Monday, December 4, 2023

Speech Problems In Parkinson’s Disease

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Parkinson Voice Projects Speech And Swallowing Therapy Program Goes Global

New program to help Parkinsonâs patients with speech problems | Nine News Australia

Speech disorders are also common in Parkinsons, affecting up to 90% of patients. Collectively known as hypokinetic dysarthria, these deficits include low speech volume, hoarseness, pronunciation difficulties, monotone pitch, and variable speech speed.

Studies suggest speech problems and FOG may share underlying disease-related mechanisms, and that voice impairment during an on-state may indicate a vulnerability to FOG.

Researchers with Chongqing Medical University in China compared the voice characteristics of Parkinsons patients experiencing FOG to those without FOG during an on-state to determine whether speech impairment can identify those susceptible to FOG.

We hypothesized that PD-FOG would manifest greater voice impairment severity than PD-nFOG ON state voice features, and may help to distinguish between these patient groups, the team wrote.

The study enrolled 40 adults with Parkinsons, ages 50 to 75, diagnosed with FOG based on a questionnaire and a motor test. All were considered dopamine-responsive because their FOG occurred mainly during an off state.

A group of 40 age-, sex-, and disease duration-matched Parkinsons patients without FOG were also recruited, as well as 40 age- and sex-matched healthy controls without speech impairments. Researchers conducted clinical and speech assessments one to two hours after patients received their dopamine-based medications.

What Emergency Type Devices Should A Person With Parkinsons Disease With Speech And Voice Problems Have At Hand

To preparing for emergencies:

  • Use an intercom system or baby monitor to alert others that there is an emergency.
  • Use bells or buzzers if you are not able to speak. Use “codes” that signify urgency. For example, a tinkling bell might mean, “I’d like company,” while an air horn might mean there’s an emergency.
  • Carry a cell phone that is equipped with pre-programmed numbers. Preprogram all of your telephones so they can automatically dial the necessary emergency number.
  • Sign up for a “Life Call” button service if you spend time alone. Pressing a button on a device usually worn on the wrist or around neck signals a service company that alerts loved ones and/or your local emergency service.

How Is Sleep Apnea Treated

A continuous positive airway pressure machine, a machine that blows air into your airway at a pressure that is sufficient to keep the airway open during sleep, is the most consistently effective treatment for obstructive sleep apnea. The CPAP machine is connected by a tube to a face mask worn when sleeping through the night. It controls pressure in ones throat to prevent the walls of the throat from collapsing, creating better sleep quality. CPAP should be worn for the entire night and for naps.

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Criteria For Considering Studies For This Review

Types of studies

We considered all randomised controlled trials comparing two types of speech and language therapy for inclusion in the study. We accepted both random and quasirandom methods of allocation.

Types of participants

  • Patients with a diagnosis of PD
  • Any duration of PD

One speech and language therapy technique versus a second.

Types of outcome measures

1. Speech and voice production parameters . Total impairments . Objective and subjective acoustic measures of speech samples . Measures of laryngeal activity . Level of communication participation. 2. Activities of daily living communication subsection ). 3. Handicap and quality of life measures, both diseasespecific and generic . 4. Depression rating scales ). 5. Adverse effects. 6. Carer outcomes . 7. Economic analysis.

We examined both the shortterm and the longterm effects of the interventions.

What Alternative Communication Devices And Tips Can Help With My Voice And Speech Problems


If you have difficulty speaking, are frustrated and stressed by your inability to communicate or tire from the efforts to speak, consider the following devices and methods to be better understood:

  • Amplification: This could be a portable personal amplifier or a telephone 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.
  • Low-technology devices: Paper-based books and boards, alphabet boards and typing devices are examples of low technology assistive methods.
  • High-technology electronic speech enhancers, communication devices: Computers with voice synthesizers and speech generating devices are available. Talk to a speech-language pathologist about the available high technology devices best suitable for your needs.

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Treatment For Parkinson’s Disease

The symptoms of Parkinson’s disease can be managed effectively for a significant period of time. Although there is still no cure for PD, there are currently many medical and surgical treatments available for PD and other degenerative diseases of the central nervous system.

The treatment should be individualized, as many factors have to be taken into careful consideration, including the patient’s symptoms/signs, age, stage of disease, degree of functional disability, and level of physical activity and productivity. Therefore, the options and decisions may vary significantly from one patient to another.

Considering the ongoing research and clinical trials, as well as the recent advances in the understanding of PD, it is realistic to expect some breakthroughs in PD treatment in coming years.

For a better understanding, treatment can be divided in pharmacologic , nonpharmacologic, and surgical therapy.

Pharmacologic TreatmentThe pharmacologic treatment of PD can be divided into neuroprotective and symptomatic therapy . In reality, nearly all of the available medications are symptomatic in nature and do not appear to reverse the natural course of the disease.

Different types of medications available to treat the symptoms of Parkinson disease include:

  • Inhibitors of enzymes that inactivate dopamine: MAO-B inhibitors and COMT inhibitors
  • Anticholinergics

Surgical Management Of Dysarthria

Like pharmacological management, surgical management in PD has generally not yielded positive outcomes for dysarthria. Deep brain stimulation involves electrode implantation surgery in specific areas of the basal ganglia.27 This surgical procedure has been reported as an effective treatment option for motor symptoms such as dyskinesias in PD in several randomized controlled trials 2830 however, its adverse effects on speech have been consistently reported in the literature.3136 Other surgical procedures have also been associated with a deterioration of speech. For example, in thalamotomies, a lesion is made in the thalamus with the goal of improving tremors. Thalamotomies have been reported to produce hypophonia, reduce speaking rate and lead to word blocking.37,38 This procedure is even thought to have resulted in some cases of palilalia.39 Consequently, thalamotomy has been abandoned as a treatment option for PD.20 Similarly, pallidotomy, in which a heated electrical probe is inserted in the globus pallidus, destroying a small region of cells in order to alleviate dyskinesias, has not been found to be conducive to improvement in dysarthric speech.20 In fact, it has been associated with the development of verbal fluency deficits, swallowing difficulties and facial weakness.40

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Risk Of Bias In Included Studies

See Table 2 and Figure 2 for summary of the methodological quality of the trials. It is impossible to blind patients and treating therapists in trials comparing the efficacy of two types of speech and language therapy. This leaves such trials open to performance and attrition bias. Blinded assessors were used for all included trials, so detection bias is unlikely in these studies.

Risk of bias summary: review authors’ judgements about each risk of bias item for each included study.

Randomisation method and concealment of allocation

Eligiblity criteria

Patient numbers

We found only six randomised controlled trials comparing two methods of speech and language therapy for speech disorders in a total of 159 Parkinson’s patients . With such a small number of patients examined, it is possible that there was bias in the selection of patients, therefore, the applicability of the data to the general population with PD is questionable. The lack of power due to the small number of patients also increases the risk of a false negative result.

Similarity at baseline

Description of speech and language therapy methods

Drug therapy

Data analysis

Swallowing And Saliva Management

Parkinsonâs Disease – Speech and Swallowing Problems: Karen Kluin

This one-hour talk is in three parts. What a speech language pathologist is, how they can help someone with PD. Why you should be concerned about swallowing problems, some indications you may have a swallowing issue, what a swallowing assessment by an SLP might look like, and recommendations an SLP might make to improve swallowing. And, why you should be concerned about having either too much or too little saliva and how to manage either situation.

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Swallowing Problems And Techniques

They are also given information and taught techniques for safe feeding, avoiding false feeding routes that can lead to pneumonia, malnutrition and dehydration. For these difficulties are common and can appear at different stages of the disease, varying in their course, with difficulties worsening as symptoms progress. Symptoms include: choking, coughing, drooling, difficulty taking pills, increased time spent eating, weight loss and pneumonia.

Speech And Communication Problems

Speech and communication problems are common for people with Parkinsons.

They can include problems with your voice, body language, making conversations and small handwriting. But with the right help and support there are lots of ways you can improve any symptoms.

Changes in the brain in people with Parkinsons mean that your movements become smaller and less forceful than before. This can lead to problems with your speech and communication.

Issues may relate to making sure your voice is loud enough, making your pronunciation clear enough and getting the right tone to your voice.

Problems creating movements that are powerful enough can also affect chewing and safe swallowing. Because of this you may find mealtimes more difficult, with an increased risk of food going down the wrong way.

Find out more: see our information on eating, swallowing and saliva control.

Other communication issues in people with Parkinsons are linked to the way you think. Brain changes mean you may not be able to process thoughts as quickly as you need to.

This includes difficulty finding the right words you need or understanding what other people mean straight away. It also includes problems getting your thoughts together quickly enough to respond to someone in the flow of a conversation. In particular, this can happen when you have to do several different things at once .

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Compensatory And Therapeutic Swallowing Techniques

Compensatory strategies control the flow of food and help to eliminate symptoms, but do not alter the swallow physiology. Compensatory strategies used in the treatment of PD to be discussed include postural changes, increasing sensory input, and altering food consistencies. Eating while upright with the chin tucked to the chest or the head tilted forward at a 45 degree angle may be helpful for patients with a delay in triggering the pharyngeal swallow, reduced tongue base retraction, or reduced airway entrance closure or protection.43 Increasing sensory input may benefit patients who are delayed in triggering the pharyngeal swallow. Foods that help to increase sensory input include highly seasoned food, cold foods, sour foods, and possibly carbonated beverages. Altering food consistencies or elimination of consistencies from the diet should be explored only after other compensatory strategies have been examined.43 In general, thick viscous consistencies will be difficult for patients with PD to swallow who experience reduced tongue base retraction and pharyngeal contraction. Emphasizing foods that are moist and form a cohesive bolus has been suggested for patients with poor pharyngeal contraction, and blenderized food that requires minimal chewing may be necessary for patients with severe dysphagia.2 Similarly, thin liquids are typically the most difficult consistency for patients with reduced laryngeal closure.

Problems With Speech And Voice

Handout: Parkinson

If you experience problems with your speech and voice you may find your speech sounds slurred or unclear, or that you speak more quickly than before. You may also find you have to slow down to make yourself understood. It can also become harder to control how quickly you speak.

Your voice can also change. It may sound:

  • unsteady and flat
  • difficulty putting enough power into your movements

Speech and language therapists are healthcare professionals who can provide assessment and advice on all aspects of communication, from facial expression and body language to speech and communication aids.

Clinical guidelines recommend that your GP, specialist or Parkinsons nurse should consider referring you to a speech and language therapist with experience of Parkinsons when youre in the early stages of the condition.

This is important because you may not notice changes to your speech and communication if they are subtle. But a speech and language therapist can uncover any issues, help you manage them and stop them becoming worse.

You may find it helpful to have regular check-ups. This will allow your speech and language therapist to monitor whether there are any changes with your speech. If there are, they can recommend specific exercises or programmes to help you.

Another recommendation in the guidelines is that youre given equipment to help you communicate if you need it .

Medication such as levodopa may help improve how loudly and clearly you speak.

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Ways To Improve Speech In Parkinsons Disease

5 min read

Parkinsons disease is a neurodegenerative disorder that affects the motor neurons. As it progresses, the person with PD may become harder to understand as their voice becomes softer or hoarse. Their face may become more masked or expressionless, and their voice may sound monotone with less emotion. They may speak faster , mumble, or repeat . Together these symptoms are known as hypokinetic dysarthria.

A speech-language pathologist is a specialist in communication disorders and can help a person with PD to speak more clearly and confidently. Here are 9 ways an SLP can help:

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How Do They Appear In Pd

The muscle problems that occur in PD can lead to problems with swallowing. Swallowing problems can be hard to figure out at first but may include:2

  • Unexplained weight loss
  • Choking or coughing while eating or drinking
  • “Pocketing” of food in the mouth
  • Frequent heartburn or sore throat
  • Trouble keeping food or liquid in your mouth while eating or drinking

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How Can I Maintain And Enhance My Speech

  • Choose an environment with reduced noise. It can be tiring to try to “talk over” the television or radio.
  • 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 understanding.
  • 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 may be counter-productive. Always ask your speech 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 may not work later in the day.
  • If you are soft spoken and your voice has become low, consider using an amplifier.
  • If some people have difficulty understanding you, the following strategies may help:
  • Data Collection And Analysis

    2 – Speech problems and Parkinson’s disease

    The review authors independently assessed the studies identified by the search strategy. We resolved disagreements about inclusions by discussion.

    We contacted the authors of trials in the cases where further trial information was required for full analysis. We assessed full papers for methodological quality by recording the method of randomisation, concealment of allocation and blinding of assessors to treatment group, whether an intentiontotreat analysis was used and the number of patients lost to followup.

    Two review authors independently abstracted eligible data onto standardised forms, checked for accuracy and amalgamated the information. We resolved disagreements about inclusions by discussion.

    We combined the results of each trial using standard metaanalytic methods to estimate an overall effect for one type of speech and language therapy intervention versus another.

    var diff = var pre + var post 2r

    where var diff is the variance of the change score var pre is the variance of the baseline score var post is the variance of the final score and r is the correlation between the pre and post treatment scores. We assumed a correlation coefficient of 0.5, which is a conservative estimate, to reduce the chance of false positive results .

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    How Do I Know If I Have A Speech Or Voice Problem

    • My voice makes it difficult for people to hear me.
    • People have difficulty understanding me in a noisy room.
    • My voice issues limit my personal and social life.
    • I feel left out of conversations because of my voice.
    • I cannot participate in telephone calls because of my voice.
    • My voice problem causes me to lose income.
    • I have to strain to project my voice.
    • My voice clarity is unpredictable.
    • My voice problem upsets me.
    • My voice makes me feel handicapped.
    • People ask, “What’s wrong with your voice?”

    Inclusion And Exclusion Criteria

    The literature search was limited to RCTs. All included studies met the following criteria: all participants with a diagnosis of PD > 18, and the study investigated the effect of SLT on voice and speech disorders. The primary outcomes consisted of SPL and VHI, and the secondary outcomes included STSD, fundamental frequency, and forced vital capacity. Studies that met one of the following criteria were excluded: no outcomes described, no control groups, or animal experiments.

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    Speaking Effectively A Strategic Guide For Speaking And Swallowing

    Booklet includes self-evaluations and caregiver surveys to determine at what point professional help is needed. Professional examinations are described along with recommendations for both home and professional intervention to improve speech, make eating easier and safer, and reduce drooling. Maintaining communication to reduce isolation is encouraged.

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