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Parkinson Disease And Speech Problems

Speaking Tasks And Speech Time Composition

Parkinsons Disease – Speech and Swallowing Problems: Karen Kluin

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.

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.

What Are Signs Or Characteristics Of Trouble With Voicing:

  • Communication partners notice speech rate is very quick
  • Communication partners frequently ask for speaker to speak up or slow down
  • Social isolation
  • Feeling like you are straining to produce voice
  • Unpredictable clarity

*Communication difficulties related to masked face making it difficult for communication partners to interpret emotions or interest in topic so when voice difficulties are added on top of that, communication partners can become frustrated.

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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.

Speech And Language Therapy For Speech Problems In Parkinson’s Disease

Speech Problems &  Parkinsons Disease

Many people with Parkinson’s disease suffer from disorders of speech. The most frequently reported speech problems are weak, hoarse, nasal or monotonous voice, imprecise articulation, slow or fast speech, difficulty starting speech, impaired stress or rhythm, stuttering and tremor. People with the condition also tend to give fewer non-verbal cues, such as facial expressions and hand gestures. These disabilities tend to increase as the disease progresses and can lead to serious problems with communication.

This review compared the benefits of speech and language therapy versus placebo or no treatment for speech disorders in Parkinson’s disease. Relevant trials were identified by electronic searches of 16 medical literature databases, various registers of clinical trials and an examination of the reference lists of identified studies and other reviews.

Only randomised controlled trials were included in this review. These were studies where two groups of patients were compared, one group had speech and language therapy, the other did not receive any therapy intended to improve speech. The patients were assigned to each of the groups in a random fashion so as to reduce the potential for bias.

To compare the efficacy of speech and language therapy versus placebo or no intervention for speech and voice problems in patients with Parkinson’s disease.

Only randomised controlled trials of speech and language therapy versus placebo or no intervention were included.

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How Does Parkinsons Affect Speech

Up to 90% of people with Parkinsons have speech and voice disorders at some point during the course of the disease. Therefore, language in Parkinsons is affected. The most common symptoms include reduced voice intensity, monotonia, hoarseness, broken voice and imprecise articulation. The cause of these symptoms is not known exactly. Their origin may be related to the stiffness, slowness and poor range of motion characteristic of the disease.

These people may not be aware that their voice is becoming weaker and their speech increasingly unpredictable and more difficult to understand, having a language in Parkinsons more imprecise and indecipherable. All this has a negative impact on them and affects their communication at work, family and social environment.

Therefore, an evaluation of the symptoms by a speech therapist is necessary in order to start rehabilitation as soon as possible.

Speech And Voice Disorders In Parkinsons

There are several reasons people with PD have reduced loudness and a monotone, breathy voice. One reason is directly related to the disordered motor system that accompanies PD, including rigidity, slowness of movement and tremor. For example, the poor muscle activation that leads to bradykinesia and hypokinesia in the limbs can translate to the muscles involved in speech. These problems with muscle activation can result in reduced movements of the respiratory system , larynx and articulation .

Another cause of speech and voice impairment in PD is a change in sensory processing that is related to speech. It is believed that people with PD may not be aware that their speech is getting softer and more difficult to understand. When people in this situation are asked to bring their voice to normal loudness, they often feel as though they are shouting, even though they are perceived by listeners to be speaking normally

Another cause of this condition is that people with PD may have a problem with cueing themselves to produce speech with adequate loudness. Individuals with PD can respond to an external cue , but their ability to cue themselves internally to use a louder voice is impaired. These problems can be frustrating both for the person and for the family.

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Misconceptions About Speech Impairment In Parkinson’s Disease

Expert center for Parkinson’s disease, Neurological department, CHU Lille, Inserm UMR 1171, University of Lille, Lille, France

Correspondence to:

Aix Marseille University, CNRS, LPL, Aix-en-Provence, France

Correspondence to:

Expert center for Parkinson’s disease, Neurological department, CHU Lille, Inserm UMR 1171, University of Lille, Lille, France

Correspondence to:

Aix Marseille University, CNRS, LPL, Aix-en-Provence, France

Correspondence to:Relevant conflicts of interest/financial disclosures:

What Type Of Healthcare Professional Helps People With Speech Problems From Parkinsons Disease

Addressing Voice, Swallowing and Speech Changes in Parkinson’s Disease

If you have speech and voice problems, see a speech-language therapist. Your primary healthcare provider can help you find a therapist in your local area. Some speech-language pathologists have specialized training that focuses on training people with Parkinsons disease to amplify their voice. This is called the Lee Silverman Voice Treatment.

Speech-language therapists are specifically trained to diagnose and treat speech, language and swallowing disorders. If you have Parkinsons disease, a speech-language pathologist can help you:

  • Maintain as many communication skills as possible. Teach you techniques to conserve energy, including using nonverbal communication skills.
  • Introduce you to assistive devices and techniques to help improve your communication.
  • Recommend exercises to help you improve muscle strength and movements needed to improve your speech and communication options.

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Statistical Analysis Of Clinical And Speech Data

Independent samples t-test or chi-squared test was used to compare demographic data in PD and HC groups, as appropriate. A two-way repeated measures ANOVA was performed on the two dependent variables of speech analysis , considering the kind of speaking task as within-subject factor and the group as a between-subjects factor . Post-hoc pairwise comparisons were used to compare PD and HC data in each speaking task and speech features in the two speaking conditions within each group . The level of significance was set as p< 0.05. Cohen’s d value was calculated to assess the effect size of pairwise comparisons using pooled variance.

Moreover, bivariate correlations were performed to test the association between the subscores of the UPDRS III and speech data. Pearson’s correlation coefficients were computed considering a p-value < 0.05 as statistically significant. The analyses were performed with SPSS version 23 .

How Can I Maintain And Enhance My Speech

  • Choose an environment with reduced noise. It can be tiring to try to “talk over” the television or radio.
  • Speak slowly.
  • Be certain your listener can see your face. Look at the person while you are talking. A well-lit room enhances face-to-face conversation, increasing understanding.
  • Use short phrases. Say one or two words or syllables per breath.
  • Over-articulate your speech by prolonging the vowels and exaggerating the consonants.
  • Choose a comfortable posture and position that provide support during long and stressful conversations.
  • Be aware that exercises intended to strengthen weakening muscles may be counter-productive. Always ask your speech therapist which exercises are right for you.
  • Plan periods of vocal rest before planned conversations or phone calls. Know that fatigue significantly affects your speaking ability. Techniques that work in the morning may not work later in the day.
  • If you are soft spoken and your voice has become low, consider using an amplifier.
  • If some people have difficulty understanding you, the following strategies may help:
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    Quality Of The Evidence

    The methodological quality of the trials and the standard of the reporting was mixed, but Scott 1983 and Ramig 1995 were published before the CONSORT guidelines were published . The trials used insufficient numbers of patients to avoid making false positive or false negative conclusions and to reduce the possibility of selection bias. It can be argued that the primary outcome of interest in SLT trials should be improved intelligibility which was an outcome in all included trials.

    The trials included in this review used a variety of randomisation methods, but all omitted to report whether concealment of allocation had been achieved, leaving the risk of selection bias unclear or high in all cases. It is vital that eligibility criteria, including type and severity of PD as well as coexisting conditions, are stated so that the population treated during the trial is well defined. This enables treating physicians to assess the results of the trials for relevance to their patients.

    There is no difference between the prevalence of PD in men and that in women . Only 28% of the patients enrolled into the trials were female and so the trial groups were not truly representative of the general PD population.

    Social Impact Of Voice Problems

    Treating Symptoms of Parkinson

    Low-volume voice and other Parkinsons-related speech impairment can have a significant impact on members social lives. Has anyone else noticed that friends you have had for years no longer call or ask you to do anything? We never hear from people whom we thought were close friends. It is very isolating and hurtful. We wonder if it is because my husbands speech isnt very good, one MyParkinsonsTeam member shared.

    Another member added, When my facial expression is frozen and I cant turn my head and have trouble with speech, people think I am ignoring them.

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    The Effects Of Parkinsons On Speech

    Parkinsons disease is a nervous system disorder that slowly progresses over time. The first signs of the disease can be small, and unnoticeable at first. It may be a small tremor in your hand or a loss of expression in your face. As the disease progresses many of the people affected begin to notice an effect on their speech. Some may notice their voice gets softer and monotone, slower and slurred, and can have a hard time finding the words they want to say. The cause of this disease is usually genetic, but in some cases, it can occur because of exposure to certain toxins. The symptoms start to occur at an older age, usually when people are in their sixties.

    Overall Completeness And Applicability Of Evidence

    Outcome measures

    It can be argued that intelligibility is the most critical outcome to be measured in speech and language therapy trials. If this global measure does not improve then it is irrelevant to the patient how many other objective speech quality measures improve they still cannot be understood. All included trials assessed intelligibility and almost all results were not statistically significant. The exception to this was the perceptual ratings of speech recordings overlaid with babble noise for which LSVTLOUD gave a greater improvement than LSVTARTIC . The noninferiority of online delivery of LSVT was supported by the intelligibility results of Constantinescu 2011, who reported no statistically significant difference between the improvements in both acoustic and perceptual measures for this group and the facetoface delivery group.

    The prosodic abnormality score, which assesses volume, pitch, tone, intonation, vocal quality , rate and rhythm, does not appear to have been independently assessed for validity.

    Adverse events were not reported by any of the trials included in this review. Although the risk associated with speech and language therapy is low, patients could be affected by vocal strain or abuse during high effort exercises.

    Speech and language therapy methodology

    Speech and language therapy terminology

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    What Is Happening To The Body

    Parkinsons mainly affects a part of the brain called the substantia nigra pars compacta. In this part of the brain, neurons are producing dopamine, which transmits signals to other parts of the brain. When Parkinsons occurs these neurons are damaged which reduces the amount of dopamine produced. The decrease in dopamine is causing the movements to be slower and less smooth. These side effects are seen in the movement of the face and mouth muscles, which is how speech is produced.

    Risk Of Bias In Included Studies

    My Parkinson’s Story: Speech and Swallowing

    See Table 2 and Figure 2 for summary of the methodological quality of the trials. It is impossible to blind patients and treating therapists in trials comparing the efficacy of two types of speech and language therapy. This leaves such trials open to performance and attrition bias. Blinded assessors were used for all included trials, so detection bias is unlikely in these studies.

    Risk of bias summary: review authors’ judgements about each risk of bias item for each included study.

    Randomisation method and concealment of allocation

    Eligiblity criteria

    Patient numbers

    We found only six randomised controlled trials comparing two methods of speech and language therapy for speech disorders in a total of 159 Parkinson’s patients . With such a small number of patients examined, it is possible that there was bias in the selection of patients, therefore, the applicability of the data to the general population with PD is questionable. The lack of power due to the small number of patients also increases the risk of a false negative result.

    Similarity at baseline

    Description of speech and language therapy methods

    Drug therapy

    Data analysis

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    Effects On Speech And Voice

    There are three ways that Parkinsons Disease can affect speech: dysarthria, hypophonia, and tachyphemia. Dysarthria affects the muscles required for speech which can cause mumbling or slurring. Hypophonia, also brought on by weakened muscles, is characterized by a soft, abnormally weak voice. Tachyphemia is rapid, stammering speech, also known as cluttering. Knowing these three conditions and their effects can help you find your best methods of treatment following diagnosis.

    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.

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    Data Collection And Analysis

    The review authors independently assessed the studies identified by the search strategy. We resolved disagreements about inclusions by discussion.

    We contacted the authors of trials in the cases where further trial information was required for full analysis. We assessed full papers for methodological quality by recording the method of randomisation, concealment of allocation and blinding of assessors to treatment group, whether an intentiontotreat analysis was used and the number of patients lost to followup.

    Two review authors independently abstracted eligible data onto standardised forms, checked for accuracy and amalgamated the information. We resolved disagreements about inclusions by discussion.

    We combined the results of each trial using standard metaanalytic methods to estimate an overall effect for one type of speech and language therapy intervention versus another.

    var diff = var pre + var post 2r

    where var diff is the variance of the change score var pre is the variance of the baseline score var post is the variance of the final score and r is the correlation between the pre and post treatment scores. We assumed a correlation coefficient of 0.5, which is a conservative estimate, to reduce the chance of false positive results .


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