Hypophonia (low volume of speech) a common motor speech symptom of persons with Parkinson’s has been attributed to a perceptual deficit or the lack of awareness of their own reduced speech loudness co-occurring with dysarthria ( a motor speech problem).
However, most individuals with Parkinson’s disease who have been diagnosed with hypophonia are often able to speak louder when their attention is deliberately directed to an explicit cue.
External cues can be verbal (e.g., “speak twice as loud”), they can include the use of auditory masking or other background noise which acts upon a reflex and triggers the individual to speak louder, or, an external cue might be visual such as the use of a sound level meter or Hi-VOLT® light for calibrated feedback during voice use. Therapy programs also attempt to teach or train the PWP to integrate an internal cue such as “think loud,” or “speak with intent.” Self-cueing has been shown to be beneficial for improving both speech and motor performance, but may be difficult for some patients to incorporate or sustain particularly in individuals with mild dementia or other cognitive impairment.
So, while most PWP CAN generate an increase in vocal intensity in response to cueing (external or internal) it may be more challenging for individuals to maintain a level of loudness or focus on other aspects of speech production (e.g., how fast or slow one is speaking) when speaking in high demand settings such as a noisy restaurant, in the car, or even at home with the television on. Environmental noise and other distractions can compete with the cognitive attention required for conversation which involves listening and processing; formulating thoughts, AND self-monitoring some aspect of speech production.
I often hear a spouse express frustration when they hear their husband/wife speaking louder in speech therapy only to get in the car or get home and revert to their low volume. And, while this can be perceived as “not trying,” it is more likely just the challenge for some people to be able to be able to maintain a level of consistent self-monitoring and focus on speech production when their own motor speech mechanism and self-perception of speech is faltering.
Hi-VOLT® Voice-activated Calibrated Feedback Helps During Therapy and Home Practice
The Voice Aerobics Hi VOLT® Voice-on-Light Bracelet is a voice activated, calibrated light, housed within a bracelet, providing augmented feedback during daily speech practice. It was designed for use by individuals with Parkinson’s or related disease diagnosis. It is activated when the user’s voice is loud enough, helping them attain therapy targets for loudness and stay loud enough for everyday conversation.
The Hi-VOLT® is convenient for speech therapists to use during initial assessments to quickly assess stimulability for loudness or during Physical and Occupational therapy when carryover of loudness can be incorporated into counting exercise reps.
When used by patients at home, Hi-VOLT® can provide the simple cue they need to gain an exercise effect when performing vocal function exercise.
Acoustic data for 98 patients with Parkinson’s collected at the time of the initial evaluation was reviewed. The increase in loudness that occurred when the patients used the Hi-VOLT is greater than would be expected by chance, and is therefore, statistically significant. https://voiceaerobicsdvd.com/parkinsons-advocacy/hi-volt-yield-statistical-and-perceptual-improvement-in-vocal-intensity-for-parkinsons-patients/
It’s FUN, It’s Easy, Just SPEAK UP AND SEE THE LIGHT!
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