Stanford PD Community Blog

Stanford Parkinson's Community
  • Home
You are here: Home / Webinars - Announcements & Notes / “Parkinson’s Disease and Communication” – Webinar Notes

“Parkinson’s Disease and Communication” – Webinar Notes

February 16, 2021 By Parkinson's Community Help

On February 16th, The American Parkinson Disease Association (APDA) hosted Lisa Sommers to speak about Parkinson’s disease (PD) and communication.  Lisa is the clinic director, Center for Language Speech, and Hearing, University of Massachusetts Amherst.  Lisa discussed the cognitive and communicative changes that happen during the course of PD and their personal impact. She detailed different treatment options such as LSVT Loud and pacing boards. 

Lisa said that 90% of people with PD will experience changes in communication. Areas affected include breath support, voice production (it becomes softer), speed and accuracy (reduced clarity), inflection of voice, and reduced facial expressions (can cause people to seem depressed or disinterested when they actually are not). Medications have not shown to be effective with speech, voice, and swallowing changes associated with PD. Some cognitive changes are attention, memory, executive function ability, language difficulties, and visuo-spatial difficulties. 

For help finding a speech language pathologist or an audiologist, please visit the American Speech-Language-Hearing Association’s page mentioned in the talk.

For more resources on speech and voice therapy, see this Stanford Parkinson’s Community Outreach page.

For more resources on speech and swallowing, see this Stanford Parkinson’s Community Outreach page.

For resources on cognitive changes, see this Stanford Parkinson’s Community Outreach page.

For speech and vocal exercises, see this Stanford Parkinson’s Community Outreach page.

Please see below for notes on the February 16th webinar. The webinar recording might be available at a later date, but I am unsure if a recording was made.

Regards, 

– Joëlle Kuehn


“Parkinson’s Disease and Communication”

Speaker: Lisa Sommers, CCC-SLP, clinic director, Center for Language Speech, and Hearing, University of Massachusetts Amherst

Webinar Host: American Parkinson Disease Association Massachusetts (APDA MA) 

Webinar Date: February 16, 2021 

Summary by Joëlle Kuehn, Stanford Parkinson’s Community Outreach

Note: The content provided in this webinar is not a one-size-fits all.  Some people experience things that others don’t and the severity also varies.

Communication changes common with Parkinson’s Disease (PD):

Interesting fact: 90% of people with PD will experience changes in communication

  • Changes such as speech, voice, cognition, and swallowing can be subtle and can fluctuate, and can occur early in the disease process 
  • Areas affected: breath support, voice production (softer), speed and accuracy (reduced clarity), inflection of voice, and reduced facial expressions (can cause people to seem depressed or disinterested when they actually are not)
  • Sensory disconnect – people feel that they aren’t communicating differently, it feels the same as before, and do not notice that they have an issue (“I’m not the one that is too soft, my spouse just needs a hearing aid”).  Hearing a recording can help a person realize this disconnected.
  • Medications have not shown to be effective with speech, voice, and swallowing changes associated with PD

Cognitive changes possible with PD:

  • Paying attention (multitasking) can become harder, such as:
    • Reading A recipe while preparing a meal
    • Talking on the phone while shopping
    • Having a conversation at a party while ignoring the other conversations around you
  • Memory challenges:
    • Learning new skills or new information
    • Learning a new way to do something you’ve always done a certain way
  • Executive functions can become more difficult:
    • Planning, managing and completing complex tasks (finances, medical appointments, med management)
    • Decision making
    • starting/stopping/switching tasks
    • Managing emotions
  • Language difficulties
    • Difficulty thinking of words quickly, especially in conversation and during dual-tasking
    • Expressive language issues are complicated by the motor challenges required to express thoughts and feelings (i.e. soft voice, small handwriting).  Need to try to speak louder, or write larger.
    • Slowed auditory processing – not a hearing loss, but processing slower and responding slower
  • Visuo-spatial difficulties
    • Difficulty keeping place when reading, shifting visual attraction (like reading music and lyrics simultaneously), visual analysis and synthesis (such as complex visual games)

Other things that impact communication:

  • Depression
  • Anxiety
  • Apathy
  • Medication related problems
  • Sleep disturbances
  • Hearing loss – is important but often underestimated or not discussed

Note: treating any of the above issues can potentially positively impact cognitive functioning

Hearing loss and cognition:

  • 1 of 3 adults aged 65+ have hearing loss. Increases to 2 of 3 by age 70+
  • Among adults 70+ with “aidable” hearing loss, only around 30% use hearing aids
  • Recent study shows that hearing loss is linked to cognitive decline and increased risk of cognitive impairment, including dementia.  Don’t know the exact nature of link between hearing loss and cognitive decline yet though 

Hearing loss may lead to:

  • Sensory deprivation
  • Social isolation and depression
  • Increased cognitive effort to go through the world

Personal impact of communication and cognitive changes:

  • Frustration
  • Changes in routines due to decreased ability (sometimes gradual decline).  Can’t go through the drive through anymore because the people taking the order can not hear the person with PD, stop taking on the telephone with people, etc.
  • Sarcasm or humor is misunderstood (facial expression is decreasing and voice is monotone)
  • People who are still working report decreased job performance or others perception of their performance
  • May curtail normal activities, like volunteering, social clubs
  • Impact on self-image, risk for depression/apathy from feeling isolated
  • At risk for social isolation that can happen gradually but insidiously.  Can start with small things such as no longer sitting and talking at a dinner party, just letting others do the talking

Seeking early treatment is the best possible thing you can do. Do not wait until you are having significant issues being understood by others. 

Evidence based treatments:

  • Best outcome is a combination of research evidence, patient values, and clinical expertise. 
  • Working with a speech language pathologist for speech therapy is helpful

Treatments focusing on speech and voice:

  • Speech-language pathology (SLP) services
    • LSVT LOUD (lsvtglobal.com) – voice treatment specifically for PD
      • Focus on voice specifically
      • Individualized for the patient
        • Standard voice exercises but also additional customized activities that are functional for you (what you need to be able to do better)
      • Intense
      • Has been studied well in terms of dosage – intensity of treatment approach matters 
        • 4x/week for 4 weeks yields best treatment outcomes according to research
      • Can be in-person or via telepractice with similar outcomes to in-person services
    • SpeechVive (speechvive.com)
      • External device worn in the ear
      • Works on Lombard effect – reflex that we have that when we are in a noisy environment, we raise our voice when speaking 
      • SpeechVive introduces background noise (not to level where it impacts hearing), but it does trigger the Lombard effect
      • Trained speech pathologist needs to calibrate device for you
      • Requires person to put effort in voice similar to LSVT LOUD
    • Voice amplifiers 
      • Complementary to other treatment
    • Pacing boards
      • Regulate rate of speech
    • Augmentative & Alternative Communication
      • For higher levels of impairment where a person is not able to communicate verbally

Not a therapy, but singing can be helpful too. It needs to be done in combination with a different therapy

What to look for in Speech-language pathology (SLP) services:

  • Intensity is important to manage speech and voice symptoms
  • Individualized and relationship-based
    • Focused on what do you need
    • Have a good relationship with the therapist
  • Exclusively focused on voice
  • Ideally, speech-language pathologist should have advanced training and certifications
  • Focus on function
    • Everyday communication that is meaningful to you
    • Focus on what communication situations are important to you as an individual
  • Evidence based
  • Beneficial to all severity levels but best to be at least evaluated (if not treated) very early after diagnosis (even if you think you sound fine)
    • Report subtle changes to doctors
    • Think about subtle changes you may be having
  • SLPs are available to you across continuum of services and throughout the years of your treatment (evaluations, treatment, re-evaluations, collaborate with other medical professionals) and they can treat speech, voice, cognition, swallowing etc
  • Virtual sessions are very effective but they require good wifi signal, camera must be on, microphone working, someone on your end to help if technology is challenging

Treatments for cognitive and language issues/challenges:

  • Report any changes in cognition to your movement disorder specialist
  • Neuropsychological assessment may be recommended
  • SLP Services include: cognitive-linguistic evaluation, retraining, compensatory strategy training (isn’t as intensive as voice therapy but it is solution focused and shorter)

Strategies to assist someone with expressive difficulties (and possibly a mask):

  • Give your undivided attention
  • Use context
  • Tell them with you did understand
  • Wait
  • Don’t interrupt
  • Work around off-periods for important discussions
  • Use yes/no questions
  • Restate the message and clarify
  • Be honest – don’t fake comprehension
  • Ask to verbalize feelings
  • Model expressiveness

Strategies for assisting someone who is having difficulty hearing or comprehending:

  • Slow down rate of speech, but not too slow
  • Beware of “elderspeak” perception
  • Strategic pauses
  • Increase your volume but keep it natural (don’t yell)
  • Face the person, be in good lighting
  • Shorten sentence length
  • Avoid grammatically complex sentences
  • Put details in writing
  • Restate and rephrase
  • Use nonverbals whenever possible

Question & Answer: 

Question: I have rapid speech, and it’s hard to slow down. Do you have any recommendations?

Answer: Talk to a speech language pathologist, and try LSVT and combine with a pacing board if it isn’t enough. 

Question: I participated in a choir but after a fall I haven’t been able to go back. Any recommendations other than getting involved in a virtual type choral group?

Answer: It depends on what else is going on with the person’s communication skills. Singing can be a compliment to skilled services. If you are experiencing problems with communication, try speech pathologist services virtually. Many insurances (including MediCare) are covering telecare now. 

Question:  I had vocal cord surgery and my voice improved significantly, however articulation has become a problem. Is there something specifically I should be looking for in a speech therapist?

Answer: It should be someone who understands the link between the voice and speech, and is willing to try different treatment combinations if someone is needing something in addition to LSVT. Pacing could be a helpful extra technique.

Question: Who writes the referral for a speech therapist?

Answer: It can be your Primary care physician, movement disorder specialist, or neurologist. A physician’s order is all that is needed. The order should say “speech language pathology evaluation and treatment,” and doesn’t have to say LSVT specifically or other treatments, but the physician can put it in the order if they want as well. 

Question: Is it possible to get a speech tune-up?

Answer: Yes, it’s a common thing to happen in PD. 

Filed Under: Webinars - Announcements & Notes

  • Home

Categories

  • Monthly List – PD Webinars
  • Webinars – Announcements & Notes
  • Monthly List – Caregiving Webinars
  • Monthly List – Support Groups
  • Support Groups – Meetings & Notes
  • News
  • Research
  • Events
  • Exercise
  • Comment

Top Pages of the Stanford Parkinson’s Community Outreach Website

  • List of Live, Virtual PD Exercise Classes
  • List of PD Exercise Videos
  • Symptoms of PD
  • For Those Newly Diagnosed
  • Support Resources for PD

Featured Posts

Your top three Parkinson’s questions answered by the APDA

The American Parkinson Disease Association (APDA) recently shared the top three questions they are … [Read More...]

National Day of Action – Thursday, September 22, 2022

From the American Parkinson Disease Association, Northwest Chapter (APDA NW), Tuesday, September … [Read More...]

Archive

  • January 2023 (3)
  • December 2022 (7)
  • November 2022 (4)
  • October 2022 (9)
  • September 2022 (2)
  • August 2022 (3)
  • July 2022 (5)
  • June 2022 (6)
  • May 2022 (9)
  • April 2022 (5)
  • March 2022 (8)
  • February 2022 (5)
  • January 2022 (13)
  • December 2021 (7)
  • November 2021 (19)
  • October 2021 (14)
  • September 2021 (12)
  • August 2021 (9)
  • July 2021 (7)
  • June 2021 (10)
  • May 2021 (10)
  • April 2021 (16)
  • March 2021 (8)
  • February 2021 (27)
  • January 2021 (18)
  • December 2020 (18)
  • November 2020 (19)
  • October 2020 (13)
  • September 2020 (7)
  • August 2020 (12)
  • July 2020 (15)
  • June 2020 (13)
  • May 2020 (17)
  • April 2020 (14)
  • March 2020 (14)
  • February 2020 (5)
  • January 2020 (12)
  • December 2019 (10)
  • November 2019 (6)
  • October 2019 (6)
  • September 2019 (7)
  • August 2019 (5)
  • July 2019 (10)
  • June 2019 (3)
  • May 2019 (8)
  • April 2019 (10)
  • March 2019 (5)
  • February 2019 (9)
  • January 2019 (12)
  • December 2018 (2)
  • November 2018 (8)
  • October 2018 (10)
  • September 2018 (2)
  • August 2018 (7)
  • July 2018 (10)
  • June 2018 (9)
  • May 2018 (3)
  • April 2018 (10)
  • March 2018 (4)
  • February 2018 (8)
  • January 2018 (11)
  • December 2017 (11)
  • November 2017 (5)
  • October 2017 (11)
  • September 2017 (10)
  • August 2017 (7)
  • July 2017 (13)
  • June 2017 (10)
  • May 2017 (14)
  • April 2017 (12)
  • March 2017 (17)
  • February 2017 (11)
  • January 2017 (13)
  • December 2016 (4)
  • November 2016 (6)
  • October 2016 (1)
  • September 2016 (11)
  • August 2016 (5)
  • July 2016 (8)
  • June 2016 (4)
  • May 2016 (2)
  • April 2016 (2)
  • March 2016 (1)
  • February 2016 (1)
  • January 2016 (4)
  • December 2015 (1)
  • November 2015 (2)
  • October 2015 (3)
  • September 2015 (1)
  • August 2015 (3)
  • July 2015 (1)
  • June 2015 (1)
  • May 2015 (1)
  • April 2015 (2)
  • March 2015 (4)
  • February 2015 (2)
  • January 2015 (1)
  • December 2014 (1)
  • November 2014 (2)
  • October 2014 (1)
  • September 2014 (2)
  • August 2014 (2)
  • July 2014 (1)
  • June 2014 (5)
  • May 2014 (1)
  • April 2014 (2)
  • March 2014 (3)
  • February 2014 (1)
  • January 2014 (1)
  • December 2013 (1)
  • November 2013 (1)
  • October 2013 (1)
  • September 2013 (1)
  • August 2013 (1)