April is Parkinson’s Awareness Month, so we’re bringing you 9 ways to improve speech in someone with Parkinson’s disease.
Parkinson’s disease (PD) 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 (hypophonia) or hoarse. Their face may become more “masked” or expressionless, and their voice may sound monotone with less emotion. They may speak faster (festinating speech), mumble, or repeat (cluttering or palilalia). 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:
Remediation: Addressing the Underlying Problem
1) LSVT LOUD®
Lee Silverman Voice Treatment is an evidence-based intensive treatment that teaches people with Parkinson’s how to speak with normal volume by thinking “LOUD.” The treatment is delivered in sixteen one-hour sessions over four weeks. Clinicians must be certified by LSVT Global to provide this treatment; certification courses can be taken online or in person for approximately $600, and certification must be renewed every 2 years.
2) SPEAK OUT!®
Parkinson’s Voice Project SPEAK OUT!® is a less-intensive speech therapy program specifically for people with Parkinson’s that combined speech, voice, and cognitive exercises. The program focuses on speaking with “intent.” The treatment is provided in twelve 45-minute sessions along with daily home practice. After individual treatment, group therapy called The LOUD Crowd® is the next step. Research shows the results last up to a year and are comparable with other programs. Administering the treatment requires clinician training (approx. $300) but not certification.
Expiratory muscle strength training (EMST) works to build up the muscles that push air out of the lungs for speech. This can result in more syllables per breath and a stronger voice for people with Parkinson’s. A simple resistance device called EMST150 or The BreatherTM is used to build strength. These exercise devices are reusable by a single patient and cost $50 or less. This type of therapy requires daily practice, but it can be done at home and has low cognitive demands (you just blow hard!).
4) Visual Feedback
Sometimes just knowing you’re not being loud enough can be enough to cue extra effort. Visual feedback on volume can help a person with Parkinson’s become more aware of when they’re speaking loudly enough. A variety of apps can provide visual feedback:
- Speak Up For Parkinson’s: This app gives users phrases to practice saying, showing them their own face using the camera on the iPad. A volume meter gives feedback.
- Bla | Bla | Bla: This app shows relative volume using quirky faces that expand and contract with loudness.
- Sound level meters: There are dozens of sound level meter apps that range from fun to highly technical. NoiSEE on iOS is the later, while Speak Up on Google Play is the former. Just search the app store for “sound level meter” to see the range of options available for your device. They all measure sound in decibels and can be used to determine the exact or relative loudness of speech.
Compensation: Using Tools to Offset the Problem
5) Speech Vive
Speech Vive is a medical device you wear that feeds background noise into your ear, prompting you to talk louder. It’s based on the fact that in noisy situations, we naturally speak louder. You can try this out for yourself with their free iOS SpeechVive app and a headset to see how well it works for you. (I was 51% louder!) The company is very helpful, and they have good research backing their device.
6) Voice Amplifiers
When the voice is soft, just turn up the volume! Use a lapel or headset microphone and portable speaker system to amplify the volume of the speaker’s voice. There are several options available as these devices are frequently used by teachers, coaches, and tour guides. An inexpensive system like this WinBridge model can be purchased on Amazon. More costly voice amplifiers, such as the classic ChatterVox, may be covered by Medicare and other insurance providers.
Augmentative and alternative communication (AAC) encompasses many things. For a person with fast rate, using a pacing board may be enough to slow down. Conversation Paceboard is an app that can help.
For a person with a fast rate or unclear speech, a first-letter strategy is a great option to improve intelligibility. AlphaTopics AAC is our app to aid dysarthric speech with a letter board, topic board, and whiteboard.
Learn why using a letter board actually improves unclear speech in this article about AAC and dysarthria.
For people with more severe dysarthria who can still control their hands, a text-to-speech AAC app or device may be needed. Proloquo4Text, ClaroCom, or Predictable are good app options. As the disease progresses, brain-computer interfaces may become appropriate. These are still in experimental stages, but show a lot of promise.
Participation: Living Life Despite the Problem
8) Partner Training
Speech-language pathologists don’t just treat the patient, they also treat the family. Since communication takes two, it’s just as important for the communication partner to know what to do. Caregivers, spouses, children, and the medical team should know how to control the environment, give feedback, and ask for clarification in ways that facilitate the successful exchange of information. Partner training goes beyond a list of strategies or tips, and should involve coaching and feedback on the use of these strategies to help relieve frustration (for both parties) at home.
Singing in a choir not only provides a venue to practice breath support and strong voicing, it’s also a great social opportunity. There are even some choirs developed specifically for people with Parkinson’s disease and other neurological communication problems. Music can lift the spirits as well as the voice.
Difficulty communicating not only makes it harder to express your wants and needs, but it is socially isolating. When a person loses their physical voice, they also lose their figurative voice tied to their identity. This sense of self and self-efficacy is critical to motivation and fending off depression. This is why it is so important to address the communication needs of people with PD in the most effective ways possible. If Parkinson’s disease affects you or your loved one, reach out to a speech-language pathologist for help.
Parkinson’s does’t just affect speech. Learn how an SLP can help with other challenges people with PD face in swallowing, cognition, and more.
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