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#1 newbob10

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Posted 06 September 2011 - 09:19 PM

Dr. Mahler,

I had a question regarding speech issues and PD. I don't have problems every day, but most days. Some days are worse than others. Most days, at some point during the day I'll begin to have trouble projecting my voice - like it's caught in the back of my throat, or being squeezed by my throat muscles - producing the breathy/hoarse voice it sounds like is fairly common here. As many others have mentioned, I'm clearing my throat to try to get past the issue when talking to others.

There doesn't seem to be a rhyme or reason to when it happens. Other symptoms are sometimes present, sometimes not. Sometimes it will last for hours. Sometimes it will go away in a short period of time - with or without talking in between. Is this common (the unpredictability?)

Are there things I can do that would be helpful during the day to "ward off" these voice issues (water, lozenges, gum, etc)?

This is a symptom that didn't bother me much in the past, but it is beginning to, and causing some quizzical looks from my co-workers. I can only blame it on a "frog in my throat" so many times.

I did have an Otolaryngologist look at my throat earlier in the spring. He said he didn't see tremors, but saw "extra movement" in my throat muscles and said only "you're not imagining things, but there's nothing I can diagnose at this point". Not sure what to do with that. Any insight on that observation would be welcome.

Thanks in advance for your reply.

Bob

#2 Dr. Mahler

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Posted 07 September 2011 - 03:01 PM

Dear Bob,

Glad you wrote to ask about your voice because there is definitely something that you can do. It is very common to have voice problems wax and wane eventually getting progressively worse. What you must also realize is that you may not be the best judge of how your voice is sounding to others and how easy or challenging it is to understand you.

Sensorimotor difficulties associated with PD have been recognized for years (Schneider et al., 1987 & Koller, 1984). It is possible that underactivation of cortical motor centers caused by decreased excitation of basal ganglia circuitry has motor and sensory components. Muscle movements are reduced in amplitude and there is a perceptual failure to select the muscle commands for movements of normal amplitude (Berardelli, 1986). A mismatch in the sensory perception of effort relative to the target output has also been identified in people with PD (Ho et al., 1999 & Ramig et al., 1995). Often people with PD think a family member or friends need a hearing aid when, in fact, the person is speaking softly or with slurred speech. Then when people with PD produce speech at an average normal loudness level their perception is that they are shouting.

Your question is important because any treatment targeted at improving functional communication for people with PD must address the speech motor and sensorimotor components of the disorder for long term carryover and success. You can achieve this through a speech exercise regimen that follows principles of motor learning. LSVT is an example of such a treatment. Start with an evaluation with a speech-language pathologist experienced with PD to get recommendation appropriate for you as an individual.

I don't know what to say about the ENT's comment without being able to read the report or see you in person for myself. However, I can tell you that starting therapy as soon as possible with maximize your communication potential and help you retain the best possible speech skills as long as possible.

Please write again if you have any further questions.

Sincerely,

Leslie Mahler, PhD, CCC-SLP


Dr. Mahler,

I had a question regarding speech issues and PD. I don't have problems every day, but most days. Some days are worse than others. Most days, at some point during the day I'll begin to have trouble projecting my voice - like it's caught in the back of my throat, or being squeezed by my throat muscles - producing the breathy/hoarse voice it sounds like is fairly common here. As many others have mentioned, I'm clearing my throat to try to get past the issue when talking to others.

There doesn't seem to be a rhyme or reason to when it happens. Other symptoms are sometimes present, sometimes not. Sometimes it will last for hours. Sometimes it will go away in a short period of time - with or without talking in between. Is this common (the unpredictability?)

Are there things I can do that would be helpful during the day to "ward off" these voice issues (water, lozenges, gum, etc)?

This is a symptom that didn't bother me much in the past, but it is beginning to, and causing some quizzical looks from my co-workers. I can only blame it on a "frog in my throat" so many times.

I did have an Otolaryngologist look at my throat earlier in the spring. He said he didn't see tremors, but saw "extra movement" in my throat muscles and said only "you're not imagining things, but there's nothing I can diagnose at this point". Not sure what to do with that. Any insight on that observation would be welcome.

Thanks in advance for your reply.

Bob


Leslie Mahler, PhD, CCC-SLP

Associate Professor

University of Rhode Island

#3 Dr. Bassich

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Posted 07 September 2011 - 03:14 PM

Dr. Mahler,

I had a question regarding speech issues and PD. I don't have problems every day, but most days. Some days are worse than others. Most days, at some point during the day I'll begin to have trouble projecting my voice - like it's caught in the back of my throat, or being squeezed by my throat muscles - producing the breathy/hoarse voice it sounds like is fairly common here. As many others have mentioned, I'm clearing my throat to try to get past the issue when talking to others.

There doesn't seem to be a rhyme or reason to when it happens. Other symptoms are sometimes present, sometimes not. Sometimes it will last for hours. Sometimes it will go away in a short period of time - with or without talking in between. Is this common (the unpredictability?)

Are there things I can do that would be helpful during the day to "ward off" these voice issues (water, lozenges, gum, etc)?

This is a symptom that didn't bother me much in the past, but it is beginning to, and causing some quizzical looks from my co-workers. I can only blame it on a "frog in my throat" so many times.

I did have an Otolaryngologist look at my throat earlier in the spring. He said he didn't see tremors, but saw "extra movement" in my throat muscles and said only "you're not imagining things, but there's nothing I can diagnose at this point". Not sure what to do with that. Any insight on that observation would be welcome.

Thanks in advance for your reply.

Bob



#4 Dr. Bassich

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Posted 07 September 2011 - 03:31 PM

Bob, I echo Dr. Mahler's advice. Studies have demonstrated that the voice muscles are affected early in the disease. Also, persons with PD commonly experience problems with gastro-esophageal reflux disease, that can cause irritation to the vocal folds. A speech pathologist who specializes in voice and PD could advise you about risk factors for reflux and counsel you about how to maintain healthy vocal folds (things such as maintaining good hydration ... drinking sips of room temperature water throughout the day, decreasing use of caffeinated or acholic beverages or juices with a high acidic content, such as orange, grapefruit juice or lemonade). Also, as Dr Mahler pointed out, vocal exercise is very important.

I hope you will find a speech pathologist who specializes in voice and PD who can provide you with a voice evaluation, vocal wellness, and vocal exercise. The Lee Silverman Voice Treatment program is supported by evidence based practice and research. You should learn about this program and see if you could participate in this type of therapy. The National Parkinson Foundation has a list of Speech Pathologists who specialize in treatment of persons with PD. I believe you can find this link on the NPF website homepage.

Dr. Bassich
Faculty Member, Allied Team Training for Parkinson Disease

#5 Dr. Mahler

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Posted 19 September 2011 - 01:49 PM

Dr. Mahler,

I had a question regarding speech issues and PD. I don't have problems every day, but most days. Some days are worse than others. Most days, at some point during the day I'll begin to have trouble projecting my voice - like it's caught in the back of my throat, or being squeezed by my throat muscles - producing the breathy/hoarse voice it sounds like is fairly common here. As many others have mentioned, I'm clearing my throat to try to get past the issue when talking to others.

There doesn't seem to be a rhyme or reason to when it happens. Other symptoms are sometimes present, sometimes not. Sometimes it will last for hours. Sometimes it will go away in a short period of time - with or without talking in between. Is this common (the unpredictability?)

Are there things I can do that would be helpful during the day to "ward off" these voice issues (water, lozenges, gum, etc)?

This is a symptom that didn't bother me much in the past, but it is beginning to, and causing some quizzical looks from my co-workers. I can only blame it on a "frog in my throat" so many times.

I did have an Otolaryngologist look at my throat earlier in the spring. He said he didn't see tremors, but saw "extra movement" in my throat muscles and said only "you're not imagining things, but there's nothing I can diagnose at this point". Not sure what to do with that. Any insight on that observation would be welcome.

Thanks in advance for your reply.

Bob

Dear Bob,

It sounds like there is variability in your speech including your voice that may be associated with fluctuations in the PD. Medications help the limb fluctuations more than the fluctuations in speech and swallowing. The best thing you can do to "ward off" these episodes is to start speech exercises as soon as possible. Exercise in PD has been shown to have positive effects for the body and speech muscles. Be careful of lozenges since some of them are for cold symptoms and can be drying to the throat which is the opposite of what you want. Drinking plenty of water is an excellent strategy. Voice changes associated with PD are not necessarily related to tremor and can exist when tremor is not present.

Get a referral from your physician for speech therapy and talk with a speech-language pathologist. They will recommend the speech exercise program that is right for you. Any speech regimen should include intensive exercise (every day) to gain the maximum benefit.

Thank you for following up. Keep writing if you have any more questions.

Sincerely,
Dr. Mahler
Leslie Mahler, PhD, CCC-SLP

Associate Professor

University of Rhode Island




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