What Emergency Type Devices Should A Person With Parkinsons Disease With Speech And Voice Problems Have At Hand
To preparing for emergencies:
- Use an intercom system or baby monitor to alert others that there is an emergency.
- Use bells or buzzers if you are not able to speak. Use “codes” that signify urgency. For example, a tinkling bell might mean, “I’d like company,” while an air horn might mean there’s an emergency.
- Carry a cell phone that is equipped with pre-programmed numbers. Preprogram all of your telephones so they can automatically dial the necessary emergency number.
- Sign up for a “Life Call” button service if you spend time alone. Pressing a button on a device usually worn on the wrist or around neck signals a service company that alerts loved ones and/or your local emergency service.
A Case Of Logopenic Variant Of Primary Progressive Aphasia With Parkinsonism And Anosmia
Article type: Short Communication
Authors: Sasaki, Shoichia b *
Affiliations: Department of Neurology, Agano City Hospital, Niigata, Japan | Department of Neurology, Toyosaka Hospital, Niigata, Japan
Correspondence: Correspondence to: Shoichi Sasaki, MD, PhD, Department of Neurology, Agano City Hospital, 13-23 Okayama-cho, Agano-shi, Niigata 959-2093, Japan. Tel.: +81 250 62 2780 Fax: +81 250 62 1598 E-mail: .
Keywords: Anosmia, 123I-FP-CIT SPECT, 123I-IMP SPECT, logopenic variant of primary progressive aphasia, magnetic resonance imaging, parkinsonism, primary progressive aphasia
DOI: 10.3233/ADR-190158
Journal: Journal of Alzheimer’s Disease Reports, vol. 4, no. 1, pp. 61-66, 2020
Abstract
A 69-year-old right-handed woman developed difficulty naming objects and word-finding. The clinical features of language disorder and predominant atrophy on MRI and predominant hypoperfusion on 123I-IMP SPECT in the left temporo-parietal junction area were consistent with the diagnostic criteria for the logopenic variant of primary progressive aphasia . Neurological examination showed slight right-side rigidity and resting tremor . 123I-FP-CIT SPECT showed presynaptic dopamine transporter reduction in the posterior putamina with left-side predominance. The odor-stick identification test for Japanese exhibited complete loss of the sense of smell . These findings suggest that lvPPA may be accompanied by parkinsonism and anosmia.
Parkinsons Disease Vs Parkinsonism: Whats The Difference
The recent death of President George H.W. Bush, who had been diagnosed with vascular parkinsonism towards the end of his life, placed this disease in the media limelight. Generally, there is a lot of confusion about Parkinsons disease and parkinsonism and many of you have asked me to clarify this distinction.
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What Are The Symptoms Of Aphasia
People with aphasia often struggle with speaking and writing.
According to the NAA, the condition is an acquired communication disorder that impairs a persons ability to process language but does not affect intelligence.
People with aphasia are intellectually intact, said Michael Biel, an associate professor of communication disorders at Cal State Northridge. Their mental competency is hidden by this disability. … Its quite easy for people with aphasia to be stigmatized as less than mentally competent.
The exact symptoms can depend on the type of aphasia a person has, which depends on where the underlying brain damage occurred.
Some types of aphasia can result in the person speaking in complete sentences with unintelligible meaning, while other types can affect the persons ability to name objects or repeat words and sentences. The most common issue is word-finding difficulty, Biel said.
Some individuals with aphasia may also experience right-sided weakness or paralysis of the arm and leg if the damage occurred in the frontal lobe of the brain, which is important for motor movements.
Inside the Aphasia Book Club, where participants work to improve their language skills with literature at the Echo Park Branch of the Los Angeles Public Library.
Speech And Communication Problems
Speech and communication problems are common for people with Parkinsons.
They can include problems with your voice, body language, making conversations and small handwriting. But with the right help and support there are lots of ways you can improve any symptoms.
Changes in the brain in people with Parkinsons mean that your movements become smaller and less forceful than before. This can lead to problems with your speech and communication.
Issues may relate to making sure your voice is loud enough, making your pronunciation clear enough and getting the right tone to your voice.
Problems creating movements that are powerful enough can also affect chewing and safe swallowing. Because of this you may find mealtimes more difficult, with an increased risk of food going down the wrong way.
Find out more: see our information on eating, swallowing and saliva control.
Other communication issues in people with Parkinsons are linked to the way you think. Brain changes mean you may not be able to process thoughts as quickly as you need to.
This includes difficulty finding the right words you need or understanding what other people mean straight away. It also includes problems getting your thoughts together quickly enough to respond to someone in the flow of a conversation. In particular, this can happen when you have to do several different things at once .
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If I Have Speech And Voice Problems How Can I Maintain And Improve My Communication
Some tips to improve communication include:
- Choose a quiet, low-noise space. Turn off televisions, radios and other devices that create noise.
- Make sure your listener can see your face. Look at the person while you are talking. A well-lit room improves face-to-face conversation, increasing the ability to be understood.
- Use short phrases. Say one or two words or syllables per breath.
- Plan periods of vocal rest before planned conversations or phone calls. Know that fatigue significantly affects your ability to speak. Techniques that work in the morning might not work later in the day.
- Keep your throat hydrated. Drink plenty of water. Dont drink caffeinated or alcoholic beverages. Use a humidifier if the air in your home is dry.
- Keep an upright posture, straight chin, slightly lifted neck to improve airflow from lungs to your vocal cords.
- If you are soft spoken and your voice has become low, consider using an amplifier.
If some people have difficulty understanding you, these additional strategies might help:
Hear Directly From Our Members: What Its Like To Have Aphasia
Our Founder, Mike Caputo, explains what aphasia is like for him and talks about our programs. Mike has Brocas aphasia, which is a type of non-fluent aphasia. People with non-fluent aphasia have effortful, fragmented speech. Comprehension of spoken language is relatively intact.
Al is another one of our members. Al has a type of fluent aphasia. People with fluent aphasia can speak in sentences that resemble normal speech. They may have trouble finding the right words, so they may substitute more generic filler words that lack meaning, or may use words that dont make sense.
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Difficulties Are Common But Can Be Managed
If you have Parkinsons disease , you probably notice that people ask you to repeat what you just said more than they used to. In addition, speaking clearly and intelligibly becomes a little more difficult when you have PD.
While the majority of people with PD experience some type of speech problems, few get treatment for those speech problems. This is unfortunate as research shows that effective treatments are available for speech, voice, and language problems in PD.
What Alternative Communication Devices And Tips Can Help With My Voice And Speech Problems
If you have difficulty speaking, are frustrated and stressed by your inability to communicate or tire from the efforts to speak, consider the following devices and methods to be better understood:
- Amplification: This could be a portable personal amplifier or a telephone amplifier that can be used to increase vocal loudness in soft-spoken people. The amplifier also decreases voice fatigue.
- TTY telephone relay system: This is a telephone equipped with a keyboard so speech can be typed and read by a relay operator to the listener. Either the whole message can be typed or just the words that are not understood.
- Low-technology devices: Paper-based books and boards, alphabet boards and typing devices are examples of low technology assistive methods.
- High-technology electronic speech enhancers, communication devices: Computers with voice synthesizers and speech generating devices are available. Talk to a speech-language pathologist about the available high technology devices best suitable for your needs.
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Q: When Should A Person With Pd Who Has A Communication Barrier Consider Using An Aac Device
A: They should consider a device when they cannot be understood, cannot make their needs known, feel isolated because of their speech difficulties, or overall cannot participate in communication with familiar and unfamiliar listeners. If an individual feels that their challenges with speaking have impaired their ability to participate in medical decisions, talk to their family members or friends, or overall negatively affect their quality of life, then a referral to an occupational therapist or speech language pathologist who specializes in AAC needs to be considered. When we work with a person with PD, we are doing it in conjunction with a speech language pathologist to make sure that all of their communication needs are being met.
Behavioral Speech Therapy For Parkinson’s Disease
Behavioral speech therapy usually involves a series of voice exercises administered by a trained and certified speech therapist. These exercises include training in control of speech rate, stress/intonation, or expression of emotion, loudness, articulation, and breathing, so as to support the voice. Sometimes the therapist uses assistive instruments, such as delayed auditory feedback, voice amplification devices, or pacing boards.
Some investigators have claimed significant success with PD patients by using the so-called Lee Silverman Voice Treatment , an intensive program of voice exercises that targets vocal intensity, quality, and variation precisely the areas of difficulty for persons with PD.
The LSVT approach centers on a single therapeutic target at a time so that effort can be invested in achieving that target alone. A therapeutic target might be increasing vocal loudness or enhancing speech intelligibility. In pursuing these sorts of therapeutic targets, the patient is drilled on a series of voice exercises and is taught to be aware of sensory feedback from the voice, as well as to self-monitor voicing patterns and voice quality. The increased self-awareness of voice allows for the correction of errors and for faster progress toward the target.
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The Lee Silverman Voice Treatment
The Lee Silverman Voice Treatment LOUD is the first speech treatment for PD proven to significantly improve speech after one month of treatment.
LSVT® Guidelines
- Must be administered four days a week for four consecutive weeks.
- On therapy days, perform LSVT exercises one other time during the day. On non-therapy days, perform LSVT exercises two times a day.
- Once you complete the four-week LSVT therapy, perform LSVT exercises daily to maintain your improved voice.
- Schedule six-month LSVT re-evaluations with your specialist to monitor your voice.
- If available in your area, participate in a speech group whose focus is on thinking loud.
- A Digital Sound Level Meter can help you monitor voice volume. Place the meter at arm distance to perform the measurement. Normal conversational volume ranges between 68-74dB.
Discover Free Resources To Learn More About Parkinsons And How It Affects Your Voice
An informative APDA booklet entitled Make Your Voice Heard! Healthy Communication and Parkinsons Disease can be downloaded from our website for free or ordered by mail at no cost to you. This book delves into many of the speech and communication concerns of people with PD. We also had a great conversation about PD and communication with a certified speech language pathologist that you may find useful.
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Q: Do You Advise Someone Who Has An Aac Device To Continue Speech Therapy
A: This is a great question for the doctor and the SLP who are working with the individual. The SLP can be instrumental in making recommendations on incorporating the AAC device into daily communication. In addition, they can make recommendations on energy conservation and ways to continue to use the speech that is preserved.
Aphasia Symptoms Associated With Dementia
People with the most common types of dementia, such as Alzheimer’s disease and vascular dementia, usually have a mild form of aphasia.
This often involves problems finding words and can affect names, even of people they know well.
It doesn’t mean they don’t recognise the person or don’t know who they are, they just can’t access the name or get mixed up.
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If You Do Notice Some Of These Symptoms And Behaviors In A Loved One What Should You Do
I think the first step is understanding whats attributable to normal aging and whats not.
There are many people who view short-term memory difficulties as something thats expected with aging, and something that is in some ways unavoidable, which is not true.
Most people do have more difficulty remembering names as they get older. On the other hand, if you forget events, if you repeat yourself, if you misplace things repeatedlythose are early signs of a potential memory problem.
I think people are pretty well aware of what those early signs of memory problems are, but I dont think there is awareness of what changes are potentially significant when it comes to personality.
People with a neurocognitive disorder may not be interested in things as much as they used to be. It can be difficult to distinguish this from just an effect of age or just a life phase, but losing interest in things is one of the common early signs of frontotemporal degeneration, as is difficulty expressing oneself.
As a starting point, if there is concern about symptoms, families should always talk to their primary care doctors. And remember that neurocognitive disorders do not just show up as memory problems. They can also present as language problems, hallucinations, motor changes or acting out dreams at night.
How Do These Disorders Manifest Differently In The Brain
The common framework for all of these disorders is that theyre caused by one or more abnormally folded proteins that accumulate in different parts of the brain. Whatever parts of the brain are affected determine what the clinical manifestations are. This provides a common framework for understanding Alzheimers disease, Parkinsons disease, amyotrophic lateral sclerosis , chronic traumatic encephalopathy , frontotemporal degeneration and other rare disorders called progressive supranuclear palsy and corticobasal degeneration.
For example, in Alzheimers disease, neurofibrillary tangles composed of tau protein accumulate in the memory center. Thats why you get memory problems.
In Parkinsons disease, Lewy bodies, which are formed by a different protein, accumulate in parts of the brain that control motor function. In some cases, Lewy bodies can also accumulate in other areas of the brain that affect thinking and behavior, which results in Lewy body dementia.
And in ALS, a different protein accumulates in different parts of the nervous system that control motor function.
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How Do I Know If I Have A Speech Or Voice Problem
- My voice makes it difficult for people to hear me.
- People have difficulty understanding me in a noisy room.
- My voice issues limit my personal and social life.
- I feel left out of conversations because of my voice.
- I cannot participate in telephone calls because of my voice.
- My voice problem causes me to lose income.
- I have to strain to project my voice.
- My voice clarity is unpredictable.
- My voice problem upsets me.
- My voice makes me feel handicapped.
- People ask, “What’s wrong with your voice?”
Clinical Confirmation Of Parkinson Disease
The diagnosis of PD is guided by the Queen Square Brain Bank diagnostic criteria,12 which require two steps. Step one focuses on the definition of parkinsonism and requires the presence of bradykinesia and of either typical rest tremor, extrapyramidal rigidity, or postural instability . However, postural instability is not an early PD feature and should alert the clinician of an atypical parkinsonian disorder. Step two focuses on features typical of the parkinsonism of PD, such as unilateral onset, excellent response to levodopa therapy, and development of dyskinesia. Exclusion criteria include pyramidal signs, stepwise deterioration of parkinsonism , repeated head injury, history of encephalitis or oculogyric crisis, neuroleptic treatment at the onset of symptoms, strictly unilateral features after 3 years, supranuclear gaze palsy, cerebellar signs, early severe autonomic dysfunction, early severe cognitive dysfunction, negative response to levodopa, and imaging evidence of communicating hydrocephalus.
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If I Have Parkinsons Disease What Kind Of Speech And Voice Problems May I Experience
If you have Parkinsons disease, some of the voice and speech difficulties seen include:
- Softened voice. Reduced volume to your voice.
- Speaking in an unchanging pitch .
- Having a hoarse or strained quality to your voice.
- Having a breathiness to your voice. Breathiness in the quality of your voice that is easily heard by your listeners. It takes more effort and energy to speak. You run out of gas as you speak.
- Trouble clearly and easily pronouncing letters and words.
- Tremor in your voice.
- Using short rushes of speech.
- Loss of your facial expression.
If you have Parkinsons disease, you may not be aware of the problems with your spoken communication. Changes in the quality of your voice may be the first sign of speech problems followed by the inability to have fluid speech and clear and distinct speech sounds. Speech problems that are severe enough to reduce your ability to be easily understood usually do not occur until later in the course of Parkinsons disease.