Merriam Webster defines magic as: the use of means (such as charms or spells) believed to have supernatural power over natural forces. To produce, remove, or influence by magic.
Patients who come to my private practice with a Parkinson’s disease diagnosis may be newly diagnosed and don’t understand the reason for a referral to speech therapy, proclaiming that there is nothing wrong with their speech or swallowing– “yet.” Other patients may have had a PD diagnosis for several years already but have never received a referral for speech therapy. In some instances patients self-refer to therapy because they recognize that their speech has changed or they are experiencing swallowing problems, and other times, patients come to see me only because a well-intentioned and concerned spouse has made the appointment.
In all instances, at the time of my assessment of a patient, I will have them complete several screening tools. I collect acoustic voice data, and typically recommend that they enroll in out-patient treatment so that they can begin to learn a program which may improve or maintain speech and swallowing function. A program, that to one degree or another they will need to continue to do on their own or with others once they have been discharged from formal therapy.
At the conclusion of an initial visit some patients enthusiastically enroll in treatment, some refuse to commit to therapy until they “think about it,” and in other instances, some tell me quite honestly that they “hate to exercise,” and it is unlikely they will follow- through with home practice.
Even for the enthusiastic patient who enrolls in treatment, it may be a while before they realize that they must commit to a lifetime of practice to sustain the improvements and changes they may have attained in therapy.
Disease progression, unrelated medical problems, and other life circumstances will pose a challenge for even the most stalwart patient.
I wish that in all cases, I could wave a magic wand, and restore function without the “work” of speech therapy, but there is no magic pill, no magic therapy, and no magic cure for speech and swallowing symptoms associated with Parkinson’s and related diagnosis.
The Magic of After-therapy Group Practice and Peer Support
In nearly 40 years as a speech-language pathologist, I can say that the closest to magic I have witnessed when working with individuals with Parkinson’s, is the power of group practice and peer support. In 1999, when I created Voice Aerobics® and offered it as a community-based after therapy program, I saw the enthusiasm participants exhibited and the benefits of group practice they reported. In 2016, when I offered Speak Easy 4 PD for the first time at a community-based Parkinson’s program, I witnessed again the enthusiasm and benefit of group speech therapy practice. And, since October of 2016, when I began to offer the LOUD Crowd®, a weekly class modeled after a program developed at the Parkinson’s Voice Project, I have witnessed for the past 6 years the benefits of group speech therapy practice.
It is probably unrealistic to expect that most or even many of our patients, once discharged from out-patient speech therapy are going to perform daily home practice. But I know that it is doable for nearly all patients to show up for a weekly group class whether in person or virtual.
In 2020, when the COVID pandemic put us all on ZOOM, my weekly LOUD Crowd, and Speak Easy 4 PD went virtual. I realized that when patients are NOT reliant on a spouse to drive them to a class, there is reduced caregiver burden, and when the commitment to show up for an hour requires nothing more than a walk to the computer, adherence and self-efficacy improves.
While research suggests that certain modes of training are beneficial for motor and non-motor signs and symptoms of PD, not all training is equally beneficial, and few interventions have demonstrated a long-term effect. Creating efficacious community-based exercise programs requires a village which includes staff and funding from Parkinson’s Associations and Foundations, patients, and collaborative community based-research which can help us better understand models of treatment that yield long-lasting results.[i]
[i] Hirsch, Mark A., Community-based rehabilitation for Parkinson’s disease: From neurons to neighborhoods Parkinsonism and Related Disorders 15S3 (2009) S114–S117
magic photo pexels-olya-kobruseva
My MissionTo 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