By working in collaboration with Community-based Parkinson’s programs, therapists can provide weekly classes that may help people with Parkinson’s (PWP) maintain improvements attained in one:one therapy, provide ongoing disease education, and perhaps, ultimately reduce dependence on the healthcare system.

Chronic Disease Management Differs from Acute Care

Occasionally, a patient referred for speech, voice or swallowing treatment will make full or near full recovery. Examples of this include: a patient with a post-op transient vocal-fold impairment, a voice patient with nodules, or the patient with mild dysphagia or speech impairment following a stroke. 

Often, however, speech-language pathologists find themselves treating patients with a communication or swallowing impairment that is chronic in nature. That chronicity may relate to the length of time the problem has already been in place, or it may reflect the cause of the impairment, such as a neurodegenerative disease which is progressive in nature such as Parkinson’s or related diagnosis such as progressive supranuclear palsy (PSP) or Multiple System Atrophy (MSA).

When working with patients with a chronic disease diagnosis, direct treatment usually includes a regimen of exercises or behavioral strategies that patients will need to continue to employ on their own, at home to maintain optimal function.

Goals of treatment will obviously differ for every patient and while some patients will make improvement in speech or swallowing, others may undertake the exercise with a goal of preserving function and maintaining safety. And while we have evidence that certain treatment protocols are efficacious for improving speech, voice and/or swallowing, what is less known, is how often or for how long a period following discharge patients adhere to post-treatment recommendations.

Failure to adhere to after-therapy recommendations may be an important factor that leads to a quicker decline in function for some patients and increased burden to the healthcare system with frequent re-enrollment in therapy or even hospital admission.

Reducing Rate of Return 

Providing therapy — speech, physical or occupational — is challenging regardless of the practice setting, in part because (Medicare) and private insurers may set limits on visits, whether by cost or frequency. With the emergence of Medicare Advantage plans, many patients find themselves in a position of having high co-payments, such as $40-$50/per visit, and consequently they self-limit their therapy visits.

Unlike businesses, where customer satisfaction is measured by a high rate of return, in healthcare, a reduced rate of return and dependence on the healthcare system is viewed as an important positive outcome measure.

So, a therapy treatment program needs to be beneficial, efficient, and cost-effective, and needs to include a plan for discharge.

From the onset of treatment, we need to be thinking about goals for discharge. Although many patients will achieve some measurable improvement in speech, voice and/or swallowing, in response to 30 days of direct treatment, in the presence of a neurodegenerative disease diagnosis, those improvements will be short lived if patients do not have the motivation, support, or resources to continue to exercise on his or her own.

Community-Based Programs

Many Parkinson’s organizations provide community-based exercise classes, and since the onset of the COVID Pandemic early 2020, many of those programs are now delivered virtually via ZOOM or other web-based platforms. Community-based programs provide the opportunity for PWP to receive exercise guidance, disease education, and peer support. The relationships built are not only with the persons conducting the classes, but also with other class members.

You might be surprised to know that when The Affordable Care Act (the Act), passed in March 2010, it contained several provisions relating to prevention under Medicare, Medicaid, and private health insurance coverage.[i]

In a section entitled “Evaluation and Plan for Community-based Prevention and Wellness Programs for Medicare Beneficiaries”, Congress directed the Secretary of Health and Human Services to conduct an evaluation of community-based prevention and wellness programs and to develop a plan for promoting healthy lifestyles and chronic disease self-management for Medicare beneficiaries. The Act specifically required that the Secretary examine programs focused on increasing physical activity, reducing obesity, improving diet and nutrition, reducing falls, promoting chronic disease management, and better managing mental health issues.

While the efficacy of some programs included in the government research was known much less was known about their effectiveness in reducing healthcare utilization and costs, and in fact only a handful of interventions included in the evidence review had research that specifically addressed program effects on health care utilization and costs.

I believe that an opportunity exists for therapists working with individuals with Parkinson’s to collaborate with community-based Parkinson’s organizations. By offering weekly classes which address the common symptoms affecting speech and swallowing, PD organizations may begin to collect their own efficacy data which may demonstrate improved adherence to post-treatment exercise, improved self-efficacy and patient quality of life, and other outcomes which may impact costs associated with the care of individuals with PD.

[1] Report to Congress: The Centers for Medicare & Medicaid Services’ Evaluation of Community-based Wellness and Prevention Programs under Section 4202 (b) of the Affordable Care Act

Still Not LOUD Enough?


My Mission: To enlist individuals in their treatment, and help them express their personality & spirit through voice. To educate  and empower. Mary Spremulli, MA, CCC-SLP * FiTOUR® Group Exercise Instructor * Voice Aerobics® A Whole Body Approach to Voice Practice

Voice Aerobics the heART and Science of Voice Practice








[i] Report to Congress: The Centers for Medicare & Medicaid Services’ Evaluation of Community-based Wellness and Prevention Programs under Section 4202 (b) of the Affordable Care Act