Speech difficulties in PD

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Leslie MahlerAnonymous
Posted: Sat Jul 21, 2007 5:11 am Post subject: Speech Difficulties

Dear Doctor,

I understand about half of all people with PD are likely develop difficulty with speech. The speech changes that occur are due to inco-ordination and reduced activities of muscles that control the speech mechanism. The main difficulties I have experience are: Loss of volume, pitch, range and intonation in the voice., speech being either too fast or too slow uncontrolled repetitions of sounds, words or phrases; slurred speech; difficulty initiating speech; reduced facial expression and natural gesture; and a harsh, breathy voice.

Is it related with Jaw tremor or trauma (the shock caused by unpleasant and upsetting experience )? Is it related to tongue-tied/twister(difficulty to speak quickly) caused by neurological disorders? Is it related with the drooling of saliva from the mouth ?
Best regards

TEOKIMHOE

Dear TEOKIMHOE, Thank you for writing with these excellent questions. It is actually more than 50% of people with PD who have difficulty with speech and communication. The data tell us that it is actually closer to 85%. You are partially correct about the underlying causes of the speech problems. PD is caused by decreased dopamine in the central nervous system. The lack of dopamine also causes changes in control of the muscles that produce speech. Typically, the motor speech changes are characterized by rigidity, weakness, difficulty in initiating movement, and difficulty making large movements. In addition, a critical component of the communication changes is the perception on the part of people with PD that they think they are speaking loud enough when, in fact, they are speaking at a low volume that also makes it difficult to understand them. The result is that speech changes occur just like you described in your email: low volume, slurred speech, reduced intonation, alteration in rate, and changes in voice quality such as sounding breathy or harsh. These symptoms are caused by the PD. Sometimes people with try to compensate for these changes in ways that can make speech more difficult. Unfortunately, the medications that can be so beneficial for limb symptoms have not been shown to have the same positive effect on speech and swallowing. However, there is a behavioral voice treatment that has been shown to help 80% of people with PD who complete the program. It is called LSVT. You can learn more about LSVT and find a certified clinician in your area by going to http://www.lsvt.org./ The last thing you mentioned is that you notice more drooling. There has been a lot of discussion about whether people with PD drool more or swallow less well. It seems the majority of the data point to the latter. People with PD swallow less frequently and with less strength and efficiency of muscle movement. One thing that can be done about this is to consciously tell yourself to swallow more frequently especially when in a social situation. If you are already noticing signs of drooling there could be other changes in swallowing taking place. It would be a good idea to discuss this with your physician and seek an evaluation with a speech-language pathologist who has experience in evaluation and treatment of people with PD. Swallowing difficulties can potentially interfere with the ability to take pills and swallow safely and it is important to be vigilant. I hope you will get treatment for your speech changes since communication is so important to quality of life.
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lmahlerJoined: 02 Apr 2007Posts: 1
Posted: Mon Jul 23, 2007 2:33 pm Post subject:


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Anonymous
Posted: Sun Jul 29, 2007 4:22 am Post subject: Speech Difficulties in PD

Speech difficulty is very common among Parkinson's patients (about 80%). Unfortunately, it is also one of the most neglected areas in the management of PD. Medications are helpful. In fact, when one's voice becomes softer and less clear, it is a sign of progression of illness. In this case, adding new medications and / or increasing the dose of existing medications is helpful. Yes, speech therapy is also useful but there are probably less than twenty qualified speech therapist in Malaysia. There should be greater awareness on the important role of speech therapist in the management of PD. Dr Chew Nee Kong, Kuala Lumpur.
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lmahlerJoined: 02 Apr 2007Posts: 1
Posted: Tue Aug 28, 2007 4:41 pm Post subject: Speech Therapy for PD

Our experience is that the medications and surgical interventions that can be so beneficial for limb movement don't necessarily have the same consistency and extent of benefit for speech and swallowing so additional behavioral treatment is needed. Since 80-90% of people with PD will have speech and swallowing difficulties at some point I recommend considering receiving treatment earlier rather than later when it is easier to learn the techniques. Research data from PET scans has demonstrated changes in brain control during speech tasks following the administration of LSVT, an intensive behavioral voice treatment. Discuss these issues with your neurologist and at least get an evaluation to consider the options that are available to you._________________Leslie Mahler, PhD, CCC-SLP Assistant Professor University of Rhode Island
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