A patient said to me this week: “I wish there was a pill for my speech.” A medication that could improve motor speech symptoms associated with Parkinson’s disease would truly be wonderful. Weight loss drugs like Ozempic or medications to help with smoking cessation have been readily welcomed by patients and physicians, because we know, that behavioral change on its own is difficult. Behavioral interventions have been the mainstay of speech therapy for people with Parkinson’s disease, and although there are no known medications that can improve speech symptoms, there are now several device interventions available, and these can often help patients maintain improvements made in speech therapy, and help with maintaining speech during conversation where attention, listening and processing information and formulating novel thoughts can create a heavy cognitive load. Device interventions can often reduce this cognitive burden and allow users to communicate more easily.
Individuals with hypophonia (low voice volume) and/or hypokinetic dysarthria (motor speech changes) resulting from Parkinson’s disease, may benefit from one:one speech therapy, employing a standardized protocol such as LSVT® Loud or SPEAK OUT!®, and so early referral to speech therapy is important.
But, 30 days of progress made in speech therapy will be short-lived without a strategy for long-term maintenance.
In light of a neurodegenerative disease diagnosis, continued speech “practice” following speech therapy makes sense, and I often tell patients: “whether you do or don’t practice, Parkinson’s really doesn’t care, it will continue on it’s path.” So, as the saying goes: the best defense is an offense, with the idea being that a proactive instead of a passive attitude will lead to a strategic advantage.
Some patients tell me that they read aloud as a way of maintaining speech improvements after therapy, and while this is a good home practice strategy, I wonder, is it enough? After-all, without some feedback to measure vocal intensity, reading aloud at a speech volume below what is necessary for conversational speech will unlikely yield a strengthening effect or improvement that will generalize to conversational speech.
Reading Aloud more effectively during home practice
PD patient reading out loud using a Hi-VOLT light for calibrated feedback.
Below are a few suggestions for how you can make reading aloud a more effective home-based practice activity:
• Implement a feedback tool to maintain a target level of loudness. This can include: Hi-VOLT® , a voice-activated light bracelet, which, when positioned 12-13” from your mouth or body will provide feedback and a target for loudness. After reading aloud, continue to use the Hi-VOLT® as you re-tell 3 main points of what you read, or answer 3 questions.
• Speak Up for Parkinson app is a free app for ipad users. It displays a sound level meter for feedback and allows you to video-record yourself while reading aloud short phrases embedded in the program, or anything of your own you would like to read. Video recording is such a great strategy for real-time feedback. It allows you to see and hear yourself the way others do. It also allows you to observe facial expression and other non-verbal gestures which may enhance or distract from what you have to say.
• Listen-a-Minute.com is a website created by Sean Banville that lends itself nicely to home practice. It was developed for English as second language users, but, with over 450 1 minute reading passages on an array of topics, it can be a fun home practice tool. Each 1 minute reading displays as a pdf file, but after the initial reading, the passage appears again with some of the information missing, giving you an opportunity to “fill in the blanks,” and judge how well you were paying attention. There is also a word jumble.
• Read poems, limericks, or Dr. Seuss out loud. The rhythm and rhyme of limericks can be a fun way to practice pitch and inflectional changes that are important components of conversational speech and add meaning to what you say. Focusing on the rhythm of speech production can help to reduce the monotone speech that is frequently a by-product of Parkinson’s. Rhythm also affects the rate of speech, and speech which is perceived as too fast by a listener can reduce understanding.
• If you have the opportunity to join a weekly speech class in person or online, this might be the best strategy for maintaining improvements attained in speech therapy. Group classes give you an opportunity for “speech practice” while engaging in activities that might include: reading aloud, choral reading, extemporaneous speaking on a variety of topics, and engaging in conversation with people who share your desire to maintain effective communication despite a diagnosis of Parkinson’s disease.
Has Parkinson’s Got Your Speech Caught in a Speed Trap?
So what does a person do when Parkinson’s or DBS (deep brain stimulation) causes the motor speech mechanism to speed up, and speech rate becomes too fast? Speech rate that is altered with rate that is too fast and words running together is referred to as festinating speech.
In Parkinson’s, festination corresponds to a tendency to speed up when performing repetitive movements. It was first described in gait where it is seen as a propensity to lean forward taking rapid, small steps, but festinating patterns can also occur in handwriting and speech. Festination is reported as one of the most disabling symptoms for people with Parkinson’s because it can truly feel like movements or speech patterns they simply cannot control. Tapping, when used as a cueing method to control or manage the festinating speech, may unfortunately also quickly degrade into a festinating pattern.
Treatment Approaches Including Device Interventions
Individuals with hypokinetic dysarthria, that includes festinating speech patterns may benefit from speech therapy protocols such as LSVT® LOUD or Speak OUT®. These are therapist guided programs, and while both are very effective in addressing hypophonia (low volume), their affect on rate disturbances may be less robust. Speech Vive is an evidence-based device intervention, developed by a Speech-Language Pathology researcher, and it introduces a background noise into one ear, thereby activating Lombard effect, a tendency we have to speak louder in a noise condition. This helps users speak at a more normal level of loudness during conversation without having to think about or self-monitor speech production. I presented a recent webinar discussing speech therapy and the Speech Vive for Neuro Challenge Foundation and it is available to view here:https://youtu.be/6YN_S220bdY?si=nYq6s2sS4kmawwtO
Patients with festinating speech patterns may not respond as easily to current behavioral interventions and it difficult for patient’s to self-monitor and maintain a more normal speech rate pattern outside of a therapy setting.If your speech disturbance is associated with DBS, it’s important that you report this to your neurologist and/or DBS programmer, as setting adjustments can sometimes improve speech production. Pacing boards have also been utilized for rate disturbance with variable long-term success. Individuals who have had limited response or sustained benefit from more traditional speech therapy approaches might want to explore a device intervention. Speech Easy® is a wearable device which uses delayed auditory feed-back (DAF). DAF has been used for aver 60 years as a method for fluency disorders and is now available for people with festinating or stuttering-like speech patterns associated with Parkinson’s disease.
Visit our website: https://voiceaerobicsdvd.com/ to order products and learn more about speech therapy and device interventions available to improve speech and swallowing symptoms associated with Parkinson’s and related disease diagnosis.
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