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Speech changes associated with Parkinson disease


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#1 Dr. Mahler

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Posted 04 October 2011 - 09:44 AM

“What? I can’t hear you.” “You need a hearing aid!”
Have you had this exchange with a person who has Parkinson disease? It is frustrating and it happens all too often!

Speech problems are very common in people with Parkinson disease (PD). It has been reported that as many as 90% of people with PD have speech deficits (Ho et al, 1998; Logemann et al., 1978). Speech deficits can interfere with communication and have a negative impact on quality of life. The cause of speech deficits in PD is complex. It involves motor changes in the muscles of speech production and changes in sensory processing. Neural mechanisms underlying PD can cause speech muscles to be weak, slow to initiate, reduced in amplitude of movement, and to have tremor. This may result in speech that is reduced in loudness, monotone in pitch, has imprecise articulation, and/or a hoarse or breathy voice quality (Duffy, 2005).

An important feature of the communication disorder in PD is the individual’s misperception about his or her own loudness when speaking. It is common for people with PD to perceive that they are speaking at normal loudness when they are actually speaking at significantly reduced loudness levels (Fox et al., 2002). This is one reason many people with PD think that listeners are not paying attention or that a spouse needs a hearing aid when they are not understood.

Unfortunately, the medications that can be so helpful for improving limb movement don’t always have a positive impact on speech and don’t address the misperception of loudness that prevents people from speaking at loudness (Trail et al., 2005). Therefore, people with PD need behavioral speech treatment. The treatment needs to address speech muscle changes associated with PD as well as the sensory deficits for treatment to generalize to functional communication and last.

If you have any questions about communication or swallowing or cognitive changes associated with Parkinson disease, please write to us at this Forum. We look forward to hearing from you.

Leslie Mahler, PhD, CCC-SLP
Leslie Mahler, PhD, CCC-SLP

Associate Professor

University of Rhode Island

#2 margedodge1@aol.com

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Posted 27 May 2012 - 05:11 PM

I am asking this question for my mother who has PD and is having difficulty speaking -- all the symptoms you mention. Is there a device and application for text to speech that you would recommend? I would like to get her a mobile device with a text to speech application that she could type in her statment of question, hit a Talk button and convert the text to speech. Also, will she eventually lose her ability to speak?

#3 Dr. Mahler

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Posted 17 July 2012 - 03:41 PM

The choice of how to address communication changes in PD is highly individual. There is great heterogeneity among people with PD. An evaluation will determine whether behavioral treatment or an augmentative device is best for your Mother. Dr. Bassich listed some devices in an earlier post in this Forum to which you can refer. My preference is for people to improve their intelligibility with exercises and use devices only when it is necessary. This is partly because the exercises that make speech more understandable may also improve strength and/or coordination of swallowing muscles. Safe swallowing is critical for maintaining a healthy quality of life. Please write again if you have any further questions.

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

Associate Professor

University of Rhode Island




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