Monday, November 19, 2007
Speech Therapists
Why PD patient has problem with speech? He has soft voice i.e. not strongenough to be listenedOver 89% of people with PD have difficulties with speech and voice. The symptoms that occur first are changes in voice including soft voice, monotone, and sometimes hoarseness or breathiness. These changes can make it difficult for a person with PD to be heard and understood. There is a speech therapy program that has been very successful in improving communication in people with Parkinson disease called LSVT/LOUD! I have provided some additional information below about the speech treatment, how to find certifed clincians, and what you should expect if you were to receive LSVT/LOUD. The most important thing is to do something about improving voice/speech NOW. Communication is a vital element in self-confidence and is something that you CAN do something about.How to locate LSVT Certified Speech Therapists:1. Go to the LSVT Website at www.lsvt.org. 2. From the opening page, click on the link, "Go to LSVT Website". 3. There are series of links on the left hand side of the webpage - click on the link, "Locate Certified Clinicians."4. Accept the disclaimer by clicking the "I agree" button5. From the map or pull down menu, select your country6. Next select your state7. A list of clinicians in your state will appear with the therapists contact information.If you have any difficulty with the website, email a request for clinicians to info@lsvt.org. Asking doctor for referral and prescription:If you are experiencing any changes in your speech or voice, be sure to tell your doctor. Ask for a referral for LSVT speech therapy. It is best if the physician can write a prescription for, "Speech evaluation and treatment utilizing the LSVT 4 days/week for 4 weeks, 50-60 minute sessions."If you have not noticed changes in your speech, but a spouse, caretaker, or friend has - pay attention to their comments. One aspect of the speech disorder in PD is that the person with PD is often "unaware" of the changes in speech or voice. He or she feels as though they are speaking loudly enough, but others can not hear or understand them. The sooner you get a speech evaluation and start speech therapy - the better!You can provide your doctor with information about LSVT. Information is available (reference list of published data) on the LSVT website at www.lsvt.org.Insurance reimbursement:LSVT has been successfully reimbursed by many insurance providers and Medicare. There are certain provisions: . speech therapy must be included on your policy . if you have Medicare, you will need to receive LSVT at a Medicare provider facility (typically hospitals, outpatient rehabs, etc.). Some private practice speech therapists are unable to bill Medicare for services. . you may need a prescription for speech evaluation/therapy from your primary care physician Pearls for receiving best therapy:1. Make sure your speech therapist is certified in LSVT. The LSVT Training and Certification is a special 2-day training course that speech therapists attend in addition to their training as a speech therapist. There is a list of LSVT Certified speech therapists on the website www.lsvt.org.2. Ask your speech therapists:How many patients have you treated?What are your typical outcomes?How long ago were you certified?3. Beware if a therapist offers a "modified" LSVT program. There is no such thing as modified LSVT. Any changes to the standardized LSVT protocol are NOT supported by research data and efficacy outcomes. IF you receive LSVT, you will get the following (this is the same everywhere in the world - there are not modifications): Components of LSVT therapy. Treatment will consist of 4 days of therapy a week for 4 weeks.. Treatment session will last 50-60 minutes. Treatment will be delivered individually.. The first half of the session will be spent on 3 daily tasks:o Sustain "ah" with increased loudness as long as you can (minimum 15 repetitions)o Sustain "ah" while going high/low in pitch - hold for 5 seconds (minimum 15 repetitions for high and 15 repetitions for low)o Repeat a list of 10 self-selected functional phrases 5 times each session (these phrases NEVER change). The second half of the session will be spent on a speech hierarchy:o Week 1 - words and phraseso Week 2 - sentenceso Week 3 - readingo Week 4 - conversationThe LSVT clinician will encourage you to bring in material for speech practice that is meaningful and interesting to you. This material will change everyday of therapy. The entire second half of the session you will be talking and practicing your LOUD voice. If your speech therapist has done a good job - you will feel tired at the end of the session. . Homework:You will have homework exercises to practice everyday of the entire month of speech therapy. On days you have speech therapy (e.g., Mon-Thurs), you will practice one other time a day for 5-10 minutes. (completing daily tasks and hierarchy exercises)On days you don't have speech therapy (e.g., Fri - Sun), you will practice twice a day for 10-15 minutes (completing daily tasks and hierarchy exercises).. Carryover exercises:Everyday of the entire month of speech therapy (Mon-Sun) you will have a carryover assignment. This is an assignment to use your LOUD voice with another person outside of the therapy room. The clinician will work with you to decide on a very specific task in which you will use your LOUD voice - as loud as you practice in the treatment room - in a real life situation. These exercises help a person with PD realize, that what feels and sounds too loud to them is actually within normal limits. The LSVT clinicians will make you accountable EVERYDAY for doing your Homework and Carryover exercises. The daily homework and carryover exercises are an essential part of the treatment program, and must be completed daily. Improving speech and voice in PD is not easy. It takes a commitment to the LSVT exercises and tasks in therapy. The benefit is priceless - improved communication.
Hormone therapy with PD
Dr. Okun,
Is Hormone therapy and lab. evaluations on antioxidant & Micronutrients helpful for PD patient?
It includes Vit.C,A ,Q10 vit. & minerals
Your early reply will be appreciated.Kim hoe teo
The only one with preliminary positive evidence of the above that I endorse for my patients is Co-Q10. The others are not solidly proven.
Michael S. Okun, M.D.
Is Hormone therapy and lab. evaluations on antioxidant & Micronutrients helpful for PD patient?
It includes Vit.C,A ,Q10 vit. & minerals
Your early reply will be appreciated.Kim hoe teo
The only one with preliminary positive evidence of the above that I endorse for my patients is Co-Q10. The others are not solidly proven.
Michael S. Okun, M.D.
Health wellness program
Posted: Sun Mar 04, 2007 4:14 am Post subject: health wellness program
I was taking part health wellness program at the Clatch Hatch Gym centre for the past of 20 years. I used to spend 1 hour daily except Sunday at the Gym. I ran treadmill, cycling, weight lifting at the gym and yet to be told by my friend I had PD symptoms i.e. stoop postures, soft voice and tremor.
I had self denial and anger at them why it came to me as I was proactive in sports? Was it true?
I had the PD symptoms for the past of 10 years. I used to complain my vision to the eyes specialist and was told it was normal.
I did screening on my constipation and was told I have haemorrhoid's. I even did screening on my brain and nervous as I had sleeping disorders but it was normal.
In the year of 2005 I joined California Gym I took part body pump class' and was told I have to do health check up and it was not suitable for me.
I did body comeback in the class and found too slow for me to follow. I realized that I have weak on my muscles.
I went to do check up and consulted the Movement Disorders neurologist and was told I have PD. It was a shock for me as I was self denial person and anger when I was told I had PD and bargaining by switching with other field specialists for treatment.
As PD is a progressive and chronic disease and the late treatment will develop other diseases.
I took part National Parkinson Foundation Discussion Forum I learn how to control and manage the diseases.Praise Lord.
TEO KIM HOE
I was taking part health wellness program at the Clatch Hatch Gym centre for the past of 20 years. I used to spend 1 hour daily except Sunday at the Gym. I ran treadmill, cycling, weight lifting at the gym and yet to be told by my friend I had PD symptoms i.e. stoop postures, soft voice and tremor.
I had self denial and anger at them why it came to me as I was proactive in sports? Was it true?
I had the PD symptoms for the past of 10 years. I used to complain my vision to the eyes specialist and was told it was normal.
I did screening on my constipation and was told I have haemorrhoid's. I even did screening on my brain and nervous as I had sleeping disorders but it was normal.
In the year of 2005 I joined California Gym I took part body pump class' and was told I have to do health check up and it was not suitable for me.
I did body comeback in the class and found too slow for me to follow. I realized that I have weak on my muscles.
I went to do check up and consulted the Movement Disorders neurologist and was told I have PD. It was a shock for me as I was self denial person and anger when I was told I had PD and bargaining by switching with other field specialists for treatment.
As PD is a progressive and chronic disease and the late treatment will develop other diseases.
I took part National Parkinson Foundation Discussion Forum I learn how to control and manage the diseases.Praise Lord.
TEO KIM HOE
words by the reader
Teo you are my hero!!68 years young and working out in the gym for"only" one hour--I'm feeling really embarrassed at 63 years old and hardly ever make t to the gym at all!!
words by Dr.Kathrynne Holden
Dear Teo,
Your faithful exercise regime over twenty years has stood you in good stead – and is still doing so. Keeping the muscles strong, the bones dense, and the balance and posture supple and erect allows for good gait, better and deeper breathing, and more stamina. Very few folks of your age, even those who don’t have PD, are able to do so well, because most of us haven’t practiced such a good and healthful regime all our lives. Advancing age does slow us all, however, sooner or later. In your case, much later than for most people. And, PD itself gradually progresses, and this adds to the slowing and tiredness. You are doing most remarkably well in managing your PD symptoms; however, it nevertheless may be time to discuss medications with your neurologist. This is outside my scope of practice, you must talk with your doctor regarding type, amount, and/or timing of medications. It is very possible that a slight change in the amount of Sinemet might be just what you need. Write back and let us know._________________Best regards, Kathrynne Holden, MS, RD
Your faithful exercise regime over twenty years has stood you in good stead – and is still doing so. Keeping the muscles strong, the bones dense, and the balance and posture supple and erect allows for good gait, better and deeper breathing, and more stamina. Very few folks of your age, even those who don’t have PD, are able to do so well, because most of us haven’t practiced such a good and healthful regime all our lives. Advancing age does slow us all, however, sooner or later. In your case, much later than for most people. And, PD itself gradually progresses, and this adds to the slowing and tiredness. You are doing most remarkably well in managing your PD symptoms; however, it nevertheless may be time to discuss medications with your neurologist. This is outside my scope of practice, you must talk with your doctor regarding type, amount, and/or timing of medications. It is very possible that a slight change in the amount of Sinemet might be just what you need. Write back and let us know._________________Best regards, Kathrynne Holden, MS, RD
It is not a rich man disease.It can affect anyone in the world.
Do you agree is it an aging disease?It is a movement disorders diseases.
It is estimated out of 2-3% at the age above 50 years old are parkinson disease suffers.Unfortunately we are shortage of PD specialists.
As the result some are wrongly disgnosed as aging and no medications are given to slowdown the disease.Exercises and medications are possiblities to slowdown the disease but they are not for treatment.
PD has 5 stages slowdown your movements.Every stage takes 3 -5 years to develop. Most PD dies at pneumonia, liver or kidney.
Do you agree is it an aging disease?It is a movement disorders diseases.
It is estimated out of 2-3% at the age above 50 years old are parkinson disease suffers.Unfortunately we are shortage of PD specialists.
As the result some are wrongly disgnosed as aging and no medications are given to slowdown the disease.Exercises and medications are possiblities to slowdown the disease but they are not for treatment.
PD has 5 stages slowdown your movements.Every stage takes 3 -5 years to develop. Most PD dies at pneumonia, liver or kidney.
words by Dr.Kathrynne Holden
Comments from a forum member;
with thanks, Dr. Kathrynne Holden
PD is a chronic and progressive disease.The patients have to learn to trust and believe on physical trainers and doctors that they can help them to slowdown the disease from its progression.The patients have to learn on how to overcome the side effect of the PD Medication.Regularly medication and physical exercises with the trainer i.e muscles stretching to relief movement stiffness and rigidity are important.PD patients have different symptoms and they vary from one people to other.It makes doctors have difficulty to prescribe the medicines.It is a movement and coordination disorders.As the result they have constipation , poor vision , stiffness face, stoop body postures, soft voice, breathing and swallowing.The patients will not die on PD disease but die on liver or kidney infection or pneumatically , a fatal complication diseases.
Posted
with thanks, Dr. Kathrynne Holden
PD is a chronic and progressive disease.The patients have to learn to trust and believe on physical trainers and doctors that they can help them to slowdown the disease from its progression.The patients have to learn on how to overcome the side effect of the PD Medication.Regularly medication and physical exercises with the trainer i.e muscles stretching to relief movement stiffness and rigidity are important.PD patients have different symptoms and they vary from one people to other.It makes doctors have difficulty to prescribe the medicines.It is a movement and coordination disorders.As the result they have constipation , poor vision , stiffness face, stoop body postures, soft voice, breathing and swallowing.The patients will not die on PD disease but die on liver or kidney infection or pneumatically , a fatal complication diseases.
Posted
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