1.
Respiration/Breathing
· Up to 87%
PD clients have decreased pulmonary/lung function
· Reduced
supply of air leads to poor support for speech because
o
Air is wasted before any sound made
o
Difficulty synchronising respiration and phonation
for speech
·
May seem that air ‘runs out’ before words do, so
speech is too quiet
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What to
do … for Respiration/Breathing
· TREATMENT
WITHIN TEAM APPROACH
· Posture -
back up straight
· Shoulders
and upper chest down when taking deep breaths
· Move your
stomach more than your ribs when you breathe
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2.
Phonation/Voice difficulties
· Most
commonly affected
· Quality
is affected through
o Loss of volume/loudness
o Loss of pitch and range
o Loss of intonation - meaning in voice
o Harsh, breathy voice
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What to
do … for Phonation and Voice box
· é Vocal cord adduction/easy onset techniques - making the most of the voice when starting to speak
·  é Fundamental frequency techniques - keeping the range of the speaking voice
· Have good coordination of vocal cords
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3.
Articulation/Speech difficulties
· Potential
movement is not much diminished, BUT
· Range,
accuracy of movements reduced
· Slurred
speech - esp. longer sentences
· Rate of
speech slower/faster
· Uncontrolled
repetitions
· Difficulty
initiating speech
4. Resonance - does the sound come through the nose or the mouth?
· Prolongation
of any sound by reflection or production of vibrations
· Either in
nose or mouth
· Excessive/hyper
nasality
· Insufficient/hypo
nasality
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What to
do … when Speaking (Articulation/Resonance)
·
Be aware of your breathing, RELAX
· Watch
your speed and spit
· Move your
jaw and lips, head, neck and shoulders - use facial exercises
· Finish
each word, then start the next
· Reduce
background noise
· Get help,
but YOU keep talking
· Lee
Silverman Voice Technique - programme to assist with voice specifically of PD
· Intensive
treatment, reinforce techniques, transfer skills
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5.
Prosody - helping speech sound smooth and natural
· Slowed
rate of speech OR
· Quick
rate of speech throughout
· Reduced
emphasis/stress
· Monotonous/flat
intonation
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What to
do … In your Environment
· Reduce
background noise
· Speak
slowly
· Make sure
they can see your face
· Over
articulate/over exaggerate
· Comfortable
posture
· Plan
around resting times and on/off times
· Think
about what is best for you
· Use an
amplifier
· Write it
down
·  Use an
alphabet board
· Establish
the topic before speaking
· Use telegraphic
speech
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Non-verbal
communication
·
Reduced facial expression and natural gesture
·
What to do? = reduce pressure and frustration
·
Face
muscles can also be affected by weakness
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As the
listener we have responsibilities
too...
· Talk
face-to-face, look at the person
· Ask
Yes/No questions if necessary
· Repeat
the bit you understood
· Ask for
repetition/speak slower/spell
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Cognition
· Thinking
processes may be affected, including
o
memory
o
reasoning
o
judging
o
changing ‘tack’
· Dementia
- reported prevalence varies 10-80%
·
May be confused with other disorders
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What to
do … with Cognitive Difficulties - brain processes
· Memory
o
write it down,
o
limit activities
o
get organised
o
use lists
o
develop a routine for retention
· Disorientation/confusion
o
use a diary,
o
the newspaper – check the date
·
Coping with complex/abstract material
o
calming routine,
o
break information
down
· Personality
changes
o
don’t take it personally,
o
identify and alter triggers and consequences,
o
give and get feedback
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Language Difficulties – everyone different
· Word
finding difficulties can occur
· Higher
level language may suffer
o subtleties
o tone
o humour
o sarcasm
· ‘Thought
freezing’
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What to
do … with Language Difficulties
· Individually
based – particular to each person
· Talk
around the word or find a substitute - circumlocution
· Point to
beginning letter if you are using a letter board, or use a picture board
·
Train/Ask for topic reminders
·
‘I don’t understand’ – let the other person know so
they can help
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Swallowing System
Issues:
· Same
anatomy, same movement difficulties, different system
· Reduced
muscle movement in mouth and throat means a gradual loss of ability to clear
food and saliva
· Team
approach
 Swallowing
phases
· Oral: -
Lip seal, coating, pooling, spillage, chewing, saliva management
· Pharyngeal:
- coating, pooling, penetration, aspiration, coughing
Choking - know how to deal with it
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Think
about …
· Developing
a routine
o
adapted crockery/cutlery as necessary to get food to
mouth
o
small amounts of food, appropriate modified
consistency (Thickened if necessary)
o
sensation and concentration
o
pattern of food in, close lips, chew, suck back
o
swallow strong
o
pause
o
cough and swallow as necessary
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Think
about …food and drink
· ESPECIALLY
WHEN EATING AND DRINKING!
· Remember
o
Posture of body and mouth
o
Focus
on activity before and after swallow
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What to do…when
eating and drinking – the Five Ps
· Posture -
before, during and after
· Plan the
process
· Pills
· Pacing
yourself - small mouthfuls, swallow
twice, take your time
· Professional
help – seek if a serious problem develops
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Drooling
or Dry Mouth Issues – What to do
We produce 1-2 litres of saliva a
day. Saliva is important, but if
drooling or dry mouth is a problem, there are steps you can take.
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If
Drooling is a problem:
·
Swallow saliva often
·
Close lips, slurp and
swallow (up, back, swallow)
·
Keep head upright to
facilitate as natural swallowing as possible
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If Dry
Mouth (Xerostomia) is a problem:
· Regular
fluids
· Reduce
caffeine
· Peppermints
· Alternative/artificial products
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Additional
Information
·
Speech and Language Therapy in the
Longford/Westmeath area
o
Midlands Regional Hospital: Mullingar 044 39148
o
St Mary’s Hospital 044 31448
o
Athlone Health Centre 090 6475301
o
Longford Health Centre 043 50169
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·
About the Writer:
o
Karen Malherbe is originally from Johannesburg, South Africa where she
graduated from the University of Cape Town. She came to Ireland in 2003, and
has been working with adults and children with the Midlands Health Board
since then. In July 2004, she moved full time into hospital adult work, which
will, says Karen, allow her to gain more experience in this field. Karen is the Senior Speech and Language
Therapist in the Midlands Regional Hospital in Mullingar, and, she concludes
“part of an excellent team of therapists”.
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