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Dr. Bassich

Speech Clinician Moderators
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About Dr. Bassich

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    Speech Clinician Moderator
  • Birthday 01/01/1970

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  1. Keep me posted of what you learn! Sometimes the best ENTs and Neurologists do not communicate. So you are doing the right thing to advocate for yourself. If sinemet is working, go with. I agree with your decision to not have Botox at this point in time. Best, Dr. Bassich
  2. As a voice clinician, I am familar with both Spasmodic Dysphonia as well as Young-onset PD. Given the brief explanation of your symptoms, I wonder if you have two co-existing neurologic disorders? I am not familar with sinemet helping Spasmodic Dysphonia. So maybe it is helping you with your voice symptoms associated with PD. The traditional method for treatment od Spasmodic Dysphonia is botox injections. But given you diagnosis of PD, botox might worsen your symptoms. It might be that you don't have spasmodic dysphonia - but that your voical and jaw tremor is a variant of your young-onset, atypical PD - not Spasmodic Dysphonia. Don't be embarrassed to ask questions at the conference this weekend. There are NO WRONG questions. Ask for information. Dr. Bassich, Ph.D., CCC-SLP
  3. Closed vocal cords

    I understand your concerns. There are many reasons for a hand tremor, other than Parkinson disease. You need to confirm a diagnosis of PD from a Movement Disorders Specialist. There are many other reasons why you are experiencing the voice problems and problems with excessive saliva. If after your meet with your MDS in OCT and a diagnosis of PD is not confirmed, I suggest you see a laryngologist (an ENT that specializes in vocal disorders). This doctor should complete an examination that includes putting a small scope (camera) in your nose, that will allow visualization of your larynx (voice box). Perhaps your speech therapist could provide you with an appropriate referral.
  4. I've been hoarse for over 4 months now

    I'm glad that you have seen a laryngologist. I am concerned about your use of the APP without checking out the settings with a Voice Clinician. If the settings are not appropriate, you could be hurting your vocal folds further. Please make sure you bring your IPAD to your first appointment with a therapist to ensure that you are speaking at a level that is best for you and not creating excessive tension in your tongue. Celia J. Bassich, Ph.D. CCC-SLP
  5. I've been hoarse for over 4 months now

    Dear Mark, There are many reasons why a person can develop a "lump, bump, or hump" on their vocal folds. I am glad you saw an ENT - but I am not sure why he referred you to "a surgeon." Without knowing more about your situation, it is difficult to advise you. That said, many people develop a growth on their vocal folds because of things they are doing that hurt their vocal folds. Some growths, even though they are not cancer, need to be removed. But others will go away with proper voice therapy with a trained speech pathologist who specialist who treats persons with voice disorders. Physical therapy will not help this problem. ENT's are "Ear Nose Throat" doctors - and not all specialize in voice problems. I recommend that you see a "laryngologist" - that is a doctor who specializes in voice disorders and who is trained to diagnose and treat vocal fold (or voice) disorders. Perhaps "the surgeon" you were referred to is a "laryngologist." If not, you should seek another referral source. Dr. Celia Bassich
  6. Sudden inability to talk

    Dear Dina, Your mother's sudden change in speech was atypical of symptoms observed in persons with Parkinson Disease. And you and your husband did the right thing by taking her to the ER. A word of caution, a CT scan completed within 24-48 hours after a stroke will not show signs of a stroke, particularly if it was a small stroke (bleed). I trust she is now recovered? Is she complaining of a "thick tongue"? Have you noticed that when you ask her to raise her arms over her head, one arm is higher? Does she have a slight droop of her face on one side? If so, these are acute signs of a stroke. If you find her speech is still slurred and she still has a dramatic change in her speech, I suggest you pursue a neurology consult and a repeated CT scan to re-evaluate if she did indeed have a small stroke. Dr. Celia Bassich
  7. Is it this hard for everyone?

    Dear Peself, I'm sorry you're having so much difficulty in finding a speech pathologist to help you. The voice problems you describe are very common in person with PD and there are therapy programs that have evidence based practice to support their efficacy. Have you contacted the NPF Helpline? This is a Helpline sponsored by the National Parkinson Foundation (NPF). NPF sponsors a national training program for health professionals that is designed to teach OT, PT, SLP, Nurses, Nurse Practioners, MDs, Music Therapists and Social Workers about special techniques for working with persons with PD. NPF should have a list of the SLPs who have completed this training. This training program is called "Allied Team Training for PD" (ATTP). To date, there have been over 22 workshops throughout the United States, including Hawaii. Another training program for SLPs who want to specialize in techniques to work with persons with PD is the Lee Silverman Voice Treatment program (LSVT). If you google LSVT you will find their website. They maintain a registry of all SLPs who have completed their training and are certified in providing this program. They also are piloting the use of TeleHealth delivery of LSVT - so if you are comfortable with a telehealth delivery model for treatment, perhaps you could ask them for such specific contacts if there are no SLPs in close proximity to where you live. I hope these tips are helpful and you can navigate to a SLP who can help you. Dr. Bassich
  8. Swallowing and PD

    Dr. Mahler raises a good question - "Is there really mucus present?" If so, you might want to try some ways to thin your mucus. There are facial steamers that can be purchased on-line or at a store that has a pharmacy. They typically cost under $40. I advise my patients to steam for 5 minutes twice daily, particularly during the dry winter months (low humidity) or if you live in a dry or arid climate. Maintaining adequate body hydration is also important. Drinking sips of room temperature water throughout the day will help to keep you body adequately hydrated. Buy a water bottle and keep it handy so you can take sips. Remember that beverages that have caffeine contribute towards dehydration, so make sure you compensate with sips of water. Also, if you have allergies and are taking antihistamines, they will also contribute towards dehydration. There are over the counter medications, such as mucinex that help the body to reabsorb mucus, but consult with your doctor to make sure they are safe for you. Finally, you might want to see an Ear, Nose, and Throat doctor (ENT) and have the doctor examine your nose and nasopharynx (the back part of your nose that is connected to your throat). This doctor might help you to determine if your problem is a reflux issue or a true problem with mucus. Sincerely, Celia Bassich Ph.D., CCC-SLP
  9. Swallowing problems

    Dear Beau's Mom, I agree with Dr. Mahler's advice but have a few other ideas. It is hard for me to provide advice with such little information. But here are some thoughts. First, you mentioned that you were diagnosed with slow esophageal motility. I hope you are seeing a GI specialist, who can advise you about this problem. I like to think of this problem as “The clogged drain problem.” In other words, even if you have a strong tongue and can swallow efficiently, the food is getting backed up, much like a sink with a clogged drain. There are some resistance exercises, that Dr. Mahler mentioned, that could possibly improve your tongue strength. But you must be under the care of a speech pathologist that specializes in swallowing. Your speech pathologist could design a program to hopefully improve tongue strength and to assist you to learn how to properly position your food after it’s chewed and avoid unsafe behaviors like kicking your head back while swallowing. There are various exercises such as “tongue push-ups” , effortful swallowing, and expiratory muscle strength training – but they must be taught and your performance should be monitored by a SLP. Finally, try to eat your meals during the middle of your medication cycles versus at other times. This could possibly maximize your swallowing and you might find that at this time you have better oral control, particularly with your tongue. I hope these ideas are helpful. Above all, I urge you to seek guidance from a GI specialist and a Speech Pathologist who specializes in swallowing problems.
  10. LSVT/LOUD software options

    Dear Pat, It's unfortunate that your husband cannot participate in traditional LSVT-Loud, as it's prescribe - meaning 4 days per week for 4 week. However, there is one study that documents positive outcomes for persons with Parkinson disease who completed LSVT using a ‘SKYPE’ or telehealth delivery model for treatment. The reference is Theodoros, D. et al., (2006). Treating the speech disorder in Parkinson’s disease online. Journal of Telemedicine and Telecare, 12(S3), 88-91. However, there are many states where Medicare or other insurance companies do not approve using telehealth for speech therapy. If reimbursement issues are not a problem for you, I suggest you navigate to the Lee Silverman Voice Therapy website to learn more about telehealth delivery and to find a therapist in your area who can work with you, if the speech pathologist who evaluated your husband is not able to provide a telehealth approach. The LSVT website is http://www.lsvtglobal.com/ I hope this helps you to seek help to find some speech therapy that will be helpful to your husband! Dr. Celia Bassich, PhD, CCC-SLP Faculty Member, Allied Team Training for Parkinson Disease, NPF
  11. drooling

    Dear Rachal, Your list of exercises is great! However, I would add more tongue base exercises, designed to improve tongue base ROM. Some are describe in Dr Logemann's text 'Evaluation and Treatment of Swallowing Disorders' 2nd Ed 1998, p. 210: 1 - Pt can be asked to pull the tongue straight back in the mouth as far as possible and to hold it for 1 sec. 2 - Pt should pull back and pretend to gargle as hard as possible and then release. 3 - Pretend to yawn, which also pulls the tongue base back. I find that the super-supraglottic swallow is too difficult for most persons with PD. Hope you find these suggestions helpful. Dr. Celia Bassich Faculty, Allied Team Training for PD, NPF
  12. Speech issues

    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
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