Parkinson’s disease

We have ways to make you talk

Communication Difficulties in Parkinson’s

• Speech - quiet voice with little intonation• Gesture - less movement because of

stiffness• Facial expression - less expression

because of stiffness

• Leads to isolation and loneliness

Importance of continuing to maintain speech

• Despite the changes brought about by Parkinson's it is essential to work on maintaining good speech

• Speech changes can bring loneliness, poor self image and isolation

Cardinal symptoms of Parkinson's are seen in speech - slowness of movement

• too slow

• too fast - festinating

• stuttering

Stiffness/rigidity

• stiff vocal cords

• leads to monotony of intonation

• bowed vocal cords cause breathiness

• stiff breathing muscles/quiet voice

Tremor

• tremulous voice quality

• like the tremor seen in hands and legs

Brain – attention skills

• Requires sustained attention for “good speech”

• Parkinson's interferes with the automatic aspect of speech

• This is the most difficult task in improving speech

Voice changes

• related to the changes of PD

• not related to intelligence

• Communication changes can make person look as if he has cognitive changes

Good news

• speech therapy

• regular practising can help to maintain voice

Bad news

• There is no magic pill

• Without regular practice the voice gets weaker

Lee Silverman Voice Treatment for Parkinson’s Disease (LSVT)

• Intensive program of regular exercise• Helps to improve individual’s perception

of his voice• Strengthens vocal cords and breath

control• Increases intonation

Evidence based Approach - LSVT

• Like medication; you want to use what works

• Scientific research has shown this treatment, when practiced regularly, maintains a functional voice for years

How do these exercises work and why?

• Individuals with PD have reduced loudness resulting in speech that is hard to understand

• Focus is only on loudness – THINK LOUD

• The exercises are simple – they focus only on voice – not breathing, posture, articulation etc.

Intensive Treatment

• Program works well because of the intensive therapy

• Therapy 4 times per week allows ______ to get a stronger voice

• This allows ________ to “recalibrate: the amount of effort required to obtain and use a louder voice

Voice Exercise 1

• Ask ___________ to sustain the “ah” sound for as long as possible

• This sound should be as loud as ________ can produce

• This simple exercise strengthens the vocal cords and improves breath control

• “THINK LOUD” – Try for as loud as possible

How Often ???

• This exercise is to be done at the beginning of each session

• 10 times each practice• Give __________ feedback

about each effort• Encourage a louder and

longer effort• Record your times

Voice Exercise 2

• After doing the first exercise work on incorporating the louder voice into speech

• Ask _________ 10 questions, requiring a short answer, and have him answer in a loud voice

• Give feedback as to the strength of the voice

Voice exercise 3

• Use your creativity to develop a situation in which ______ can practice his louder voice. Some ideas:

• Read a joke• Tell a story• Discuss a topic from the paper• Role play

Gentle reminding/coaching

• In a kind way remind __________ to use a strong voice

• Frequent reminding can be annoying and so use humor and gentleness

Divided attention – need for support

• Some people with PD have difficulty doing a few things at the same time

• Speech is challenging as one has to concentrate on many things at the same time (message, listener, finding words, listening to the response, speaking clearly)

• Honest feedback about voice improves awareness

Need for support with speech

• Easier to use skills to speak clearly with support and reminding from friends and family

• When family and friends help with practicing it takes responsibility off of spouse

• Can be reminded to use these strategies

_____________’s speech group"Communication Circle"

• Who: friends and family• What: provide speech therapy 4 times per

week• Where: ________’s home• Why: intensive treatment will help to

maintain speech

Description of project

• Learn about Parkinson’s • Learn specific therapy techniques• Practice therapy strategies with

_______________ according to schedule• Meet periodically with other group

members• Consent to participate in research study

Practice! Practice! Practice!

• Speech exercises are only effective if practiced regularly

• Like medications, they only work if used

• Good friends practicing regularly are like a very effective medication