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A. Halpern MS CCC-SLP

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About A. Halpern MS CCC-SLP

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  • Birthday 01/01/1970

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  1. Thank you for your message. I completely understand your fears, and you have every right to be concerned. I would recommend that your husband receive another swallowing evaluation as soon as possible. I would recommend that the swallowing evaluation be a modified barium swallow study. This may or may not be what he had the first time. The modified barium swallow study is an x-ray of swallowing and provides the best information for specific techniques that could help your husband swallow more safely. This study should be done with a speech therapist. The therapist will give your husband various things to eat and drink and watch how he swallows. The therapist can then try strategies during the x-ray to determine what works best for your husband. The therapist can also provide your husband with the best exercises, strategies and positions to help him to swallow more safely and more effectively. There are many strategies and exercises available and without seeing your husband in person for an evaluation it is not possible for me to provide you with the best exercises for him. The speech therapist can outline a detailed strategy/exercise plan that is specific to your husband’s particular needs. I would recommend another swallowing evaluation as it sounds as if your husband’s swallowing has become worse since the first evaluation, and he also needs to be provided with some specific strategies to swallow safely. I would not wait to schedule this until your routine appointment with the neurologist, I would make the appointment for the swallow study as soon as you can. If the new neurologist can not request the study, you could call the old neurologist and ask them to request a modified swallow study, or call your husbands primary care physician and ask them to request the modified barium swallow study. You need to let the doctors know the severity of the problem and that you need to schedule the swallow study as soon as possible, and not wait for a follow-up appointment. It is indeed highly likely that food or liquid getting into your husband’s lungs (aspiration) has caused the previous episodes with pneumonia that you describe. This is why prompt action is necessary in order to avoid choking or having food/liquid get into his lungs and causing more episodes of pneumonia. The technique you describe above of “throw the entire mess to the back of his throat” is not safe and can put him at risk for choking or getting something into his lungs. It can put the material to the back part of the mouth where he has less control and it may go down before he is ready to swallow it. Also the posture of throwing the head back actually closes off the entrance to the esophagus more, putting individuals at higher risk for material entering the lungs. A safer way to swallow is actually to tuck the chin to the chest while swallowing. This technique could be demonstrated by a speech therapist during the modified barium swallow study. The other recommendation is typically to put the pill in a spoonful of yogurt, or pudding, but it sounds as if you are already trying this. Until you can receive another swallow evaluation, another thing you could try is to crush the pills and put them in the types of food that he does not have trouble swallowing. You need to check with the pharmacist before you do this however, in order to make sure that it is okay to crush the pills. Certain pills should not be crushed. You could also ask the pharmacist if any of the pills come in a liquid form. My overall recommendation however, is that your husband obtain a modified barium swallow study as soon as possible. I would recommend you call your husband’s doctor as soon as you can and request this study.
  2. Dear Jeanne, Thank you for your message. In answer to your question, yes, I think it would be helpful for you to see a certified LSVT therapist. You can find such a therapist by going to www.lsvt.org. If it is possible, you could try to schedule an appointment so that you are near the end of your medication cycle and then the therapist could see you in both your on and off state. The therapist could determine if the LSVT is appropriate in helping with the symptoms you mention above, or if a different approach may be helpful. You are correct that low volume and hoarse voice are the more common complaints in PD. Without seeing you in person for an evaluation, or knowing your full medical history, it is difficult for me to give you a specific answer regarding the issues you mention above, as the speech problems you describe could be occurring for different reasons related to the PD. This is why an evaluation with a speech therapist who has a specialty in PD would be beneficial to you.
  3. Dear Friend, Hoarse voice and low volume are very common in Parkinson disease. Fortunately, there is something that you can do! There is an effective treatment that can help improve voice and speech by training increased loudness, it is called the LSVT®. The LSVT® has been documented to increase loudness and improve intelligibility in individuals with PD. To find a certified LSVT therapist in your area, and to find out more about the LSVT read more below. In regards to doing speech exercises at home. The best course of action is to see a speech therapist. Home exercises can be very effective as a follow-up to treatment with a speech therapist, but they should not be used as a substitute. It is important to first see an LSVT therapist to learn how to produce the appropriate amount of loudness in a healthy way. How to locate LSVT Certified Speech Therapists: 8. Go to the LSVT Website at www.lsvt.org. 9. From the opening page, click on the link, “Go to LSVT Website”. 10. There are series of links on the left hand side of the webpage - click on the link, “Locate Certified Clinicians.” 11. Accept the disclaimer by clicking the “I agree” button 12. From the map or pull down menu, select your country 13. Next select your state 14. A list of clinicians in your state will appear with the therapists contact information. If you have any difficulty with the website, email a request for clinicians to info@lsvt.org. Asking doctor for referral and prescription: If you are experiencing any changes in your speech or voice, be sure to tell your doctor. Ask for a referral for LSVT speech therapy. It is best if the physician can write a prescription for, “Speech evaluation and treatment utilizing the LSVT 4 days/week for 4 weeks, 50-60 minute sessions.” If you have not noticed changes in your speech, but a spouse, caretaker, or friend has – pay attention to their comments. One aspect of the speech disorder in PD is that the person with PD is often “unaware” of the changes in speech or voice. He or she feels as though they are speaking loudly enough, but others can not hear or understand them. The sooner you get a speech evaluation and start speech therapy – the better! You can provide your doctor with information about LSVT. Information is available (reference list of published data) on the LSVT website at www.lsvt.org. Insurance reimbursement: LSVT has been successfully reimbursed by many insurance providers and Medicare. There are certain provisions: • speech therapy must be included on your policy • if you have Medicare, you will need to receive LSVT at a Medicare provider facility (typically hospitals, outpatient rehabs, etc.). Some private practice speech therapists are unable to bill Medicare for services. • you may need a prescription for speech evaluation/therapy from your primary care physician Pearls for receiving best therapy: 1. Make sure your speech therapist is certified in LSVT. The LSVT Training and Certification is a special 2-day training course that speech therapists attend in addition to their training as a speech therapist. There is a list of LSVT Certified speech therapists on the website www.lsvt.org. 2. Ask your speech therapists: How many patients have you treated? What are your typical outcomes? How long ago were you certified? 3. Beware if a therapist offers a “modified” LSVT program. There is no such thing as modified LSVT. Any changes to the standardized LSVT protocol are NOT supported by research data and efficacy outcomes. IF you receive LSVT, you will get the following (this is the same everywhere in the world – there are not modifications): Components of LSVT therapy • Treatment will consist of 4 days of therapy a week for 4 weeks. • Treatment session will last 50-60 minutes • Treatment will be delivered individually. • The first half of the session will be spent on 3 daily tasks: o Sustain “ah” with increased loudness as long as you can (minimum 15 repetitions) o Sustain “ah” while going high/low in pitch – hold for 5 seconds (minimum 15 repetitions for high and 15 repetitions for low) o Repeat a list of 10 self-selected functional phrases 5 times each session (these phrases NEVER change) • The second half of the session will be spent on a speech hierarchy: o Week 1 – words and phrases o Week 2 – sentences o Week 3 – reading o Week 4 – conversation The LSVT clinician will encourage you to bring in material for speech practice that is meaningful and interesting to you. This material will change everyday of therapy. The entire second half of the session you will be talking and practicing your LOUD voice. If your speech therapist has done a good job – you will feel tired at the end of the session. • Homework: You will have homework exercises to practice everyday of the entire month of speech therapy. On days you have speech therapy (e.g., Mon-Thurs), you will practice one other time a day for 5-10 minutes. (completing daily tasks and hierarchy exercises) On days you don’t have speech therapy (e.g., Fri – Sun), you will practice twice a day for 10-15 minutes (completing daily tasks and hierarchy exercises). • Carryover exercises: Everyday of the entire month of speech therapy (Mon-Sun) you will have a carryover assignment. This is an assignment to use your LOUD voice with another person outside of the therapy room. The clinician will work with you to decide on a very specific task in which you will use your LOUD voice – as loud as you practice in the treatment room – in a real life situation. These exercises help a person with PD realize, that what feels and sounds too loud to them is actually within normal limits. The LSVT clinicians will make you accountable EVERYDAY for doing your Homework and Carryover exercises. The daily homework and carryover exercises are an essential part of the treatment program, and must be completed daily. Good luck to you!
  4. Dear Linda, Thank you for your message. What you report is very common in Parkinson disease. Fortunately, there is something that you can do! There is an effective treatment that can help improve voice and speech by training increased loudness, it is called the LSVT®. The LSVT® has been documented to increase loudness and improve intelligibility in individuals with PD. To find a certified LSVT therapist in your area, and to find out more about the LSVT read more below. How to locate LSVT Certified Speech Therapists: 1. Go to the LSVT Website at www.lsvt.org. 2. From the opening page, click on the link, “Go to LSVT Website”. 3. There are series of links on the left hand side of the webpage - click on the link, “Locate Certified Clinicians.” 4. Accept the disclaimer by clicking the “I agree” button 5. From the map or pull down menu, select your country 6. Next select your state 7. A list of clinicians in your state will appear with the therapists contact information. If you have any difficulty with the website, email a request for clinicians to info@lsvt.org. Asking doctor for referral and prescription: If you are experiencing any changes in your speech or voice, be sure to tell your doctor. Ask for a referral for LSVT speech therapy. It is best if the physician can write a prescription for, “Speech evaluation and treatment utilizing the LSVT 4 days/week for 4 weeks, 50-60 minute sessions.” If you have not noticed changes in your speech, but a spouse, caretaker, or friend has – pay attention to their comments. One aspect of the speech disorder in PD is that the person with PD is often “unaware” of the changes in speech or voice. He or she feels as though they are speaking loudly enough, but others can not hear or understand them. The sooner you get a speech evaluation and start speech therapy – the better! You can provide your doctor with information about LSVT. Information is available (reference list of published data) on the LSVT website at www.lsvt.org. Insurance reimbursement: LSVT has been successfully reimbursed by many insurance providers and Medicare. There are certain provisions: • speech therapy must be included on your policy • if you have Medicare, you will need to receive LSVT at a Medicare provider facility (typically hospitals, outpatient rehabs, etc.). Some private practice speech therapists are unable to bill Medicare for services. • you may need a prescription for speech evaluation/therapy from your primary care physician Pearls for receiving best therapy: 1. Make sure your speech therapist is certified in LSVT. The LSVT Training and Certification is a special 2-day training course that speech therapists attend in addition to their training as a speech therapist. There is a list of LSVT Certified speech therapists on the website www.lsvt.org. 2. Ask your speech therapists: How many patients have you treated? What are your typical outcomes? How long ago were you certified? 3. Beware if a therapist offers a “modified” LSVT program. There is no such thing as modified LSVT. Any changes to the standardized LSVT protocol are NOT supported by research data and efficacy outcomes. IF you receive LSVT, you will get the following (this is the same everywhere in the world – there are not modifications): Components of LSVT therapy • Treatment will consist of 4 days of therapy a week for 4 weeks. • Treatment session will last 50-60 minutes • Treatment will be delivered individually. • The first half of the session will be spent on 3 daily tasks: o Sustain “ah” with increased loudness as long as you can (minimum 15 repetitions) o Sustain “ah” while going high/low in pitch – hold for 5 seconds (minimum 15 repetitions for high and 15 repetitions for low) o Repeat a list of 10 self-selected functional phrases 5 times each session (these phrases NEVER change) • The second half of the session will be spent on a speech hierarchy: o Week 1 – words and phrases o Week 2 – sentences o Week 3 – reading o Week 4 – conversation The LSVT clinician will encourage you to bring in material for speech practice that is meaningful and interesting to you. This material will change everyday of therapy. The entire second half of the session you will be talking and practicing your LOUD voice. If your speech therapist has done a good job – you will feel tired at the end of the session. • Homework: You will have homework exercises to practice everyday of the entire month of speech therapy. On days you have speech therapy (e.g., Mon-Thurs), you will practice one other time a day for 5-10 minutes. (completing daily tasks and hierarchy exercises) On days you don’t have speech therapy (e.g., Fri – Sun), you will practice twice a day for 10-15 minutes (completing daily tasks and hierarchy exercises). • Carryover exercises: Everyday of the entire month of speech therapy (Mon-Sun) you will have a carryover assignment. This is an assignment to use your LOUD voice with another person outside of the therapy room. The clinician will work with you to decide on a very specific task in which you will use your LOUD voice – as loud as you practice in the treatment room – in a real life situation. These exercises help a person with PD realize, that what feels and sounds too loud to them is actually within normal limits. The LSVT clinicians will make you accountable EVERYDAY for doing your Homework and Carryover exercises. The daily homework and carryover exercises are an essential part of the treatment program, and must be completed daily. Improving speech and voice in PD is not easy. It takes a commitment to the LSVT exercises and tasks in therapy. The benefit is priceless – improved communication.
  5. Dear Jacob, The most common voice/speech complaints for people with PD are reduced loudness, a monotone voice, or hoarse/breathy voice. People with PD who have more severe voice and speech problems can develop what sounds like a stutter or stammer, it is a rapid pattern of speech, and certain parts of speech are repeated. It is not as typical for people to report problems with particular words or sounds as you describe above, but rather having the problem in general. I know that you mentioned that you would rather not see an SLP. I would recommend that you at least seek an evaluation to determine what voice/speech exercises may work for you to possibly help to improve your ability to communicate. You have important things to say that need to be shared! To find a speech therapist who has more experience with PD, you can go to the LSVT website at www.lsvt.org.