PMDC speech therapy program boosts communication, connection for people with Parkinson’s and other disorders
PMDC speech therapy program boosts communication, connection for people with Parkinson’s and other disorders
By Sean Gorman
Along with causing tremors, muscle stiffness and other symptoms, a movement disorder can seriously hinder a person’s ability to speak.
People living with Parkinson’s and other diseases — like Progressive Supranuclear Palsy and Multiple System Atrophy — might talk with a raspy voice, stutter or speak so quietly that others can’t tell what they’re saying, notes Woodford Beach, Ph.D., a speech pathologist at the Parkinson’s and Movement Disorders Center (PMDC).
“Very often in a social situation when you can’t hear someone talk, you’re probably not going to interact with them as much because you don’t know how to politely say, ‘I can’t hear you,’” Beach says. “So people just won’t talk with them.”
But speech therapy at PMDC can help those living with Parkinson’s and other movement disorders regain their voice — and maintain their connection with those around them.
Beach notes there’s a significant need for speech therapy interventions. For example, while 80 to 90% of Parkinson’s patients will eventually develop speech problems, only 5% get treatment for them, he says.
That wide disparity is due to many factors, including a person not realizing they have a problem, lack of motivation to undergo treatment, or not knowing what can be done about it, Beach says.
At the PMDC, speech therapists like Beach use different therapy approaches — known as LSVT LOUD® and SPEAK OUT!® — to elevate a patient’s voice. LSVT stands for “Lee Silverman Voice Treatment” and is named after a woman who has Parkinson’s, according to LSVT Global, the Arizona-based organization that runs LOUD.
Say it LOUD
Many of the patients who undergo PMDC speech therapy are Parkinson’s patients whose disease has eroded their speaking volume.
There are a couple of schools of thought about why Parkinson’s disrupts a patient’s speech, Beach notes. One is that Parkinson’s patients have lower levels of dopamine, a hormone and neurotransmitter produced in the brain.
“So when they’re not really thinking about it, they have insufficient dopamine to give the ‘oomph’ necessary to produce a loud voice,” Beach says.
Another hypothesis is that a person living with Parkinson’s has a “mis-calibrated loudness meter” and incorrectly thinks their faded voice is still spoken at a normal volume, Beach adds.
To fix that, PMDC therapists offer LSVT LOUD® — an intensive therapy approach that requires patients to take part in four hour-long sessions for four weeks. The program is a total of 16 sessions.
“It demands a lot of endurance,” Beach says. Patients do vocalizations and change the pitch of their voice. As Beach tracks their volume using acoustic measuring software, patients also read from something that interests them, like the Bible or a novel. One man who went through Beach’s therapy read from financial reports of the stocks he followed, Beach says.
“We start out the first week by having them just read words. Then we move to sentences. Then we move to paragraphs,” Beach says. “And then the final week is a conversation that’s sort of open-ended.”
Patients build up their voice over time, even consciously working to speak louder at home with their family, he says.
“Many of my patients will say after they’ve successfully completed the program that their waiter is not leaning in to try to hear what they have to say,” Beach says. “They don’t feel isolation that otherwise happens if it’s hard for people to hear them.”
Beach says data from the organization that runs the LOUD program suggests that 80% of those who complete the program maintain proper volume for two years. There are also studies suggesting LOUD can help improve other symptoms like slurred speech, swallowing issues, respiratory control and facial masking, he adds.
Another Option
Given the intensity of the therapy, Beach knows LOUD is not for everyone.
Both he and others at the PMDC use SPEAK OUT!®, a speech therapy approach developed by the Parkinson’s Voice Project that entails fewer visits where a patient works on talking with more intent and more deliberation, which often results in a louder voice.
Generally, patients undergo two sessions each week for four weeks, he says.
Both SPEAK OUT!® and LSVT LOUD® suggest keeping tabs on a patient’s speech patterns over the long term and returning for follow-up therapy sessions as needed, Beach says. Regardless of which therapy approach is used, Beach notes it’s important to address speech problems as early as possible.
“It’s very difficult to treat people late in the course of their disease when they are talking in a whisper,” Beach says. “At that point, we’re probably looking towards electronic communication devices.”
And through therapy, someone who was once barely audible in a quiet room can become easily heard while conversing in most settings, Beach says.
“When we conclude therapy, unless there is some incredibly loud noise, they’re going to be heard as well as I,” Beach says. “They feel much better because they find that people are not asking them to repeat, that people aren’t just nodding without understanding them but are actually getting what they’re saying.”