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Speaking changes being noticed


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#1 MShep

MShep

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Posted 07 November 2011 - 11:30 AM

Dear Dr.s: I was diagnosed with PD 8yrs ago and have had all of the usual additions of med's (Sinemet, requip) increased over that period with the changes in my condition. I have noticed in the last 6-8 months, my speaking seems loud to me when in fact according to my wife and others, it gets soft and hard to hear at times when I think it might be loud. The other change has been speaking faster as I am talking and have a real problem getting the words to come out and/or hesitation, stuttering at times. This is bothersome to me and an embarrasement more than anything. Is this just one of the normal progressions of PD? I have heard that is the case but thought I would ask an expert. No diagnosis required!!. Ha Ha.
Thanks in advance.
Shep

#2 Dr. Mahler

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Posted 14 November 2011 - 07:35 PM

Dear Dr.s: I was diagnosed with PD 8yrs ago and have had all of the usual additions of med's (Sinemet, requip) increased over that period with the changes in my condition. I have noticed in the last 6-8 months, my speaking seems loud to me when in fact according to my wife and others, it gets soft and hard to hear at times when I think it might be loud. The other change has been speaking faster as I am talking and have a real problem getting the words to come out and/or hesitation, stuttering at times. This is bothersome to me and an embarrasement more than anything. Is this just one of the normal progressions of PD? I have heard that is the case but thought I would ask an expert. No diagnosis required!!. Ha Ha.
Thanks in advance.
Shep


Dear Shep,

Thank you for writing with this important question. Speech problems are very common in people with Parkinson disease! It has been reported that as many as 89% of people with PD have trouble with their speech or voice. The most common difficulties include reduced vocal loudness, monotone, mumbled articulation and a hoarse or breathy sounding voice.
The underlying cause of some of speech and voice difficulties has multiple sources:
• Reduced vocal fold adduction
• Reduced mouth opening
• Decreased dynamic modulation of muscles of articulation
• Mismatch between the person’s perception of their loudness during communication and actual levels of loudness

It is common for a mismatch to exist between the person’s perception of their loudness during communication and actual level of loudness and understandability just as the one you reported. For example, someone with PD may think people in their family need hearing aids when in fact it is the person with PD who is speaking too softly to be easily understood.

Unfortunately, the medications that can be so helpful for improving limb movement don’t always have a positive impact on bradykinesia for movement of speech muscles. That is why people who have communication difficulties as a result of PD need behavioral speech treatment.

The good news is that speech treatment may help you. I recommend that you speak to your physician and get a referral to a speech-language pathologist (SLP). Find an SLP who is experienced in treating communication deficits associated with PD. That person will do an evaluation to determine how much of your difficulty is due to changes in speech motor control and how much may be caused by changes in cognitive/linguistic abilities. Over 20 years of research has gone into the development of LSVT LOUD to help improve voice and speech in people with PD. Today there is level I evidence that the improvements gained following LSVT LOUD can last for up to two years. A speech and language evaluation will determine whether you are a candidate for this treatment.

I hope this information helps and that you will seek an evaluation soon to get started on improving your communication skills.

Dr. Mahler
Leslie Mahler, PhD, CCC-SLP

Associate Professor

University of Rhode Island




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