Speaking up – Overcoming Speech Difficulties in Parkinson’s Disease

Dysarthria, a motor speech disorder commonly observed in Parkinson's disease (PD), significantly impacts communication. It is characterised by disturbances in the muscular control of speech production, affecting respiration, phonation, articulation, resonance, and prosody.

In PD, dysarthria typically manifests as hypokinetic dysarthria, primarily due to the underlying degenerative changes in the basal ganglia and related neural pathways. These changes lead to difficulties in initiating and coordinating movements required for speech production, resulting in reduced vocal loudness, monotone or hoarse/strained, reduced breath control, voice quality, imprecise articulation, and overall reduced speech clarity.

Moreover, sensory and cognitive changes commonly associated with PD can further exacerbate speech difficulties. Sensory feedback mechanisms, essential for monitoring and adjusting speech production, may be compromised, leading to inaccurate self-monitoring and reduced awareness of speech errors. People with Parkinson’s often under report their symptoms and their caregivers report the need to frequently ask the person to repeat themselves. Changes to other cognitive skills like multi-tasking, working memory, attention and executive function, can interfere with language processing and formulation, contributing to speech hesitations and difficulties finding the right words.

However, there is hope for individuals with PD experiencing dysarthria or cognitive communication changes. One evidence-based intervention that has shown promising results is LSVT LOUD. This intensive speech therapy program focuses on the underlying sensorimotor mechanisms involved in speech production.

LSVT LOUD at SPIN Clinic consists of two sessions twice a week for 8 weeks, with home tasks twice a week. The treatment emphasises high-effort, intensive vocal exercises designed to recalibrate the sensorimotor system, increase vocal loudness, and improve speech precision. By consistently practicing these exercises, individuals with PD can retrain their speech muscles, improve vocal projection, and enhance their speech.

There are various studies on the efficacy of the program, with some studies reporting maintenance of treatment effects up to two years post-treatment. Parkinson’s is a degenerative condition and to ensure you are able to maintain gains we offer booster sessions, and LSVT LIFE in a social format.

In conclusion, dysarthria in Parkinson's disease can pose significant challenges to communication, but with appropriate intervention strategies like LSVT LOUD, individuals with PD can experience meaningful improvements in their speech abilities. By addressing the underlying motor and sensory deficits, LSVT LOUD offers a promising approach to enhancing speech clarity and communication effectiveness, ultimately improving the quality of life for individuals living with Parkinson's disease.

References:

• Ramig, L. O., Sapir, S., Countryman, S., Pawlas, A. A., O'Brien, C., Hoehn, M., & Thompson, L. L. (2001). Intensive voice treatment (LSVT®) for patients with Parkinson's disease: A 2 year follow up. Journal of Neurology, Neurosurgery & Psychiatry, 71(4), 493-498.

• Fox, C., et al. (2002). "Lee Silverman Voice Treatment for Parkinson’s disease with dysarthria: A pilot study." NeuroRehabilitation, 17(4), 237-246.

• National Parkinson Foundation. (n.d.). LSVT LOUD. Retrieved from https://www.parkinson.org/Living-with-Parkinsons/Treatments-and-Therapies/LSVT-BIG

• LSVT Global. (n.d.). LSVT LOUD. Retrieved from https://www.lsvtglobal.com/therapy/lsvt-loud

• Duffy, J. R. (2019). Motor speech disorders: Substrates, differential diagnosis, and management (4th ed.). Elsevier.

• Ramig, L. O., Halpern, A., Spielman, J., Fox, C., & Freeman, K. (2018). Speech treatment in Parkinson’s disease: randomized controlled trial (RCT). Movement Disorders, 33(Suppl 2), 389.

• Fox, C., Ebersbach, G., Ramig, L. O., & Sapir, S. (2016). LSVT LOUD and LSVT BIG: Behavioral treatment programs for speech and body movement in Parkinson disease. Parkinson's Disease, 2016.

• Sapir, S., Spielman, J. L., Ramig, L. O., Hinds, S. L., & Countryman, S. (2007). LSVT®LOUD voice treatment for people with Parkinson disease: A 12-month follow-up. Journal of Neurology, Neurosurgery & Psychiatry, 78(5), 566-570.