Does Parkinson’s Affect Your Voice

Carry A Pen And Paper

If you do end up feeling fatigued or are having difficulty communicating verbally, use a pen and paper to write down what you want to say.

Its not the most efficient method of communication, of course. But, its better than getting frustrated or overwhelmed because youre not able to say what you want to say.

You dont need to use the pen and paper the whole time, either. Sometimes, people just need to take a short break from speaking and write for a few minutes before they jump back in.

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.

Essay About Parkinsons Disease

language, called Wernickes aphasia. Cerebral palsy is a broad term for brain damage sustained close to birth that permanently affects motor function. The damage may take place either in the developing fetus, during birth, or just after birth and is the result of the faulty development or breaking down of motor pathways. Cerebral palsy is non-progressive that is, it does not worsen with time. During childhood development, the brain is particularly susceptible to damage because of the rapid growth

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What Does Parkinsons Do To The Brain

Deep down in your , theres an area called the substantia nigra, which is in the basal ganglia. Some of its cells make , a chemical that carries messages around your . When you need to scratch an or kick a ball, dopamine quickly carries a message to the nerve cell that controls that movement.

When that system is working well, your body moves smoothly and evenly. But when you have Parkinsons, the cells of your substantia nigra start to die. Theres no replacing them, so your dopamine levels drop and you cant fire off as many messages to control smooth body movements.

Early on, you wont notice anything different. But as more and more cells die, you reach a tipping point where you start to have symptoms.

That may not be until 80% of the cells are gone, which is why you can have Parkinsons for quite a while before you realize it.

Experimental Conditions Across Studies

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So What Do We Know So Far

Location of the substantia nigra. CC BY-SA 4.0

The substantia nigra is an area of the mid brain located at the top of the spinal cord, which has been the focus of much work into how Parkinsons affects the brain.

There are a right and a left substantia nigra, and often one side is affected before the other. Because of this, people with Parkinsons often experience symptoms primarily on one side of their body, particularly in the early stages. Indeed, this common feature of the condition often helps to distinguish Parkinsons from other similar conditions.

When it comes to confirming a diagnosis, it is the substantia nigra where pathologists look for changes at the end of life in brain tissue that has been donated to research. And the loss of the dopamine-producing cells in this area of the brain, accompanied by the presence of clumps of alpha-synuclein protein , has been the hallmark of Parkinsons for decades.

You can read more about the alpha-synuclein protein, and how it plays a role in the spread of Parkinsons, in a previous blog post:

What Is Parkinson Disease

Parkinson disease is a movement disorder. It can cause the muscles to tighten and become rigid This makes it hard to walk and do other daily activities. People with Parkinsons disease also have tremors and may develop cognitive problems, including memory loss and dementia.

Parkinson disease is most common in people who are older than 50. The average age at which it occurs is 60. But some younger people may also get Parkinson disease. When it affects someone younger than age 50, its called early-onset Parkinson disease. You may be more likely to get early-onset Parkinson disease if someone in your family has it. The older you are, the greater your risk of developing Parkinson disease. Its also much more common in men than in women.

Parkinson disease is a chronic and progressive disease. It doesnt go away and continues to get worse over time.

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Recognizing Signs Of Parkinsons Disease

Parkinsons disease causes several specific movement-related symptoms. These are called motor symptoms. Motor symptoms affect everyday tasks like buttoning clothing or writing. Motor symptoms can also affect the way you walk.

• Progression of symptoms over time

• Response to treatment

Your doctor may order brain scans or blood tests to rule out other conditions with similar symptoms.

Treatments

The Effects Of Parkinsons Disease

* Memories: Brain stores short-term memories of the experience in a part of the brain called the hippocampus, then those memories are later consolidated and transferred to another part of the brain, more precisely in neocortex, for a long-term storage Memory cells are placed in three parts of the brain, the hippocampus, the prefrontal cortex, and also the basolateral amygdala, which is responsible of emotional associations. In fact these cells are necessary to evoke the emotions linked with

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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.

Treatment Programs: Speak Out And The Loud Crowd

• The SPEAK OUT!® program typically consists of 12 speech therapy sessions combined with daily home practice. Together with a student speech-language pathology clinician , you will complete speech, voice and cognitive exercises using a workbook provided by the Parkinson Voice Project. SPEAK OUT!® emphasizes speaking with intent to convert speech from an automatic function to an intentional act. Upon completion of the SPEAK OUT!® program, you will transition to the LOUD Crowd® program.
• The LOUD Crowd® program provides accountability and education through weekly group sessions where SPEAK OUT!® exercises are performed and participants continue to practice speaking with intent. This maintenance program is ongoing and promotes camaraderie, providing an atmosphere of support and encouragement.

Refresher courses are also a part of these programs. Six weeks following conclusion of the SPEAK OUT!® program, you will meet with your student speech-language pathology clinician to review your exercises and receive assistance with establishing a daily home practice . You will also discuss your transition to the LOUD Crowd® program to ensure your success.

Continued evaluation – Six months after completing the SPEAK OUT® program , you will meet with the Parkinson’s Voice Clinic student clinicians and supervising speech-language pathologist to evaluate your continued progress. If needed, you will have the opportunity to engage in speech therapy sessions.

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Other Vocal Symptoms Of Parkinsons

PD symptoms can also affect your mouth in other ways other than how you speak. For instance, people with the condition may notice changes in or difficulty swallowing, eating, or drinking.

These symptoms can show up at any time, but as with other vocal symptoms of Parkinsons they tend to increase as PD worsens.

Because PD affects movements in other parts of your body, it may also affect the muscles in your face, mouth, and throat, which you use in eating or drinking.

The author of the 2009 study notes that between 40 to 95 percent of people with Parkinsons have dysphagia or problems swallowing certain foods or liquids. One sign of dysphagia is coughing or choking when eating or drinking.

Moreover, hyposmia, or reduced sense of smell, is also often an early sign of PD. Although not all people with reduced sense of smell will go on to develop the condition, most people with Parkinsons experience some loss of their sense of smell.

Hyposmia is an under-recognized symptom. Its not always a common concern that doctors ask about or patients report. However, reduced sense of smell might impact your appetite, ultimately affecting your ability to consume adequate nutrition and hydration.

Stooping Or Hunching Over

Are you not standing up as straight as you used to? If you or your family or friends notice that you seem to be stooping, leaning or slouching when you stand, it could be a sign of Parkinson’s disease .

What is normal?If you have pain from an injury or if you are sick, it might cause you to stand crookedly. Also, a problem with your bones can make you hunch over.

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Voice And Swallowing Impact From Neurologic Disorders Treatment

If your symptoms are mainly voice related, your treatment team will recommend treatments aimed at improving your vocal quality, projection and effort required to speak:

• Spasmodic dysphonia and tremor can be treated in the office setting with botulinum toxin to chemically weaken the muscles that are abnormally firing. Our experts often use specialized electromyography EMG equipment to perform these vocal cord muscle injections. An EMG is used to measure the electrical activity of your vocal muscles.

• When appropriate, vocal fold atrophy or vocal cord immobility can be treated with in-office vocal fold injections designed to increase the volume of the vocal cords and help them come together better. This can also help make swallowing safer.

• Lee Silverman Voice Treatment is an evidence-based voice therapy program for Parkinsons disease.

If your problems are mainly swallowing related, your treatment team will discuss with you the treatment options available.

Johns Hopkins Division of Laryngology

We offer personalized and comprehensive treatment plans for patients with voice, swallowing, and complex airway disorders. You will benefit from laryngologists who have vast experience in treating these disorders and can provide patients top-notch care.

Treating Speech And Language Problems In Parkinsons Disease

Potential treatments for speech and language problems of PD include medication, behavioral therapies, and surgery. The most recent assessments of these therapies suggest, however, that surgery is not effective for speech problems, although it may improve some of the severe motor problems of PD. In addition, there are no medication therapies that are effective when used alone.

Treating the basic motor problems of PD optimally appears to be a prerequisite for improving speech problems. That is, if the PD motor problems are untreated, the speech problems do not respond well to behavioral treatments. PD medication is, therefore, necessary but not sufficient. In short, the optimal treatment strategy for speech and language problems of PD appears to be a combination of PD medication plus some form of behavioral speech therapy.

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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.

Trouble Moving Or Walking

Do you feel stiff in your body, arms or legs? Have others noticed that your arms dont swing like they used to when you walk? Sometimes stiffness goes away as you move. If it does not, it can be a sign of Parkinson’s disease. An early sign might be stiffness or pain in your shoulder or hips. People sometimes say their feet seem stuck to the floor.

What is normal?If you have injured your arm or shoulder, you may not be able to use it as well until it is healed, or another illness like arthritis might cause the same symptom.

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For The Person With Parkinsons Disease

It is a good idea to tape your speech using a tape-recorder. This will help to give you an idea of how your speech sounds.

• Try to talk more slowly and exaggerate your mouth movements

This will help to make your speech clearer and easier to understand.

• If asked to repeat, try to speak more slowly and emphasise key words in the sentence

This may make the message easier to understand

• Encourage the use of shorter sentences while speaking

Speaking in shorter sentences gives the person with Parkinsons disease a chance to take a breath between each sentence.

• Think Loud, Think Shout

If you imagine that you are speaking loud, this will automatically encourage you to sit with better posture, take deeper breaths, exaggerate your mouth movements, and generally make you easier to understand. It does not mean that you need to shout, you just need to imagine you are going to!

• Get into the habit of looking at one another while having a conversation

Watching the persons lips and face can greatly improve comprehension.

• Reduce background noise during conversation

Turn off the radio or TV, close doors to noisy areas, etc.

• Be aware that facial stiffness is a feature of Parkinsons disease

Avoid depending on facial expression to read the emotions felt by the individual with Parkinsons disease. Do not assume that the person does not understand what you have said as masked facial expression may be due to rigidity of facial muscles.

• Be patient. Try not to rush responses in conversation.

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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Are You Really Talking Too Loud Or Is Parkinsons Messin With Your Head

Behavioral speech therapy interventions for individuals with Parkinsons disease typically focus on increasing the amplitude of voice and speech production. Most patients typical response to an increase in loudness during the early weeks of therapy is almost always a statement like: this is too loud, I feel like Im screaming, this doesnt feel normal. The last comment, in particular, speaks to the fact that modifying or changing a habit and replacing it with another behavior, can at first be difficult. Lying down new motor patterns and re-wiring the brain requires lots of repetition and practice that focuses on the target behavior and desired outcome.

This doesnt feel normal

At the moment, I have a few patients that are finding the change in perception difficult. One, in particular, an engineer by background, asked today if he could hear himself. So, I audio recorded him while he performed some of his speech tasks, and near the end of his session another patient joined us and also provided feedback. When the engineer heard himself, he said: I sound normal, its not what I imagined in my mind. The patient who joined him affirmed that his voice sounded great, and went on to let him know when his voice dropped too soft.

Perception of the world, and perception of ourselves has a lot to do with what we believe at any given moment in time, as well as what our mind constructs from our sensory experiences.