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Sunday, May 7, 2017

Parkinson’s can cause speech problems, but therapy can help


Elizabeth Campbell

Each year during May, speech-language pathologists and audiologists raise awareness about people with communication disorders and ways to improve their quality of life. This includes people with a variety of communication challenges that can affect speech, language, voice, hearing and problem solving. Communication may seem automatic, but for people with communication disorders, it can require extra assistance and hard work.
One condition that can result in a communication disorder is Parkinson’s disease. The Parkinson’s Disease Foundation estimates that 1 million Americans are affected by Parkinson’s. Parkinson’s disease is a disorder of the brain that causes damage to specific nerve cells. This results in tremors, muscle weakness, stiff muscles, balance problems and difficulty walking. Parkinson’s is a progressive illness, meaning these impairments worsen as the disease advances. 
Throughout the course of the illness, Parkinson’s disease can affect a person’s speech. For these patients, this includes a low speaking volume (hypophonia), hoarseness, monotone voice quality and unclear words (imprecise articulation). Patients also have difficulty coordinating their breathing and speaking. These changes can interfere with communication. Imagine if others asked you to repeat yourself in a conversation, could not hear you on the phone, or described your voice as monotone. Furthermore, imagine you are unable to monitor your own loudness. You would probably feel frustrated. These common problems for patients with Parkinson’s make it difficult for them to improve their speech without assistance.
Fortunately, there are treatments that can help. One is called Lee Silverman Voice Therapy: LSVT LOUD. This program uses loud speech tasks to strengthen motor systems used for speech, with the goal of improving a patient’s ability to communicate. It follows a series of exercises that emphasize “thinking loud” by using healthy vocal loudness, not shouting or yelling. 
Research shows that it helps patients speak more loudly, with more natural intonation, and with a clearer voice. This program helps patients improve their awareness of their volume by stimulating the sensory and motor systems. With louder and clearer speech, patients often become more confident in their communication. This improves the quality of life for the patient and the people they communicate with.
Researchers have studied LSVT LOUD therapy for over 20 years. Treatment is intensive and involves four sessions a week for four weeks; this is required for the brain to develop a better process for louder speech. Patients who are interested in improving their Parkinson’s-related speech changes will need an evaluation with an otolaryngologist (ear, nose, and throat doctor) to assess the voice box (larynx), as well as an evaluation with a speech-language pathologist who specializes in voice disorders.
If LSVT LOUD therapy is recommended, patients should look for speech-language pathologists with an LSVT LOUD certification, as there is specific training that clinicians must complete before using this program.
Elizabeth Campbell is a speech-language pathologist at the University of Kentucky Voice and Swallow Clinic in Lexington.

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