Every year during April, Parkinson’s’ Awareness month, I pose the same question to my patients: “why should we care?”
With so many changes going on in our country, we all have lots of concerns, and for someone with Parkinson’s disease, or any chronic disease diagnosis, for that matter, fears about research funding for medications or other treatments, payment for therapy and other services, and the rising cost of drugs and of everyday items may have you overwhelmed. So, this month, when organizations reach out for your donations, and encourage you to spread Parkinson’s awareness, what do you want people to know?
I asked a patient of mine that question today, and he said: “I want them to know I have difficulty speaking, I’m not dumb.”
Share your thoughts in the comments at the end of this blog post.
How Common are Speech Problems in Parkinson’s?
Anywhere from 70-90% of persons with Parkinson’s have speech and voice problems, collectively referred to as hypokinetic dysarthria. Problems of reduced loudness, reduced effort, and inaccurate feedback are also related to a breakdown in the multisensory integration in our brain. As brain changes occur, many people with Parkinson’s mis-judge their voice and vocal effort, often reporting that their very soft speech is “loud enough” or even “too loud, and a cue to “speak up” and be normally loud often elicits the comment: “it feels like I’m shouting”. The pathophysiology underlying this impairment in internal cueing is only partially understood, but some speech studies indicate that different cueing mechanisms are located in different regions of the brain, with internally generated movements involving the basal ganglia, and frequently disrupted in Parkinson’s. This internal cueing deficit can often be improved in response to external cueing, such as feedback from a sound level meter or other external device source, or internal cueing for example, for example, “think loud,” or “use intent.” . The improved motor speech response from an an external cue a different region of the brain, the cerebellum.
Since the basal ganglia is also involved in helping us switch from one movement to the next, brain changes from Parkinson’s can also cause trouble with preprogramming and initiation of speech movements, which may be reflected in hesitancy, long pauses of silence, difficulty in starting a word, or difficulty in moving from one word to another.
Since speech and voice tend to improve dramatically in response to external cueing, many behavioral approaches in speech therapy take advantage of this effect, in hopes that patients will internalize the cue and begin to self-cue (e.g. “think loud”).
Unfortunately, for many individuals with Parkinson’s, they may be able to generate louder and clearer speech while in therapy with the speech therapist frequently cueing them, only to lose the effect once they leave the treatment room and are back home in their own environment.
This is not because of lack of effort on the part of an individual but rather, it is the challenge of trying to compensate for a motor speech mechanism that has been changed or is changing due to Parkinson’s. Dyskinesia and dystonia associated with fluctuations in medications can further contribute to an individual’s speech difficulties. Speech devices like SpeechVive can augment behavioral interventions, helping individuals retain speech improvements once engaged in every-day conversation. I have often concluded a presentation with the quote below.
Nothing Works for Every Patient. Remember Your Uniqueness
“Variability is the law of life, and as no two faces are the same, so no two bodies are alike, and no two individuals react alike and behave alike under the abnormal conditions which we know as disease. ” Sir William Osler
How LOUD is TOO LOUD?
I frequently re-assure patients that the high effort voice tasks which may be a part of their speech treatment are designed to provide a strengthening effect. Muscles get stronger when they work against resistance (think weight training). Because I cannot put weights on the larynx or breathing muscles, the strengthening effect comes about with the performance of HIGH EFFORT vocal function exercises. These exercises, when introduced by a speech therapist, should never irritate the voice, but should help in overcoming some of the vocal fold stiffness or muscle weakness that may be a symptom of Parkinson’s but may also be a part of normal aging.
Hi-VOLT® 4 PD voice-on-light. Feedback you can USE to Strengthen Your Voice
Could external feedback during speech practice in the clinic and at home help to strengthen your voice and re-calibrate the system?
Hi-VOLT® 4 PD, is a portable, calibrated, voice activated bracelet, that was created with this goal in mind.
Hi-VOLT® use in Speech, Physical and Occupational Therapy
The Hi-VOLT light is small and portable and can be helpful to patients in and out of therapy, helping them feel the effort required to strengthen their voice.
Whether you are in Speech Therapy, Physical Therapy, or Boxing for Parkinson’s, the Hi-VOLT ® can be worn as a bracelet when counting exercise reps, placed at eye level when reading,or worn in the car when you are a passenger, letting you practice using a LOUD voice wherever you go.
Does it Work?
Using LSVT® Companion software, acoustic data was collected and analyzed on 98 patients at the time of their initial speech assessment. Patients performed a series of speech tasks un-cued and cued while using the Hi-VOLT® positioned 13” from their body and a single cue: “be loud enough to activate the light.”
Hi-VOLT® yielded a change that was statistically significant and perceptually audible.
Re-calibration to more normal perception of speech/voice is the desired outcome from most speech therapy protocols for persons with PD, feedback tools which patients can utilize at home, on their own, may help them practice more effectively and improve or maintain strength of the respiratory and phonatory muscles. Hi-VOLT® 4 for PD is an affordable and portable device option I invite you to try.
To learn more or order a Hi-VOLT® light please visit: https://voiceaerobicsdvd.com/.
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 * Voice Aerobics® A Whole Body Approach to Voice Practice* Certified End of Life Specialist Training (CEOLS) * FiTOUR® Group Exercise Instructor
Voice Aerobics the heART and Science of Voice Practice