Enhancing Parkinson's Disease Communication Through Speech Therapy Interventions

1. Parkinson’s diseaseInterventions Whitney Mundy Dr. Davis

2. Parkinson’s disease • James Parkinson first described it extensively in 1817. • Is a chronic, progressive disorder of the central nervous system that belongs to a group of conditions called motor system disorders. • Direct result of the loss of cells in a section of the brain called the substantia nigra. • Those cells produce dopamine, which is a chemical messenger responsible for transmitting signals within the brain. • Loss of dopamine causes neurons in the brain to fire out of control, leaving the person unable to control their movements in a normal manner.

3. Importance of studying • It is important to study Parkinson’s disease in the Gerontology field because it affects about 1%* of the population older than 60. • Mean onset of this disorder was estimated to be in the late 50’s, but now thought to be in the early-to-mid 60’s.* • The course and degree of Parkinson’s varies substantially • Many people with PD are undiagnosed • I believe on a personal level it is important to study PD because it affects a close family member of mine

4. Gradually yet with increased severity: Tremors or trembling Difficulty maintaining balance and gait Rigidity or stiffness of the legs and trunk General slowness of movement (bradykinesia) Eventually: Difficulty walking Difficulty talking Completing other simple tasks Symptoms of Parkinson’s disease

5. Speech and Communication in Parkinson’s disease • Various speech and voice disorders affect 70-85% of individuals with Parkinson’s disease.** • They include hypophonia, reduced loudness, hoarseness, monotone, mono-loudness, imprecise articulation, reduced stress, and instability in speech rate.** • Moreover, there may be a reduction in the pragmatic communication skills, especially in the areas of conversational appropriateness, turn-taking, prosodics, and proxemics.** • Furthermore, individuals with PD often exhibit reduced motivation for communication and low morale.**

6. Why an intervention? • Communication is an important part of being a human. • We start communicating the day we are born and some would say even before then. • It can become very frustrating when we are unable to express how we feel through words. • It is crucial to maintain our sense of communication as long as we are able. • A combination of interventions could possibly give a person with PD a better quality of life and would increase confidence and self-esteem. • (Combination could include speech and physical therapy)

7. Types of interventions for PD • Speech therapy • Physical therapy • Drug treatments (i.e. Sinemet) • Surgery (although is usually last resort) • Combination of interventions (i.e. Speech and physical therapy combined with drug treatment)

8. Speech therapy intervention • Speech therapy is considered a valuable and effective intervention for people with Parkinson’s disease, particularly when treatment is administered intensively and patients are motivated and actively involved in the therapeutic process.**

9. Speech intervention by individual or group? • The intervention should be conducted individually so that the therapist is able to maximize the direct practice time in the therapy session and facilitate specific exercises designed to the individuals needs.** • This also is suggested so that the patient can receive the therapists undivided attention.** • Some people with PD also feel more comfortable discussing personal problems with one person versus in a group.**

10. Intervention Model • Intervention consists of eight 75-minute sessions.** • Four parts- • Spontaneous speech • Voice exercises (single word production, phrase production, sentence production, speech initiation with increased loudness, question production with focus on modifying intonation) • Guided discussions (telephone conversations, role-play, meeting new people, self-evaluation) • Task assignments (10 minutes a day)

11. Intervention on speech and communication skills • During the 1980’s, speech therapy mainly addressed the prosodic aspects of speech.** • Later other facets of speech and communication were added to the ever changing therapeutic scheme, including respiration, pitch variation, articulation, vocal loudness, strength and speed of articulators, speaking rate, and intonation and stress patterns.**

12. Results of intervention • Modifications in treatment program were reported to have favorable effect on various aspects of speech.** • Most patients reported that the improved speech pattern was maintained after the conclusion of the therapy program.**

13. Why choose a speech therapy intervention? • Speech therapy helps PD patients communicate more effectively. • Gave PD patients a sense of confidence which many of them lack due to unclear speech. • Assistance in regaining the lost art of conversation.** • Emotional support and understanding from therapist or other patients about the embarrassment or frustration some may experience due to speech difficulties.

14. Conclusion • Because the course and degree of Parkinson’s disease varies in each individual it is important to pick the intervention(s) that fits the individual. • I believe that because 70-85% of people with PD have speech and voice disorders, it is important to include a intervention of speech therapy. • These disorders directly affect the social skills, lifestyle, and psychological well-being of people with PD, therefore it is important to assist them in maintaining their communication and speech.**

15. References • *Samii, A., Nutt, J., & Ransom, B. (2004). Parkinson’s disease. The Lancet, 363, 1783-1789. • **Manor, Y., Posen, J., Amir, O., Dori, N., & Giladi, N. (2005). A Group Intervention Model for Speech and Communication Skills in Patients with Parkinson’s disease. Communication Disorders Quarterly, 26:2, 94-101.