Speech-Language Pathologists (SLP) are essential members of the team who evaluate and treat persons with movement disorders. SLPs can evaluate and treat all sorts of difficulties affecting communication like problems with language, speech, and voice. They also lead the management of swallowing and cough problems. Although they are involved in the care of all persons with Movement Disorders, the information below highlights the needs of persons with PD.
Speech & Voice in Parkinson’s Disease
Parkinson’s Disease affects the coordination, timing and force characteristics of the muscles used for speech and voice. It is estimated that 75% of individuals with PD experience changes in speech and voice at some point throughout the disease progression. The same physical symptoms that occur in the limbs, such as reduced movement, rigidity and tremor, affect speech.
- Tremor or unsteadiness in the voice
- Hoarse/raspy voice
- Reduced vocal loudness/ Soft Voice
- Pitch variability
- Monotone voice
- Difficulty forming words
- Slurred Speech/mumbled Speech
- Imprecise Consonants
- Rapid Rate
- Short Rushes of Speech
- Increased speech at the end of a phrase
Effects of Parkinson’s Drugs on Voice and Speech
A few studies have shown that with PD meds, voice and speech characteristics improve but most individuals report very little improvement. Systematic studies with tight experimental controls are needed. Peak medication periods as well as typical on/off patterns need to be studied.
- Examine all the muscles and structures that contribute to your voice and speech production
- Visual exam of the larynx
- Assess your speech patterns, quality, preciseness of articulation
- Assess your vocal quality and respiratory support
Importance of Voice and Speech Therapy
Speech-language pathologists have an essential role in the management of individuals with Parkinson’s Disease. Proper treatment of voice and breathing may play a key role in restoring and preserving the individual’s quality of life and possibly economic situation.
Speech-language pathologists also evaluate and treat difficulties with language production. Language difficulties are not as common in Parkinson’s disease, but can occur, particularly with other Parkinsonian disorders. These may include difficulties thinking of the words you want to use, forming complete sentences, or even difficulties in the comprehension of language. There are various standardized tests that are given to evaluate language function and Speech-Pathologists also have ways of treating these deficits.
Swallowing and Cough
Just as the muscles of speech and voice are affected by Parkinsonism, the swallowing and cough muscles are also greatly affected by the disease. In fact, some claim that 100% of people with Parkinson’s disease will develop some sort of dysphagia (swallowing difficulty). It is essential that dysphagia be properly evaluated and treated because it can result in life threatening consequences like aspiration pneumonia, malnutrition, and/or dehydration. We now also know that cough can become impaired in people with PD. Cough and swallowing are closely related and a strong/effective cough is important for keeping food and liquid out of the airway.
- Slow eating
- Coughing/Choking with meals
- Food residue in the mouth or throat
- Difficulty starting the swallow
- Loss of interest in eating
- Aspiration Pneumonia
- Weight loss
Effects of Drugs on Voice and Speech
As in speech and voice, studies have shown that swallowing function is not typically improved by anti-PD medications.
The evaluation process will depend on your personal swallowing complaints. Some techniques include:
Examination of range and force of structures associated with swallowing
Observing you swallow different materials
Visually examining your larynx while eating
Video x-ray of your swallowing in the radiology suite
There are many options for the treatment of speech and swallowing problems associated with PD and Parkinsonism. The selected treatment will be based on the results of your evaluation. Here we describe two possible treatment options.
One therapy for UFMDC patients is Respiratory Muscle Strength Training. It is a 4 week program developed by Drs Sapienza, Davenport and Martin that specifically works to increase the strength of the expiratory muscles using an expiratory muscle strength training device. The treatment involves assessment of baseline function that examines the patient’s abilities in breathing, swallowing, speech and coughing.
The treatment is done in the patient’s home with weekly visits to the clinician. Outcomes have ranged from an 30-150% improvement in respiratory strength following the program and have positively influenced the functions of speech, swallow and cough after treatment.
The Lee Silverman Voice Treatment Program is a voice treatment program for individuals with Parkinson disease developed by Dr. Lorraine Ramig and colleagues. This innovative treatment program, now known as LSVT, was named for one of the first patients to receive treatment. LSVT is an intensive, behavioral treatment given over sixteen sessions in one month. The techniques are intended to help the individual with Parkinson disease increase speech intelligibility and vocal loudness.