson’s also lose the nerve endings that produce norepinephrine, the main chemical messenger of the sympathetic nervous system, which controls many functions of the body, such as heart rate and blood pressure. The loss of norepinephrine might help explain some of the non-movement features of Parkinson’s, such as fatigue, irregular blood pressure, decreased movement of food through the digestive tract, and sudden drop in blood pressure when a person stands up from a sitting or lying-down position.

Many brain cells of people with Parkinson’s contain Lewy bodies, unusual clumps of the protein alpha-synuclein. Scientists are trying to better understand the normal and abnormal functions of alpha-synuclein and its relationship to genetic mutations that impact Parkinsons disease and Lewy body dementia.

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How Speech Is Affected

When Parkinsons is developing, other speech changes can occur as well. Some can affect the tone and rate of speech. Hypophonia can cause a persons speech to be softer, due to the muscles in the face weakening. On the opposite side of the spectrum, Tachyphemia can occur. This causes speech to be excessively fast, which can be hard for people to understand. Dysarthria is another effect that can occur, which is classified as a motor speech disorder. Parkinsons affects the muscles in the face that are required for speech. These disorders begin to develop because as the disease progresses, the nerves in the brain and body are being affected.

Closing The Gap For Voice Impairment In Parkinsons

Speech and voice impairments are common among those living with Parkinsons. As many as 90% of people with Parkinsons experience difficulties such as hypophonia or a more monotone, raspy or breathy voice . Speech can become less intelligible and can make communication difficult, especially if paired with decreased facial expressions . It comes as no surprise that speech and voice impairments can impact quality of life.

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Incidence Of Parkinsons Disease

Its estimated that approximately four people per 1,000 in Australia have Parkinsons disease, with the incidence increasing to one in 100 over the age of 60. In Australia, there are approximately 80,000 people living with Parkinsons disease, with one in five of these people being diagnosed before the age of 50. In Victoria, more than 2,225 people are newly diagnosed with Parkinsons every year.

Speech And Swallowing In Pd

Apathy describes a lack of interest, enthusiasm or motivation. It is a non-motor symptom of Parkinsons Disease and interferes with the effective management of PD symptoms, since apathetic people are less inclined to exercise and follow their medication schedules. Here are some resources to understand apathy and how to cope with it.

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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 Are The Primary Motor Symptoms Of Parkinsons Disease

There are four primary motor symptoms of Parkinsons disease: tremor, rigidity, bradykinesia and postural instability . Observing two or more of these symptoms is the main way that physicians diagnose Parkinsons.

It is important to know that not all of these symptoms must be present for a diagnosis of Parkinsons disease to be considered. In fact, younger people may only notice one or two of these motor symptoms, especially in the early stages of the disease. Not everyone with Parkinsons disease has a tremor, nor is a tremor proof of Parkinsons. If you suspect Parkinsons, see a neurologist or movement disorders specialist.

Tremors

Rigidity

Bradykinesia

Postural Instability

Walking or Gait Difficulties

Dystonia

Vocal Symptoms

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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.

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.

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How Does Parkinson’s Improve Speech

speechcanParkinson’s

. In this way, how does Parkinson’s affect your speech?

Parkinson’s disease affects approximately one million Americans and can cause several motor and non-motor symptoms. There are several ways PD may affect speech: The voice may get softer, breathy, or hoarse, causing others difficulty hearing what is said. Speech may be slurred.

Secondly, how does Parkinson’s affect the throat? Speech & Swallowing Problems. People with Parkinson’s may notice changes in or difficulty chewing, eating, speaking or swallowing. Just as PD affects movement in other parts of the body, it also affects the muscles in the face, mouth and throat that are used in speaking and swallowing.

Also question is, how does speech therapy help Parkinson’s disease?

Speech therapy also includes non-verbal communication skills to help patients communicate without spoken words, by making use of expressions and gestures. Non-verbal communication can help by reducing the stress of not being able to communicate and alleviating the pressure to speak, thereby relaxing patients.

How did Michael J Fox know he had Parkinson’s?

Although Parkinson disease occurs mostly in older people, it sometimes does strike people in their forties or, as with Mr. Fox, even younger people. Mr. Fox was first diagnosed when he noticed a “twitch” in his left little finger while he was working on the set of the 1991 film Doc Hollywood, he told People magazine.

Challenges Of The Mask

Interaction with others is a mixture of verbal and nonverbal communication, and facial expressions play a large role in the nonverbal communication, displaying our emotions and interest. When PD affects the facial muscles, causing a mask-like expression, many of the nonverbal cues are not present, which may lead to challenges communicating with others and negatively impact relationships. The relationships most often affected are those with family and friends, as well as relationships with healthcare providers. The emotion behind the words may be further compromised by a monotone voice, another symptom that makes it difficult for a person with PD to vary the tone of their voice.3,4

Research into the facial masking that occurs with PD has found that people with PD have less facial masking when responding to positive questions and more facial masking is seen when patients respond to negative questions. Unfortunately, most healthcare appointments focus on problems, which may lead to more missed cues in relationships between people with PD and their healthcare providers.4

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