Speech Therapy for Parkinson's Disease

Dysarthria (difficulty speaking) and dysphagia (difficulty swallowing) can be severely limiting symptoms of Parkinson’s disease and can be helped by referral to a speech therapist. Until recently, traditional speech therapy had not provided sustained improvement. A new program called the Lee Silverman Voice Therapy Program has been developed, which has demonstrated significant value for patients with Parkinson’s disease. The patient should be referred to a speech therapist experienced in administering the Lee Silverman Voice Therapy Program.

Information tips for improving communication

As the muscles weaken in the voice box (larynx), throat (pharynx), roof of the mouth (soft palate) tongue, and lips, people with Parkinson’s disease might find it difficult to pronounce words clearly.

Some resulting speech impairments might be:

            Hoarse or strained voice

            Muffled or nasal-sounding voice

            Unclear or slurred speech

Speech-language therapists 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 therapists are also available to:

            Recommend appropriate communication techniques to provide treatment that will aid in the success of daily activities.

            Treat all types of speech, language, and communication problems.

            Evaluate swallowing function and recommend changes as necessary.

Tips to maintain and enhance communication

.    Choose an environment with reduced noise. It can be quite 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 intelligibility.

.    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 might be counter-productive. Always ask your speech-language 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 might not work later in the day.

.    If you are soft spoken and your voice has become low, consider using an amplifier.

.    If you are on a respirator (with fully inflated cuffs), an electrolarynx or respiratory tube that provides an alternative air source might be used.

.    If some people have difficulty understanding you, the following strategies might help:

                        If you are able to write without difficulty, always carry a paper and pen as a backup so you can write down what you are trying to say.

                        If writing is difficult, use an alphabet board to point or scan to the first letter of the words that are spoken.

                        Spell words out loud or on an alphabet board if they are not understood.

                        Establish the topic before speaking.

                        Use telegraphic speech. Leave out unnecessary words to communicate the meaning of the topic.

Non-verbal communication

            Non-verbal communication, also called augmentative and alternative communication (AAC), is a method of communicating without spoken words. When communication needs cannot be met through speech, the following techniques can be practiced by people with Parkinson’s disease:

            Residual speech (making the best use out of what speaking ability is left)

            Effective use of expressions and gestures

            Non-verbal communication can help people with speech difficulties actually speak better by:

            Reducing the frustration and stress of being unable to communicate

            Alleviating the pressure to speak

            Allowing the person to be more relaxed and come across in a more intelligible manner

Assistive devices

Here’s a sample of the assistive devices that are available to help people with Parkinson’s disease communicate more clearly.

Palatal lift

This is a dental apparatus that is similar to a retainer. It lifts the soft palate and stops air from escaping out of the nose during speech.

Amplification

This is a personal 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 can be typed.

Low-technology devices

Notebooks and language boards can be used as alternative communication techniques.

High-technology electronic speech enhancers, communication devices

Computers with voice synthesizers and dedicated communication devices are available.

Patients who are interested in purchasing electronic communication aids should discuss this with a speech-language therapist before contacting sales representatives for these devices.