Speech and Voice Disorders in Parkinson s Disease

Transcription

1 Speech and Voice Disorders in Parkinson s Disease Matt McKeon M.S. CCC-SLP Lead Speech-Language-Pathologist Parkinson care team lead The Virginian CCRC and outpatient clinic March 28, 2015

2 Numbers for thought ~89% of people with PD will have a voice or speech disorder ~3-4% will receive speech therapy

3 Why does Parkinson s affect how I sound or how I swallow? Parkinson s affects: muscle strength muscle coordination muscle range of motion muscle speed of movement

4 This includes: Muscles for respiration or breath control Muscles of throat and larynx(voice box) Muscles of mouth and palate

5 Symptoms of Voice Disorder Low speaking volume Hoarse voice Breathy/airy sounding voice Monotone Mumbled speech Hesitating speech Short rushes of speech Reduced awareness of speaking quietly Flat Affect

6 How will this impact my life? What did you say? Withdrawal from social interaction Misunderstanding with communication partner Overall reduced ability to be understood in social settings

7 Treatment LSVT-LOUD Developed by LSVT-Global Evaluation with 16 Tx. sessions: 4x/wk x 4 weeks 1 hr. sessions with an SLP Speak Out! Developed by the Parkinson Voice Project/ Dallas TX Evaluation, PD info session, and (12) 45 minute Tx. Sessions

8 Speak Louder! The volume of our voice is determined by many factors but perhaps the most important one is taking a bigger breath and speaking on our air.

9 Speech Therapy results and statistics using LSVT LOUD (An internal restrospective review) Treatment was 4x/week x 4 weeks; 16 sessions total An internal retrospective review of 49 patients 83% (41) were male / 17% (8) female Average age at first treatment = 73.4 (Range of years old) >95% of new clients were not aware of the severity of their voice disturbance upon the initial evaluation Average increase in volume was 7.7dB which is perceived by listeners as a doubling of your volume. This increase brought their speaking volume to a normal and natural sounding level. Results consistent with findings from LSVT LOUD research which reports a doubling of one s intensity.

10 Maintain 1. Parkinson Foundation of the National Capital Area (PFNCA) Communication Club: $15 registration fee. 2. LSVT-Global offers client based software for you to practice at home following Tx. ~$ Northwest Parkinson Foundation: Speak up for Parkinson s App for I-pad: $0

11 Swallowing disorder Any difficulty with chewing, preparing the item to be swallowed, and/or the act of swallowing a food or liquid. Symptoms include: Coughing with meals/drinks Wet vocal quality with or following a meal/drinks Choking Feeling of something hung up in throat after the swallow Needing to swallow multiple times Having food left in your mouth after multiple swallows

12 Treatment for a swallowing disorder Vital-Stim: Neuro-muscular electrical stimulation (NMES) Length of Tx: 4-8 weeks, at least 3 sessions per week: min each Outcomes: Reduced coughing after swallow with either food and/or liquids Reduced risk for aspiration Pneumonia Less time to eat meals with reduced risk for weight loss

13 Treatment for a swallowing disorder Strengthening Exercises Length of treatment: 2-8 weeks, 30-45min sessions Expected Outcomes include: Improved Speed Range of motion Strength of affected muscles interfering with swallowing function Improved ability to protect the airway before, during, and after the swallow

14 Treatment for a swallowing disorder Change in diet textures (if exercises are not effective) Changing the consistency of the food Thickening your liquids Length of treatment: 1-4 sessions Outcomes: Reduced risk for aspiration Pneumonia Reduced risk for weight loss, strength, and loss of energy. Increased risk for possible dehydration while on thickened liquids Alternative Means of Nutrition: used at times if no intervention is effective in eliminating aspiration pneumonia and/or as a means of supplementing your oral nutrition to meet your nutritional needs. The decision to pursue this approach should be carefully considered with all involved health care professionals as benefits/consequences from this solution are different for each individual.

15 Factors influencing response to Awareness of deficit therapy Compliance with exercises and recommendations Performing exercises correctly Ability to work hard! Motivation

16 Retrospective review of 11 patients with Parkinson s Disease referred for a swallowing disorder as their primary deficit 82% of patients with a swallowing disorder also had symptoms of a voice disorder. 91% of these patients with a swallowing disorder were unable to perform an effective throat clear when prompted. They effectively lost the strength and coordination of their respiratory and laryngeal muscles systems needed to clear residue from their airway after the swallow. Our ability to clear our throat and cough are our bodies main defenses from foreign objects (food/liquid/saliva) from going into our lungs. Without this skill we are unable to clear food or liquid from our airway when we want to. 50% of these patients regained this skill with treatment. (Taken from outpatient and inpatient caseload within The Virginian)

17 In Conclusion Discuss your symptoms of a voice, speech, and/or swallowing disorders with your Doctors immediately and request to receive an evaluation from a qualified Speech and Language Pathologist before the symptoms turn into a problem.

18 Biography Matt McKeon s interest in treating Parkinson s Disease began in 2008 after realizing the effectiveness of treatment for low speaking volume in PD using the LSVT LOUD program. Matt is responsible for creating the PFNCA Communication Club in 2012 after realizing the need for continued support following speech/voice treatment. Matt was instrumental in making this program available in 6 locations across the greater D.C./VA/MD. These clubs serve as a free maintenance program to those with and at risk for voice and speech deficits that often accompany Parkinson s Disease. Matt is the lead Speech Language Pathologist(SLP) and lead SLP on the Parkinson care team at The Virginian continuing care retirement community(ccrc) in Fairfax, VA. The Virginian Parkinson care team is comprised of over 10 health care professionals and therapists who have received specialized education and training in the evaluation, treatment, and management of Parkinson s Disease. The Virginian provides some of the most comprehensive outpatient and inpatient therapy and wellness programs in the region for the treatment and management of Parkinson s Disease and other neurological diseases. Matt can be reached at [email protected] OR Helpful Links