Parkinson Disease

Parkinson disease (PD) is a neurodegenerative disease that deteriorates parts of the brain over time because of a loss of dopamine (Suchowersky et al., 2006). Parkinson disease impacts a variety of motor movements including those necessary for speech (e.g. tongue, lips, or jaw movement), swallowing, and limb movements including legs and arms can become impaired with the progression of the disease (Fox et al., 2006).

Studies have shown that individual’s with PD consider the reduced ability to communicate one of the disease’s most difficult aspects, but only 2-3% of people diagnosed with the disease seek speech and language services (Fox et al., 2002). Due to the impaired motor movements, individuals with PD have specific voice characteristics such as:
Reduced loudness

  • Monotone
  • Breathiness
  • Hoarseness
  • Imprecise articulation
  • Reduced facial expression

All of these features can impact intelligibility and understanding for listeners. This can become frustrating for a person with PD and they may withdraw from social activities or communicating with others all together, but there is another option!

Yes, the disease will continue to impact more and more of the neurological system, but speech-language pathologists (SLP) have a unique understanding of motor learning and the speech system needed for communication. This means, SLPs are prepared with research-backed therapy approaches designed to help improve some of the voice characteristics associated with PD in order to help the individuals with successful communication.

Treatment

There are a few ways to approach the speech and language therapy for an individual with PD. Following an initial assessment, the client and the speech-language pathologist will sit down and create an individualized treatment plan tailored to their goals and needs. This will take into account the length or duration of therapy, available time commitment, voice use, and personal goals.

Speech therapy for degenerative neurological diseases is controversial because therapy will not recover speech and language to its original state; however, we can provide strategies to improve communication for as long as possible (Ramig et al., 2007).

Lee Silverman Voice Treatment (LSVT®-LOUD)

The Lee Silverman Voice Treatment program (LSVT®-LOUD) is based on principles and evidence-based reports within the fields of neurology, physiology, motor learning, muscle training, and neurophysiology. According to Fox et al. (2006), the combined approach of LSVT-LOUD allows for increased breath support, more complete vocal cord closure, and improved vocal quality, which results in increased loudness with the greatest and most lasting positive effects.

The concepts underlying the Lee Silverman Voice Treatment (LSVT®-LOUD) are as follows:

  1. Exclusive focus on voice (specifically loudness)
  2. Multiple repetitions of high effort (loud) productions
  3. Intensive treatment (four individual sessions a week for four week, 16 sessions in a month)
  4. Increase awareness of loudness

(Ramig et al., 2007)The therapy is simple, redundant, and intensive, with only one target, LOUD (Trail et al., 2005). This removes any difficulty a person may have with learning or processing new information as it’s simply one directive, talk LOUD. The makeup of the therapy allows for overlearning and internalization of the loudness, which allows to generalization outside of the therapy room. The clinician pushes the client for the duration of the 45-60 minute session to continue using that LOUD voice and is continuously pointing out when the loudness stops in order to raise the client’s awareness.

Cognitive Strategies

In addition to the focus on voice, speech and language therapy can address any cognitive strategies that may help the individual function in daily living. With PD, an individual may notice more difficulty with higher level learning such as memory and sequencing (Voyzey, 2012). Therefore, the speech-language pathologist can introduce different strategies to improve their functional status in everyday life. Such strategies may include:

  • Visual cues (e.g. laminated calendar to orient to the day/date/month)
  • Verbal cues (e.g. reminder from a loved one, a recorded message, etc.)

Such cues can help a person complete sequencing tasks (e.g. the steps to getting ready in the morning), planning an activity/day, and performing different daily tasks.

Similarly, complex tasks like balancing a checkbook, creating a budget, shopping, using the telephone, as well as processing and manipulating information may be difficult. However, in speech-language therapy, the clinician can provide strategies to aid in the completion of these tasks such as

  • A diary (handwritten, photographic, or recorded) for recall
  • Memory books to track visitors or for important information (e.g. names, birthdates, email addresses, etc.)
  • Written/visual instructions for task completion and sequencing
    • A written list of questions to answer before leaving the house to maximize safety
      • Is the stove off/on?
      • Do I have keys?
      • Do I have my wallet?
      • Is the water off/on?

(Voyzey, 2012)

Augmentative & Alternative Communication (AAC)

Augmentative and alternative communication is when we use a means other than speech to communicate. It can be via alphabet boards, text-to-speech software, sign language, etc. In terms of PD, attending therapy four days a week or even once a week may not feasible; however, there are other options because of AAC. Depending on the progression of the PD, individuals may find some benefit in amplifiers, which would be like a hand held device with a microphone that would allow them to project their voice louder than they could independently. Similarly, if the disease is more progressed, there are different technologies, either low or high-tech, that may be beneficial. Research surrounding AAC and PD is small and has mixed results (Mathy, 2002), but by creating an individualized treatment plan the client and speech-language pathologist can determine which device would be suited for that person’s needs.

The Next Step

If you or someone you know has been diagnosed with Parkinson’s disease, contact us to talk about your options or to set up an appointment for a full comprehensive assessment. We are committed to providing you with individualized service that meets your needs and goals for successful communication.

References

Fox, C., Morrison, C., Ramig, L., Sapir, S. (2002). Current Perspectives on the Lee Silverman Voice Treatment (LSVT) for individuals with idiopathic Parkinson disease. American Journal of Speech-Language Pathology, 11, 111 – 123.

Fox, C., Ramig, L., Ciucci, M., Sapir, S., McFarland, D., & Farley, B. (2006). The science and practice of LSVT/LOUD: Neural plasticity-principled approach to treating individuals with Parkinson disease and other neurological disorders. Seminars in speech and language, 27(4), 283 – 299.

Mathy, P. (2002). Augmentative and alternative communication intervention in neurogenic disorders with acquired dysarthria. Perspectives on Neurophysiology and Neurogenic Speech and Language Disorders, 12(4), 11 – 19.

Ramig, L. & Fox, C. (2007). Voice treatment for individuals with Parkinson’s disease. Perspectives on Gerontology, 12, 2 – 11.

Suchowersky, O., Reich, S., Perlmutter, J., Zesiewisz, T., Gronseth, G., & Weiner, W. (2006). Practice parameter: Diagnosis and prognosis of new onset Parkinson disease (an evidence-based review). American Academy of Neurology, 66, 968 – 975.

Trail, M., Fox, C., Ramig, L., Sapir, S., Howard, J., & Lai, E. (2005). Speech treatment for Parkinson’s disease. NeuroRehabiliatation, 20, 205 – 221.

Voyzey, G. (2012). Cognitive strategies for individuals with Parkinson’s disease. Perspectives on Gerontology, 17, 60 – 68.