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Constant tongue movements, lower speech volume. slurring words


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#1 Beau's Mom

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Posted 15 January 2011 - 07:52 PM

I was diagnosed with Parkinson's in December 2010, but have had symptoms for about ten years. For the last six months or so, I have noticed that my tongue moves constantly in my mouth. It looks OK but feels sore and swollen. Sometimes I feel like I am slurring my words or stumbling over my tongue. For the past two years I've been asking my husband to have his hearing checked and he insists that I talk too softly. Most others hear me fairly well but sometimes ask me to repeat myself. This has caused friction with my husband. Any suggestions? My neurologist tells me I don't need speech therapy and doesn't know what to do about my tongue movements.

I am not a human being trying to have a spiritual experience; I am a spiritual being having a (sometimes difficult) human experience.

 

First symptoms: right-hand tremor, constipation and restless arms 1978 (age 25). Depression and anxiety (non-motor symptoms) began in 1989 and worsened through the years. Last inpatient episode June 2013.

Diagnosed December, 2010 by a regular neurologist (age 57). After negative reactions to Requip, Mirapex and selegiline began Sinemet 25/100 3x/day. First MDS visit in Houston in February of 2011 was inconclusive. Second MDS visit at Baylor Fort Worth in May/June 2011 diagnosis changed to Parkinsonism, Sinemet stopped. Third MDS visit in August 2011 in WA State: received a confirmed diagnosis of idiopathic PD which had started on the right side and had now crossed to the left side as well. Restarted on Sinemet 25/100 4x/day. A short trial of Amantadine caused audio hallucinations in September 2011.

 

Current medications at age 62: Sinemet 25/100 ODT every 2.5 hours while awake (7/day). One Sinemet 25/100 CR between midnight and 4 AM. Trazodone 200 mg at bedtime, Fluvoxamine 300 mg at bedtime. Clonazepam 0.5 mg morning and afternoon, 1 mg at bedtime. Vit D3 2x/day, Calcium Carbonate Susp. 5 cc daily, Baclofen 10 mg 3x/day, Flonase two sprays 2x/day, Calcitonin-Salmon nasal spray once daily (for osteoporosis). Gel eye drops as needed throughout the day, Restasis Eye drops 2x/day, Nighttime eye ointment at bedtime. 02 2L per nasal cannula while asleep. Walker, electric wheelchair, moist and soft or pureed foods and 115 caregiver hours/month keep me sane.

 

All of the above subject to change based on progression, stress level, and dyskinesia. Whew! I'm glad I finally wrote that all out.


#2 Dr. Mahler

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Posted 18 April 2011 - 10:59 AM

I am glad you wrote about whether receiving speech treatment is appropriate for you.

Without seeing you in person for an evaluation, it is difficult for me to diagnose the exact nature of your tongue and speech problem. However, I can tell you that approximately 75-90% of individuals with Parkinson disease (PD) have speech and voice disorders at some time in the course of their disease. The most common perceptual speech characteristics include reduced loudness, monopitch, hoarseness, a breathy voice quality and/or imprecise articulation.

As you have experienced first hand, speech symptoms associated with PD can have a significantly negative impact on quality of life. The presence of speech disorders can effect communication at work, with family
or with friends. Seeking an evaluation with a speech-language pathologist experienced with PD as early as possible is important so you can begin an effective treatment program.

Although the incidence of speech and swallowing disorders in PD is high, the referral rate to speech-language pathologists for treatment is relatively low. One reason for the low referral rate is that the average age of diagnosis of PD is 60 so the perception is that speech and voice changes are just the result of normal aging. However, a study by Fox & Ramig (1997) demonstrated that people with PD were statistically significantly softer than healthy age-matched controls. In addition, studies of electromyography demonstrated that people with PD have less muscle stimulation to the thyroarytenoid muscles than healthy age-matched controls. A study by Baker et al., (1998) compared EMG activity of the thyroarytenoid muscles between young, healthy aged and people with PD. They found that EMG activity of people with PD was significantly less during a variety of phonatory tasks than for the healthy age-matched participants. In a swallowing study comparing people with PD to healthy controls it was found that people with PD swallowed more often during inhalation and at low tidal volumes than healthy age-matched controls placing them at greater risk for aspiration (Gross, Atwood, Ross, Eichorn, Olszewski, & Doyle, 2008). Also, physicians are not always aware that there are behavioral treatments that can improve speech and swallowing for people with PD.

I suggest you see a speech-language pathologist for a recommendation about whether there is a treatment that can help you.

Sincerely,
Leslie Mahler, PhD, CCC-SLP

Associate Professor

University of Rhode Island




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