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Speech Problems Caused by Muscle Tightness


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#1 Washburn71

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Posted 07 October 2011 - 01:41 AM

I have had parkinson's for about 11 years. I had dbs surgery in December 2009.For the last few months I have had problems with my speech. When I talk the muscles in my neck, lower jaw, and mouth tighten up and my speech is slurred. I have been to a speech therapist and completed the Lee Silverman Voice Treatments. I did very well with the treatments completing them a week early, however, I was not able to resolve my speech problem. AT night time when I relax and am in bed I can talk in a normal voice but when I get up my speech problems start. When talking I can relax my muscles by speaking in a soft voice but when I try to speak louder my muscles tighten.

I have assumed this problem was parkinson's related, however, I find it very stange that I am able to relax my muscles at will. From my experienes in the past muscle tighting and relaxing are controlled by parkinson's. I am also trying to control some anxiety problems and I am wondering if that could be a cause of some of the problem. I thought that with your experience that you may have seen this before and could advise me if ther is anything I could do.

Thanks

#2 Dr. Mahler

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Posted 13 October 2011 - 06:08 PM

Changes in speech intelligibility frequently occur in PD affecting approximately 75-90% of the population (Ho et al., 1994; Logemann et al., 1978). Levodopa has been used as an effective treatment for the symptoms of PD but long term dopaminergic therapy may be complicated by motor fluctuations and levodopa-induced dyskinesias (Gentil et al., 1999). In contrast to other motor symptoms of PD, dysarthria has been poorly responsive to pharmacological treatments (D’Alatri et al., 2007). Recently, DBS has been applied to the subthalamic nucleus (STN) to alleviate symptoms of PD. However, DBS for PD patients may have little effect on speech intelligibility and in some instances it may result in worsening of dysarthria and hypophonia (Dromey et al., 2000). There are a limited number of studies reported in the literature that have specifically addressed voice and speech behaviors after DBS and very few have used quantitative measures to analyze communication variables (D’Alatri et al., 2007). There is an article in the New England Journal of Medicine (Krack, et al. 2003, pgs 1925-1934), on five-year follow-up of bilateral stimulation of the subthalamic nucleus in advanced Parkinson's disease. In the article it was documented that speech was one symptom resistant to improvement in patients post-surgery. As we complete more research with speech measures being taken pre- and post-surgery, the information for patients and families prior to surgery will improve.

Four people who received LSVT LOUD, an intensive behavioral voice treatment, following DBS were studied to examine the efficacy of treatment for improving communication in people who have PD (Spielman et al., 2010). This group was compared with four participants randomly assigned to a group that received LSVT LOUD but did not have DBS and four participants randomly assigned to a no-treatment group who did not have DBS. Participants were matched for age, time since diagnosis and severity of voice and speech symptoms.

The results of changes in loudness and vowel space following LSVT LOUD demonstrated that treatment outcomes for people who had DBS were similar to those of people with PD who did not have DBS. However, the clinicians who administered the treatment described qualitative differences that included; poorer voice quality throughout treatment for the DBS patients, more perceived effort on the part of the DBS patients to use a loud voice, and more difficulty with carryover activities. In addition, slurred speech and imprecise articulation were more problematic with the DBS patients.

These data support the efficacy of intensive behavioral treatment of voice and speech such as LSVT LOUD for people with DBS even though qualitative differences in treatment administration and outcomes may be experienced. Tripoliti et al., (2010) have identified stimulator placements and high stimulator settings that have a greater likelihood of a negative impact on speech. You might discuss your stimulator settings with your neurologist and see if there can be a compromise reached for movement and communication.

Sincerely,

Leslie Mahler, PhD, CCC-SLP


I have had parkinson's for about 11 years. I had dbs surgery in December 2009.For the last few months I have had problems with my speech. When I talk the muscles in my neck, lower jaw, and mouth tighten up and my speech is slurred. I have been to a speech therapist and completed the Lee Silverman Voice Treatments. I did very well with the treatments completing them a week early, however, I was not able to resolve my speech problem. AT night time when I relax and am in bed I can talk in a normal voice but when I get up my speech problems start. When talking I can relax my muscles by speaking in a soft voice but when I try to speak louder my muscles tighten.

I have assumed this problem was parkinson's related, however, I find it very stange that I am able to relax my muscles at will. From my experienes in the past muscle tighting and relaxing are controlled by parkinson's. I am also trying to control some anxiety problems and I am wondering if that could be a cause of some of the problem. I thought that with your experience that you may have seen this before and could advise me if ther is anything I could do.

Thanks


Leslie Mahler, PhD, CCC-SLP

Associate Professor

University of Rhode Island




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