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Thursday, June 22, 2017

Building stronger voices: UMass offers Parkinson’s patients help to be heard

Staff Writer

June 22, 2017
Doug Adler opens his mouth as wide as he can and out booms his voice, “Ahhhhhhhhhh,” smooth and low like an a cappella baritone.
He is a slender man, 68, with perfect pitch, but he isn’t in a recital hall, he is a Parkinson’s patient strengthening his vocal cords in a classroom at the University of Massachusetts, Amherst.
“Think about projecting your voice over to that corner,” says speech pathology graduate student Ashley Higgins, 22. She points to a spot in the classroom more than 10 feet away.
He lets out another, “Ahhhhhhhh.” 

Adler, a retired fundraiser who lives alone in Belchertown, came here because his voice was getting softer, a change that came on gradually. At first he thought that the changes were age related, but then his sister struggled to understand him over the telephone and friends became confused when he answered phone calls, thinking that his weakened voice was a monotone answering machine.
Then, two years ago, he was diagnosed with Parkinson’s disease, a neurological disease that impacts the muscles, and he learned that his struggles with speech were likely related.
“Your voice is something that you take for granted all your life and when you start losing it, you realize what a precious gift it is,” he says as his eyes fill with tears after a recent voice training session.
There is no cure for Parkinson’s and the disease tends to get worse over time, often marked by hand tremors and a shuffling gait. Communication problems are frequently overlooked by doctors but have a devastating impact on a patient’s quality of life, says Lisa Sommers, clinical assistant professor and clinic director of the Center for Language, Speech and Hearing at UMass.
“We are really trying to get this on the radar screen,” she says.
That’s why, three years ago, she organized a five-week course that pairs speech therapy graduate students with Parkinson’s patients, like Adler.
The class is both to train future clinicians, but it is also a preventative measure for people early in the disease. Like most college courses, it requires readings and presentations by the students, but they also work one-on-one with patients — in Adler’s group there were 10. The Massachusetts chapter of The American Parkinson Disease Association provides funding for it.
Gradual decline
The patients learn about the anatomy of voice and practice vocal exercises that they can do at home. They also learn about the physiology of breathing.
“It is a use it or lose it scenario,” Sommers says. “You really need to stay engaged.” She is standing at the front of the room watching Adler work with Higgins.
Higgins is facing Adler as he inhales deeply, his belly expands, and he lets out another “Ahhhhhhh.” This time Higgins waves her finger in front of him like a conductor signaling for him to raise and lower his pitch. Like a coach, she pushes him to keep going.
When he is done, she flashes him a wide grin and says, “Killing it, awesome job.”
Like any muscles, the vocal folds in the throat can be exercised. As Adler’s pitch changes, his vocal cords become longer and shorter. Air is pushed through, creating the vibration which makes sound. 
The lengthening and shortening of the vocal cords is how inflection naturally occurs in speech to convey meaning, like sarcasm or a question. In Parkinson’s patients, this ability can diminish. The vocal cords also often don’t come together as firmly or as rapidly, so the voice takes on a muted, monotone sound. Breathing even becomes shallow, so air pressure in the vocal cords decreases and voices become quieter. This happens so gradually, that patients often don’t notice until they are severely impaired, Sommers says. 
“They appear soft and mumbled, unenthused with what they are talking about – when in reality they are none of those things.” she says, “They are impaired in their verbal communication. ...This is the story of Parkinson’s – how slowly things creep up on people.”
About 90 percent of people with the Parkinson’s will have some decline in their ability to communicate, says Sommers. If there is no intervention with speech therapy, some patients will lose all ability to be understood, she says, which makes of this symptom crucial, she says.
Singing again
Adler doesn’t remember exactly when changes in his voice first appeared, because, he says, he didn’t pay much attention to them. As the years went by, his voice would tire easily and became raspier. He always tried to make light of it and didn’t realize that he could have a debilitating problem.
“I would joke about it saying I never would have made it as a politician because I can’t speak that long,” he says.
But after his Parkinson’s diagnosis, he realized it was no joke. Still, he didn’t think there was anything he could do to prevent the deterioration of his voice until someone in his Parkinson’s support group in Greenfield told him about the program at UMass.
“There is a lot of support if you reach out for it,” he says. “It is important to be engaged and take some ownership and responsibility for your health.”
He clears his throat and then takes a sip of water before he projects another, “Ahhhhh” across the room. 
He is just finishing up the program, but he plans to continue with the voice exercises at home. He says he still has a long way to go, but simply being more aware of his voice has made a difference. On a recent Sunday he worked up the courage to sing in church again. Friends and family have noticed his voice is stronger and has more inflection.
At the end of the course, Sommers and the students planned to sit with each patient to work out a plan to continue with voice training. She says she will recommend that all of the 10 patients in this year’s program go on to have regular speech therapy with a clinician.
“I feel like the people who leave this group, leave with a lot of great information. This is going to help their outcome.” 
Lisa Spear can be reached at
How to connect
The cost is $250 for 10 1½-hour sessions, Tuesdays and Thursdays, 4 to 5:30 p.m., beginning each May at the Center for Language, Speech and Hearing at 358 North Pleasant St., Amherst.

The building has its own parking area and is handicap accessible. Space is limited to 10 and there are typically some scholarships available. To register, call 545-4010.

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