Parkinson’s Disease and How Speech Rehabilitation Can Help

What is Parkinson’s Disease?

Parkinson’s Disease (PD) is a common movement disorder that affects approximately one million Americans. It is a neurological condition that typically progresses slowly and may worsen over time.

One of the earliest and most widely occurring signs of Parkinson’s is a tremor, along with stiffness and balance issues. Additionally, speech, swallowing and cognitive problems can be present as the disease progresses which can have a significant impact on daily life.

Does Parkinson's Disease affect speech?

For those living with PD, an overwhelming majority experience an impact on their speech and swallowing abilities.

Speech

Research shows that at least 89 percent of patients with PD develop speech or swallowing problems. This results in difficulty with:

• articulation: producing sounds imprecisely, resulting in slurred sounding speech
• voice: reduced loudness, monotone and hoarse, breathy vocal quality
• rate: increased, decreased or variable rates of speaking

Swallowing

Many of the muscles that are used for speech also play a role in the eating process. More than 80 percent of patients with PD develop problems with feeding or swallowing over the course of their disease. This is known as dysphagia, which can:

• reduce quality of life
• complicate medication intake
• lead to malnutrition and/or aspiration pneumonia, the major cause of death in PD

Mild cognitive impairment

Some individuals with PD may experience mild cognitive impairment. This may result in difficulty focusing, making it harder to divide attention during a group conversation. It may also lead to memory issues and trouble finding the right words.

How speech therapy for Parkinson's can help

Speech language pathologists (SLP) are specially trained and certified rehabilitation professionals. For individuals with PD, an SLP can evaluate and treat a number of conditions that arise with PD, including:

• communication deficits
• dysphagia (feeding/swallowing)
• saliva control
• cognitive impairments at all stages of the disease

Therapy in the early stages can make a big difference on improving or maintaining current function. Working with an SLP can help patients continue to be independent in their daily living and enjoy their regular activities. Therapy at the later stages may focus more on ways to make up for functional deficits as the disease progresses.  Some patients may benefit from the use of personal amplification for making the voice louder. Others may need what is known as augmentative communication (AAC). That is using alternative methods for supplementing or replacing natural speech such as a speech generating device.  

Rehabilitation for speech and swallowing

Research has shown there are benefits for PD patients who take part in high intensity exercise. This is true for the muscles involved in speech and swallowing as well.

There are a few evidence-based rehabilitative treatment methods that have proven effective. Working with a speech language pathologist, patients may choose from:

• Lee Silverman Voice Treatment (LSVT) LOUD focuses on the concept of sensory re-calibration and using a loud voice. PD affects the sensory system, so it takes more effort to use a strong clear voice. Patients may often feel as if they are shouting if they are using a "normal" volume. Treatment in this program consists of a total of 16 sessions (four sessions per week for four weeks). Each session is 60 minutes long. There is also a home component to the program as well, which is performed once daily on treatment days, and twice a day on non-treatment days.
• Maximum Performance Therapy is similar to LSVT LOUD with exception to frequency and duration. Treatment is twice per week, over a course of eight weeks. Again, a home program is completed once a day on treatment days, and twice a day on non-treatment days.
• SPEAK OUT! focuses on the concept of intent. SPEAK OUT! strengthens the muscles used for speaking and swallowing. It places emphasis on speaking with intent and converting speech from an automatic function to an intentional act. In therapy, you and your clinician work through a series of speech, voice, and cognitive exercises outlined in the free SPEAK OUT! Workbook. Treatment consists of a total of 12 sessions (three sessions per week for four weeks). Each session is 45 minutes long. There is a home program as well that requires daily practice.

All treatment options require intense effort and ongoing practice during treatment as well as after. A therapist will also recommend periodic "tune-up" therapy sessions to maintain the strong clear voice and participation in maintenance groups.

Cognitive therapy for Parkinson's disease

A speech language pathologist trained in cognitive therapy can help address the communication breakdown that can result from PD. The goal of treatment is to identify strengths and strategies that may improve functional performance. These may include:

• memory retraining strategies
• self-cueing strategies to increase speed and accuracy of word retrieval
• organization strategies

There are several communication deficits associated with PD. In addition to speaking issues, individuals with PD can also experience comprehension deficiencies. These may include:

• syntactic comprehension (grammar/word order)
• emotion recognition
• pragmatic comprehension (recognition of speaker meaning)

Recommendations for caregivers and family

Cognitive therapy may help by modifying the way caretakers communicate with a patient. Recommendations for caregivers, family and physicians include:

• Avoid complicated sentences. Do not use embedded clauses such as, “My car, which is very old, is in the shop." Sentences should be kept short when possible and pauses should be incorporated when long sentences are required.
• Avoid taxing word memory. Chunk information into smaller units whenever possible and wait for acknowledgment before proceeding. For example, phone numbers are not typically remembered in a long string of numbers, but rather 123-456-7890.
• Clearly specify topics. Conversations should be structured to thoroughly discuss a single subject in a compartmentalized manner before shifting to a new and unrelated topic.
• Avoid reliance on emotional expressions. Do not rely on facial expressions to display emotions. Individuals with PD may have trouble recognizing emotional expressions such as a smile or a frown.
• Avoid using phrases with non-literal meaning. For instance, saying “she hit the sheets” instead of she went to bed can be confusing for the patient.
• Minimize distractions and background noise. A speaker should be oriented to face the listener. This will also help with understanding speech that may be impaired.

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