How Do You Know Its Time To See A Speech
People should be aware that changes can occur in multiple areas of the body that contribute to communication. People may find that they are being asked to repeat themselves frequently. They may find that their voice is hoarse or breathy, or that they are clearing their throat frequently to turn on their voice. They may feel that they are running out of air and need to speak in shorter sentences. They may be misunderstood by others because of the reduced clarity of their speech or their soft voice. People may give them feedback that they appear bored or upset due to the use of a monotone voice and reduced facial expression. These changes often occur gradually and those close to the person with PD may not notice. It is good to be aware of how well strangers understand the person with PD in order to gauge whether or not there are changes in verbal and nonverbal communication. ;If youre experiencing any of these symptoms on a somewhat regular basis, it is time to see an SLP. You do not need to wait for symptoms to be severe in order to seek professional help. Early intervention can make a positive difference.
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A Swallowing And Medication
As previously mentioned, levadopa treatment tends to have the most predictable effects on limb symptoms in PD. Nonetheless, certain aspects of eating and swallowing may be enhanced by medication. It therefore is recommended that patients time their meals and medication in such a way that they receive maximum medication effect during meals so as to facilitate upper extremity control and possibly oral and pharyngeal function. Similarly, some patients may show improvement in swallowing when medication is changed. Thus, in patients who have changed medication, the clinician may opt to wait several weeks to begin swallow therapy especially in the form of active range of motion exercises to determine whether the medication benefits the patients swallow. Some patients experience xerostomia as a side effect of pharmacologic treatment for PD. Depending on the existence of other swallowing and eating difficulties, taking frequent sips of water, throat lozenges or lemon drops, as well as synthetic saliva may prove helpful.
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How Can I Maintain And Enhance My Speech
What Changes Can Occur
There are several ways PD may affect speech:
- The voice may get softer, breathy, or hoarse, causing others difficulty hearing what is said.
- Speech may be slurred.
- Speech may be mumbled or expressed rapidly.
- The tone of the voice may become monotone, lacking the normal ups and downs.
- The person may have difficulty finding the right words, causing speech to be slower.
- The person may have difficulty participating in fast-paced conversations.1
Some of the medical terms that describe the speech changes that can occur with PD include:
- Dysarthria, which is a motor speech disorder or impairment in speaking due to PD affecting the muscles required for speech
- Hypophonia, which means soft speech, is an abnormally weak voice caused by the weakening muscles
- Tachyphemia, also known as cluttering, is characterized by an excessively fast speed of talking and a rapid stammering that makes it difficult to understand the person speaking2,3
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How Can I Improve My Speech With Parkinson’s Disease
Speech-language pathologists can help people with Parkinson’s disease maintain as many communication skills as possible. They also teach techniques that conserve energy, including non-verbal communication skills. Speech-language pathologists are also available to:
- Recommend appropriate communication technologies that will help with daily activities.
- Treat all types of speech, language, and communication problems.
- Evaluate swallowing function and recommend changes as necessary.
Tip: Do I Have A Speech Or Voice Problem
These are statements many people have used to describe their voices and the effects of their voices on their lives. Choose the response that indicates how frequently you have the same experience. .
- It is difficult for people to hear me0 1 2 3 4
- People have difficulty understanding me in a noisy room0 1 2 3 4
- My voice difficulties restrict personal and social life0 1 2 3 4;
- I feel left out of conversations because of my voice0 1 2 3 4
- My voice problem causes me to lose income0 1 2 3 4
- I feel as though I have to strain to produce voice0 1 2 3 4
- The clarity of my voice is unpredictable0 1 2 3 4
- My voice problem upsets me0 1 2 3 4
- My voice problem makes me feel handicapped0 1 2 3 4
- People ask, Whats wrong with your voice?0 1 2 3 4
To find your score, add up your answers. A score of 10 or higher indicates you might have a speech or voice problem that is affecting your quality of life and you should ask for a referral to a speech pathologist.
*Please note that not all content is available in both languages. If you are interested in receiving Spanish communications, we recommend selecting both” to stay best informed on the Foundation’s work and the latest in PD news.
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Do Swallowing Problems In People With Parkinsons Disease Also Affect Speech
Swallowing problems are a common problem in people with Parkinsons disease. They can occur at any stage of the disease, can change throughout the disease course and often get worse as symptoms progress. Let your healthcare provider and/or speech-language pathologist know as you notice you are having swallowing problems. Symptoms of swallowing problems include drooling, choking, coughing, difficulty taking pills, taking a long time to eat, weight loss and dehydration. The most serious complication of a swallowing problem–and the reason why you should see your provider right away– is aspiration. Aspiration is when food or liquid goes into your windpipe , then passes down into your lungs, which can lead to aspiration pneumonia.
Although swallowing problems may not directly affect your speech, swallowing problems and voice and speech problems often occur at the same time.
A note from Cleveland Clinic
Voice and speech difficulties are common problems in people with Parkinsons disease, especially as the disease worsens. These problems affect your ability to communicate in the work setting and with family and friends which affects the quality of your life. Fortunately a speech-language pathologist can develop an effective treatment program to help improve your ability to communicate.
How Are Speech Problems Treated
There are many options to help improve your speech. A speech-language pathologist can help you pick the right approaches for you. Speech-language pathologists are trained health care professionals who specialize in evaluating and treating people with speech, swallowing, voice, and language problems.
Ask your doctor for a referral to a speech-language pathologist. It is also important to contact your health insurance company to find out what therapy and procedures are eligible for reimbursement and to find a list of SLPs covered by your plan. Finally, visit a SLP who has experience treating people with PD.
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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.
- My voice problem causes me to lose income.
- I have to strain to produce 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?”
Language Problems Of Parkinsons Disease
Besides the frustrating speech and voicing problems of PD, there may also be language problems. These language problems very likely make the speech problems more difficult to deal with, so it is important to identify these language difficulties when they appear.
Speech is about expressing ideas via the use of language. Language is a cognitive ability that can be present even when you cannot speak. In the case of people with PD, they may exhibit word-finding difficulties and grammatical difficulties. They tend, for example, to use simplified sentence structures with an increase in the ratio of open-class items to closed-class items , as well as an increase in the frequency and duration of hesitations and pauses.
When listening to others speak, it’s sometimes hard for persons with PD to understand the others language, if they use complicated sentences to express their ideas. Thus, in both the production of language and comprehension of language, people with PD sometimes experience significant difficulties.
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Causes Of Cognitive Impairment In Pd
The exact causes of cognitive impairment or dementia in Parkinsons disease are not fully understood. There may be changes in the neurochemical signals that the brain uses to pass along information to different regions of the brain. Besides dopamine, the neurochemical signals acetylcholine, serotonin, and norepinephrine are especially important for cognition, memory, attention, and mood. In autopsy studies, Lewy bodies, abnormal protein accumulations, have been found in neurons in brain regions responsible for cognitive processes. Other causes include co-existing strokes or mini-strokes or Alzheimers disease pathology.
Are There Reasons That Someone With Mild Pd May Benefit From A Speech Therapy Evaluation
Yes! As with physical therapy, there are many things to teach a person with even mild symptoms. A baseline evaluation is an excellent idea, as many people are already exhibiting changes of which they might not even be aware in their volume, pitch range, voice inflections, and facial expression. Early treatment and education about the correct exercises can be very effective, particularly for younger people with PD who are not yet ready to reveal their diagnosis to others . The subtle communication impairments can significantly impact work relationships and effective communication and the perception of competence. People often tell me that they wish they would have known about the value of speech-language pathology services earlier. They are often so focused on their gait or tremor that they do not realize the impact of their communication impairment on their work and home life. Even subtle changes can signal challenges ahead and having a baseline evaluation and a treatment plan that can be amended over time is empowering and effective.
What Is Parkinsons Disease
At the most basic level,;Parkinsons Disease ;is a disorder of the nervous system. PD causes vital nerve cells in the brain to deteriorate, significantly decreasing the bodys stores of dopamine;and other essential neuro-chemicals responsible for controlling movement.
This results in the tremors that are classically associated with PD.
Tremors, however, are only one of the varied and unpredictable symptoms of PD.
Persons with PD may also experience muscle rigidity or weakness. Movement may be slowed and problems with balance and coordination are common.
Additionally, PD can lead to challenges in thinking, concentrating, or remembering. Patients may even experience hallucinations, delusions, or paranoia as a result of changes in the brain.
Its estimated that more than;10 million people;worldwide have PD, with more than 95% of patients diagnosed after the age of 50.
How Does Parkinson’s Affect Communication
Many people with Parkinson’s Disease will experience a voice problem. The most common problem is a soft, quiet, monotone voice that gradually becomes quieter and harder to understand. Speech can become slurred or mumbled and imprecise. These communication problems often result in social isolation.;
People with communication problems due to Parkinson’s Disease typically have an unreliable;self-feedback mechanism. As a result, they often do not realise how quietly they are speaking and may initally believe that others are deaf. As more and more people ask for repetition, the person begins to realise that they have a;problem.
Other individuals with Parkinson’s Disease may have rapid;speech. They often have a reduced awareness of how fast their speech is and also difficulty controlling their speech rate.
Lee Silverman Voice Therapy ;;
Speech treatments for people with Parkinson’s disease in public healthcare are usually given at a low-intensity dosage . However, an intensive therapy approach is needed in order for individuals with Parkinson’s to make gains and improve their voice.;
LSVT LOUD is considered the gold standard in the treatment of Parkinson’s voice. It focuses;on increasing vocal loudness to normal levels. Therapy is delivered in an intensive, high-effort manner.;LSVT LOUD consists of 4 one-hour sessions per week for 4 weeks .;;Find out more about the benefits of LSVT; by watching the video below.;
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How Are Swallowing Problems Treated
The first step to addressing swallowing issues is to speak to a neurologist about getting an evaluation performed by a SLP. This professional will take a medical history and interview the person with PD about eating and swallowing.
This is typically followed by either a video X-ray or an endoscopic examination, so the medical specialist can observe the swallowing process as an individual sips liquid and eats food, as these substances flow from the mouth, down the throat and esophagus, to the stomach. With these tests it is possible to see where the trouble is occurring and to recommend therapies.
Follow the recommendations of the swallowing specialist, which may include the following:
- Exercise and Swallow Hard.;Just as exercise can ease other PD-related movement difficulties, it can also help with swallowing. The Lee Silverman Voice Technique® helps a person exaggerate speaking and swallowing. Working with an SLP on an individualized program helps the person to swallow hard and move food from the mouth down the throat.
- Expiratory Muscle Strength Training.;This therapy strengthens respiratory muscles, improves cough and swallowing and reduces aspiration.
- Change in food.;Modifying liquids and solids can help. For people who find liquids get into the airway, liquids may need thickening. Taking bigger or smaller bites or sips or pureeing solid foods may help. First get an evaluation, so the SLP can recommend how to modify food and liquid.
Symptoms Of Parkinsons Disease
Parkinson’s Disease has associated speech and swallowing difficulties.;
SPEECH: The name for the type of speech problem associated with Parkinsons disease is dysarthria. Dysarthria is a general term that refers to an entire group of speech disorders which result from impaired muscular control of speech production.;
VOICE: Loss of volume in voice can affect patient’s with Parkinson’s. Overall loss of voice volume can be one of the first symptoms of hypokinetic dysarthria. The physiologic basis for decreased ability to speak at an acceptable level of loudness is rigidity and/or stiffness of muscles of breathing, since exhaled air is the power behind our voice. Stiffness in the breathing muscles also impairs voice volume, as these muscles normally are elastic and therefore can move with variable force and speed
SWALLOWING;difficulties are also associated with PD. Because the disease may disrupt the normal sensations in the throat, some patients with Parkinson’s;may not be aware if food or liquid goes down the wrong way or gets stuck in the throat.
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Speaking Tasks And Speech Time Composition
Figure 6 shows the mean composition of the utterance for the two different speaking tasks in PD and HC speakers.
Figure 6. Mean speech time composition in PD and HC productions . PD, Parkinson’s disease; HC, healthy control.
As the graph in the figure shows, no significant differences were observed between the two groups of speakers in terms of speech time composition. In the reading task, percentages are very similar in PD and HC; in the case of monologs, PD productions are characterized by a slightly higher percentage of silence and of disfluency .
As expected, the most evident result is related to the effect of the speaking task on the composition of the utterance: the mean increase of the percentage of disfluency in the monologs of both groups of speakers in comparison with the reading tasks and the subsequent reduction of the fluent speech percentage.
Support Groups And Networking
There are many different types of support groups. But they can broadly be defined as a group of people who have something in common – in this context Parkinsons – who meet to discuss and exchange ideas and information, or voice concerns. The group may also include partners, family and/or carers.
Each group will be individual with varying activities, meeting places, opportunities and capabilities. Sometimes there is a trained leader, such as a counsellor or social worker, although many Parkinsons groups are run by people with the condition as well as experienced volunteers. Groups often meet once a month, but many meet more regularly.
Most members find participating in a group supportive and a good way to interact with others in a similar position. Many Parkinsons organisations have support groups. To find out about how groups operate in your own country contact your national Parkinsons association.
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