Speech and Swallowing in Parkinson’s Disease

Prepared byFauzia ShahSpeech Therapist AKUHPresented by Haroon Basheer

IntroductionIntroduction

Parkinson’s is a slowly progressive Parkinson’s is a slowly progressive neurological movement disorder caused neurological movement disorder caused by a degeneration of dopamine producing by a degeneration of dopamine producing cells.cells.

Hypokinetic dysarthria is reduced Hypokinetic dysarthria is reduced movement of the muscles of speech and movement of the muscles of speech and swallowing.swallowing.

Researches say about 89% of people will Researches say about 89% of people will have speech and voice symptoms.have speech and voice symptoms.

Introduction Introduction (Cont…..)(Cont…..)

Speech symptoms affecting.Speech symptoms affecting.

Respiration (breathing).Respiration (breathing).

Phonation (voice production).Phonation (voice production).

Articulation.Articulation.

Introduction Introduction (Cont…..)(Cont…..)

Other symptoms associated with PD:Other symptoms associated with PD:

Dysphagia.Dysphagia.

Drooling.Drooling.

Progressive difficulty with writing.Progressive difficulty with writing.

Decreased facial expressions.Decreased facial expressions.

Voice Handicap Index Voice Handicap Index (Cont…..)(Cont…..)

FUNCTIONAL

My family has difficulty hearing me when I call them.

I use the phone less often than I would like to.

My voice problem restricts my personal and social life.

Voice Handicap Index Voice Handicap Index (Cont…..)(Cont…..)

PHYSICAL

I run out of air when I talk.

The sound of my voice varies through out the day.

I use a great deal of effort to speak.

Voice Handicap Index Voice Handicap Index (Cont…..)(Cont…..)

EMOTIONAL

I am tense when talking to others.

I find that other people do not understand my voice problem.

I feel annoyed when people ask me to repeat.

Source: VHI: The American Journal of Speech Language Pathology.

Caregiver ConcernsCaregiver Concerns

I have difficulty hearing / understanding my I have difficulty hearing / understanding my Parkinson's partner when he / she speaks.Parkinson's partner when he / she speaks.

My Parkinson's partner does not talk as My Parkinson's partner does not talk as much as in the past.much as in the past.

He / she does not attend social functions as He / she does not attend social functions as frequently as in the past.frequently as in the past.

He / she clears his / her throat more often.He / she clears his / her throat more often.

He / she suspects that I need a hearing aid.He / she suspects that I need a hearing aid.

Speech SymptomsSpeech Symptoms

Overall loudness level is reduced.Overall loudness level is reduced.

Rate of speech: too slow or too fast.Rate of speech: too slow or too fast.

Difficulty initiating speech, or Difficulty initiating speech, or inappropriate pauses.inappropriate pauses.

Voice is usually tremulous and Voice is usually tremulous and monotonous.monotonous.

Hoarse /breathy vocal quality.Hoarse /breathy vocal quality.

Articulatory effort is reduced or imprecise.Articulatory effort is reduced or imprecise.

BreathingBreathing

Improper breathing patternsImproper breathing patterns:: Use short breathsUse short breaths Hold breath while attempting to speak.Hold breath while attempting to speak.

Try speaking loud by counting in one Try speaking loud by counting in one breath:breath:

1 -- 2 --31 -- 2 --3 1 -- 2– 3---41 -- 2– 3---4 1 – 2—3—4—5………..101 – 2—3—4—5………..10

Breathing Breathing (Cont…..)(Cont…..)

Strategies to improve breath support Strategies to improve breath support for loud voicefor loud voice::

Take a deep breath (inhale).Take a deep breath (inhale). Slowly exhale and say the vowels ‘Slowly exhale and say the vowels ‘ah’ or ah’ or

‘ee’ ‘ee’ Try to hold the sound for 15-20 seconds.. Try to hold the sound for 15-20 seconds..

(Repeat 3 times with a 1-2 minutes rest (Repeat 3 times with a 1-2 minutes rest after each try).after each try).

Repeat 3-4 times a day.Repeat 3-4 times a day.

Vocal QualityVocal Quality

Breathy vocal quality can result from weakened vocal fold closure.

Strong closure is necessary for the vibration that produces sound.

Vocal Quality Vocal Quality (Cont…..)(Cont…..)

increase loudness and vocal quality:

Sit, stand or lie down.

Put both palms together.

Take a deep breath and exert pressure into your palms.

Exert air into a vocal grunt.

Sustain the grunt until the air supply is gone.Source: The source of Dysarthria Lingiuisystems,Inc

Exercises to improve pitch Exercises to improve pitch variation or monotone variation or monotone speech speech

1, 2, 3, 4, 5

1 2 3 4 5 6

Source: Working with Dysarthric Clients, Communication Skill Builders

1, 2, 3, 4, 5, 6,

Count and gradually decrease the volume.

Count and gradually increase the volume.

Count with decrease and increase the volume.

ArticulationArticulation

Slow and imprecise lip movements.Slow and imprecise lip movements.

Slow and imprecise tongue movements.Slow and imprecise tongue movements.

Imprecise speech sounds.Imprecise speech sounds.

Strategies to improve Strategies to improve speechspeech

Practice lip/tongue exercises.Practice lip/tongue exercises. Reduce the speed.Reduce the speed. Use short phrases.Use short phrases. Exaggerate the sounds and do not leave any Exaggerate the sounds and do not leave any

sounds of any words out.sounds of any words out. Close lips firmly for b, p, m sounds.Close lips firmly for b, p, m sounds. Try to explode the sounds t, d, k, g.Try to explode the sounds t, d, k, g. Pause between the words, keeping the vocal Pause between the words, keeping the vocal

loudness up until the end of the sentence.loudness up until the end of the sentence.

I Want a Glass of Water

Tactile voicing

Cheek Puff/ Lip Purse

Smile Exercise 1

“O” Exercise

Lateral Tongue Stretch

Tongue Tip Movement

Straight Tongue Stretch

Speech practiceSpeech practice

10 Functional words and phrases for 10 Functional words and phrases for daily practice:daily practice:

Hello.Hello. Yes / NoYes / No Good-bye.Good-bye. Thank you.Thank you. How are you?How are you? I am okay.I am okay. Come here please. Get the Come here please. Get the

phone.phone. Where is the paper?Where is the paper? I am not feeling well.I am not feeling well.

Improving Improving communicationcommunication

NoiseNoise: turn down television or radio.: turn down television or radio. Lighting:Lighting: make sure the lights are turned on make sure the lights are turned on

in the room.in the room. Maintain Maintain eye contacteye contact with the speaker. with the speaker. Distance:Distance: stand or sit close to the speaker stand or sit close to the speaker

to help you hear what is said.to help you hear what is said. WritingWriting: Keep writing materials accessible at : Keep writing materials accessible at

all times.all times. Pointing systemsPointing systems: notebook, pictures, : notebook, pictures,

words, alphabet boards for daily needs.words, alphabet boards for daily needs.

Primary problems in Primary problems in swallowingswallowing

I feel weak and tired often.I feel weak and tired often.

I have recently an unintentional loss of I have recently an unintentional loss of weight.weight.

It takes me longer to eat than other It takes me longer to eat than other people.people.

I pocket food on either side of my mouth.I pocket food on either side of my mouth.

I cough before, during after swallow.I cough before, during after swallow.

I choke or gag when I drink liquids.I choke or gag when I drink liquids.

Primary problems in Primary problems in swallowingswallowing

(Cont…..) (Cont…..)

I have thick or excess saliva or phlegm.I have thick or excess saliva or phlegm.

I drool sometimes.I drool sometimes.

Food sticks in my throat.Food sticks in my throat.

Figuring out what I can or can not eat is a Figuring out what I can or can not eat is a problem for me.problem for me.

I am afraid of choking when I drink I am afraid of choking when I drink liquids.liquids.

Source: Source: A strategic guide for speaking and swallowing, American Parkinson's A strategic guide for speaking and swallowing, American Parkinson's Disease Association Inc.Disease Association Inc.

Disorders of swallowingDisorders of swallowing

Difficulty initiating a swallow.Difficulty initiating a swallow. Unexplained weight loss.Unexplained weight loss. Pocketing/pooling of food or saliva.Pocketing/pooling of food or saliva. Cough/choking during or after Cough/choking during or after

swallowing.swallowing. Change in voice or speech.Change in voice or speech. Nasal /oral regurgitationNasal /oral regurgitation Drooling.Drooling. Excessive secretions.Excessive secretions. Recurrent pneumonia.Recurrent pneumonia.

Safe swallowing Safe swallowing strategiesstrategies

Sit upright during all meals, even when taking Sit upright during all meals, even when taking pillspills

Tilt the head slightly forward, not backward as Tilt the head slightly forward, not backward as you swallow.you swallow.

Take small bites, sips of water. Chew thoroughly Take small bites, sips of water. Chew thoroughly and swallow before taking the next biteand swallow before taking the next bite

Double swallow, or take a sip of water between Double swallow, or take a sip of water between bites of food to wash it down.bites of food to wash it down.

Oral and mouth care.Oral and mouth care.

Safe swallowing Safe swallowing strategies strategies (Cont…..)(Cont…..)

Diet consistenciesDiet consistencies:: Thickened liquids.Thickened liquids.

Pureed / blenderized.Pureed / blenderized.

SoftSoft