6 tips for improving speech in Parkinson’s

PD in Practice

Author: Mary SpremulliPublished: 23 May 2019

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Speech therapy

Mary Spremulli runs a speech-language pathology private practice in Florida, US, specialising in the treatment of adults with voice, speech, and swallowing problems associated with Parkinson’s disease. Here, she lists her six top tips for healthcare professionals working with people living with the condition

1. Listen out for ‘low volume’

The most typical speech and voice problems in people living with Parkinson’s are low volume (hypophonia) and ‘word finding problems’ (cognitive-linguistic decline).

With hypophonia, there may also be a change in perception. The voice has become softer, but to the individual it still feels normal, and a request to be louder is often met with resistance or a comment such as “that feels like I’m shouting.”

Patients with cognitive-linguistic decline can experience word finding problems, reduced attention and concentration, and reduced memory. If you combine these problems with soft voice, conversational speech becomes a real challenge, and many people may start to withdraw from social interactions.

Some people also experience a change in speech rate – particularly in post-DBS patients –it’s what I refer to as “run-away speech,” meaning, despite what the individual tries to do, it feels impossible for them to slow down their rate.

2. Speech therapy is not a “one size fits all” solution

Clinicians need to be familiar with current scientific evidence and treatment recommendations for specific problems, but they also need to regard patient preferences, values and beliefs in treatment planning. A patient may have no interest in going to Tai Chi, for example, which can help with balance. They may express an interest in bowling instead – this can also help with balance issues

In planning treatment consider the type of support someone has at home. Patients may self-limit their sessions because of cost, so giving the most effective treatment in the least number of visits is important. Home-based practice is always a large component of treatment.

3. Don’t give up on ‘challenging’ patients

Some “challenging” patients are those who are experiencing a more rapid decline due to the nature of their disease. When providing treatment and home programmes, it can feel as if you are trying to stay two steps ahead of the disease. Swallowing decline for some patients is often a big issue, and eventually the benefits and/or risks of feeding tubes must be discussed.

Others “challenging” patients are those who experience a decline in muscle function and may have lost the normal drive to eat. In these cases therapy has to be somewhat aggressive, while at the same time, cautious so as not to compromise safety.

4. Group classes can improve outcomes

If an individual stops home practice, it’s likely they will experience a de-training effect and a gradual voice decline. Remember, voice changes don’t happen because someone is being lazy, or just not trying hard enough – they come about because of the disease in the background changing the way muscles are working. So, to some extent, if someone hopes to retain improvements made in speech and physical therapy, they need to continue some level of home practice for the duration. Group classes and after-therapy programmes can be a tremendous asset in this regard as they provide a light-hearted atmosphere.

5. Sometimes, it’s psychological

Some issues that people with Parkinson’s face, when struggling to speak, be heard and understood are psychological. The comments I hear most often from patients is that they are “starting to withdraw”, or “people are passing me by.” Conversational speech is fast, and full of interruptions and distractions. If thinking has become a little slower, processing what other people say will be a little slower. With these changes people may just make the decision, consciously or unconsciously, to speak less. I think the real loss in these situations is for other family members. It is really such an important part of our human connection.

6. Embrace tech to empower patients

Apps and devices can give individuals more control over the choice of therapy plans.  There are already apps available for home practice such as Speak Up For Parkinson’s, for improving loudness or for normalising speech rate. There are also speech aid devices such as Speech Vive and Speech Easy. I offer some online coaching using the internet, and it is really a great way to deliver some speech and voice treatment. Even some of my 80-year-old patients have computers and smart phones, so the possibilities are almost limitless. As long as people realise that the technology and the devices are just the mode of delivery, and hopefully, they will never replace the human interaction between patient and therapist.

Mary and Frank Spremulli

Mary (left) with her father, who, despite his PD, was Mayor for 42 years

Learn more by visiting Mary’s website.

This article was originally published in 2016

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  • mary spremulli

    Imagine my surprise to come home from a long (hot) day of work and see my comments included in the wonderful Parkinson’s Life newsletter. Thank you @parkinson’s_life I am honored to share in your great newsletter.

  • Berniece Bradford Kovac

    Mary, my aunt was diagnosed with Parkinson’s about 12 years ago. However in the last year her new neurologist has stated that he really thinks she has Lewey Body Disease. Add to that she has Macular Degeneration and is practically blind. She recently lost her ability to communicate because of lack of volume and inability to form a sentence. The words come out wrong or don’t come out at all. She is currently at the Palliative Care stage but the Therapists keep saying that they can’t help her anymore. I just want to keep her talking when possible. Do you have any recommendations on where to find material that I can learn so I can help her? Thank you.

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  • Five Point Oh

    Pretty sure the thousands of dollars you spent on drugs for Parkinsons you ended up spending on medicinal herbs that are not cheap either. Repeatedly calling it a deadly disease is incorrect, you die with Parkinsons and there is no cure.
    Stop with the fake cures and lies. People don’t need that.

    • carolyn wise

      have you done research?? there are people out there that have “healed” themselves of ALL symptoms….NOT wackos but REAL educated reliable people! so don’t poo poo this person for posting something that worked for them….sometimes ALTERNATIVE medicine is the way too go!!! 🙂

      • Jules

        I agree, I did some research and my Grandpa who has Parkinson’s started taking alternative medicine for his PD due to the fact that many PD patients find they can’t take PD prescription meds for the dangerous side effects that can occur. Along with some simple herbal supplements and therapies he has had major improvements. Inflammation in the body is a huge contributor to PD and eating an anti-inflammatory diet along with certain herbal supplements and essential oils has really helped my Grandpa. That is just one part of what he does, physical exercise including vocal exercises are hugely important too. Don’t be afraid to get second opinions of various Dr.’s, and other health professionals. You are your own health advocate and I hate to say it but many Dr.’s out there are making money off pharmaceuticals and they would rather treat symptoms instead of the underline cause of something and won’t advise other therapies(alt. Med, P.T., O.T., etc.) and that is not ok.

  • ron

    My friend was diagnosed with PD(Parkinson’s Disease) in the summer of 2012. Her initial symptoms were quite noticeable. She first experienced weakness in her right arm and her speech and swallowing abilities were profoundly affected. She did so much to seek help for this disease, as she had been her brother’s caregiver a few years earlier for the same disease. Early this year she started on organic/natural PD treatment from Best Health Herbal Centre (ww w. besthealthherbalcentre. co m). The treatment worked very effectively and all her symptoms simply disappeared completely after seven weeks of usage.

  • Manas Wilson

    There is no man that cures Parkinson disease as Doctor Bude does. i am 51 yrs old and was diagnosed of Parkinson Disease in my 40’s, i suffered the disease and it chronic symptoms for more than 6 years until 3 years ago when i came in contact with some comments about natural herbs that helps cure Parkinson disease. i tried to get it but failed because i mistake the doctors contact for another and couldn’t get in touch with him for assistance, after about few days i was able to correct it to ( dr.bude100@gmail.com ) and i talked with him for some days and he prepared me some natural herbs medicines which he sent to me and advised me to use them daily for weeks. i did use them as instructed, i remember one of the medicine was bitter tasting and i still had to manage talking them on because i wanted to totally kill Parkinson out of my body. I am proud of my courage to use that herbs medicine and so happy that it changed my life forever. I have been feeling okay since i took that medicines and till now i no longer feel the tremor, stiffness and other symptoms i used to get. I have been examined medically and the doctors here say i have been cured from Parkinson. finally I did it. and i think you can survive the disease as well. check through his website https://drbude.wixsite.com/herbalremedies or email dr.bude100@gmail.com and whatsapp phone number +2348160881495

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