In early August, the Parkinson’s Foundation hosted a webinar on how speech therapy can help with thinking changes. The speaker, Darla Freeman, discussed the reasons you may need to see a speech pathologist for cognitive impairment.  The impairments can include asking repeated questions (memory loss), taking an unusually long time to find the right words when speaking, and having difficulty maintaining a topic in a conversation. See our notes from this webinar.

Additional cognitive impairments addressed by the speaker include:

• problems following multi-step directions (such as arranging appointments, making a simple recipe) 
• decreased interest in social activities
• cannot remember what you need to remember

Speech therapists can also help people remember how to have a fun conversation with family and friends. Essentially, people who feel as if their entire existence has become changed and want to regain control of their speech and social life, will likely want to see a speech pathologist.  

The webinar was recorded and is accessible on the Parkinson’s Foundation’s YouTube page.

The Stanford Parkinson’s Community Outreach Program has two webpages with more information on topics raised in this webinar:

Cognition

Speech Therapy

If you live in Northern California and need assistance finding a speech therapist near you, contact the Stanford Parkinson’s Community Outreach Program.

See notes below for much more details. 

Regards, 

– Sheela

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Using Speech Therapy for Cognitive Impairment

Webinar Host:  Parkinson’s Foundation

Webinar Date:  August 2, 2021

Summary by:  Sheela Sakariya, Stanford Parkinson’s Community Outreach

Speaker: Darla Freeman, SLPD (doctor of speech language pathology), CCC-SLP, The Florida Center for Voice and Swallowing

Today’s Topics:  Is cognitive impairment impacting your everyday life? Speech pathologists can help you.  Diagnostic assessment that will show the degree of cognitive impairment. And what system works best for you.

Speech Language Pathologists are here to help you with:

• Cognitive problems  
• Your memory
• Word finding
• Your ability to think of what you want to say
• And handling that dreadful drool 

Speech pathologists will make a diagnostic assessment.  And working with a speech pathologist will provide you with suggestions that will be: 

• Integral part of your life
• Makes you successful
• Support you in being independent

Treatment can addressed in two ways: 

A. Group Treatment:  One way to engage in group treatment is music – ever thought about what music does for the mind?  Highly encourage patients to start a choir or join a choir which is a fun way to: 

• Stimulates memory
• Stimulates attention and concentration
• Brings about a sense of community bonding

B. One-on-One Treatment:  In contrast, this treatment shows one person’s unique perspective and what you need to be successful in your daily life.  Compensation Technique inventory will let your speech pathologist match up with what you do everyday and what type of aid will best fit your need: 

• Internal aid: Cognitive behavioral treatment which are specific tasks to make your memory without using external aids.  Errorless learning: help improve your memory, improve your problem solving and organization skills, planning skills. 
• External aid: Using devices in the right way at the appropriate time

The Pause:  When working with a speech pathologist, it is important to take the pause for understanding of linguistics and cognition in a person.  “The Pause” can be used as biomarkers to determine the degree of impairment and the stage of Parkinson’s.

Drooling:

• Is a cognitive impairment
• Decline in the ability to remember to swallow frequently

How to Reduce Drooling: 

• Think more about swallowing
• Swallow more frequently
• Set a timer
• Use a metronome app
• External cueing system

Word Finding:  Distracting in conversation.  Lose a word while in conversation.  How to decrease word finding difficulty: 

• Describing what it is you are trying to talk about 
• Use words that are similar
• Be patient with yourself
• Continue to talk

Verbal Fluency:

• Drill and skill for anomia.  [Anomia = inability of retrieving known words]
• Practice in everyday life

Brain Games: 

• Stimulate your brain 
• Very fun with your family members

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Q&A Session: 

Question:  Is there a connection between a runny nose and drooling? 

Answer:  Need to swallow frequently enough during day and nighttime.  There are techniques to help decrease drooling and there are also drugs/medications that serve to dry up the drooling.  Also, see your speech pathologist to address your drooling concerns. 

Runny nose could be something else; not heard anything about nasal drip with drooling either. 

Question:  How do you find a speech pathologist?  LSVT and SPEAK OUT! therapists? 

Answer:  Like any other medical professional, find someone who specializes in Parkinson’s disease.  The Parkinson’s Foundation website can help you find a speech therapist.  Also, there are 3 other programs to find a speech pathologist:  

• LSVT: systemic program developed in 1990, speaking up louder; allows better communication; 4 day-a-week program

• SPEAK OUT!: 3 day-a-week (45-minute session); speaking louder; does not have a cognitive session

• Speech with device:  Hearing aid-like device that gives a background noise which encourages you to speak loudly. 

Question: What communication devices do you recommend? 

Answer:  Memory stimulation devices and communication devices: cell phone, iPad, and tablet.  Work with a speech pathologist and occupational therapist on how to use the device and your needs.

Question: What to do when their loved one has stopped talking altogether? 

Answer:  Do not give up on communication.  Use gestures and expressions.  Have a discussion about augmentative or alternative routes of communication may be your route through the APDA (American Parkinson Disease Association).  Work with your speech pathologist to see what device works best.

Question: How do you address hoarse voices?  Or stuttering? Speech freezing? Word finding? 

Answer:  Some weakness and rigidity are expected as you move through Parkinson’s.  The core of communication is articulation and using our capabilities including our lips, teeth, tongue and palate.  Reduced movement is expected and articulators making the movement become imprecise which causes slurred speech.  To resolve this, take deeper breaths, correct posture, and building respiration and intensity will help your vocal cords to vibrate.  Again, using LSVT and SPEAK OUT! workshops will help with these conditions. 

Other possibilities for hoarse voice are allergies, possible reflux, etc. 

Question: Any special hints for singing? How did I lose my singing capabilities? 

Answer:  Most speech pathologists will be able to hear your cords by simple test such as if you are able to take in a breath and hold out the sound.  If not, then mechanically the vocal cords are unable to do what they should be doing which is opening to take a breath and closing to regulate while you are talking.  This is probably why your voice has changed or singing has changed, and again therapists can help with this problem. 

Question: Any particular vocal practices you recommend? 

Answer:  What I recommend is singing!  Always remember to take a nice deep breath and try to improve your respiration.  Do not try to sing beyond a point where you are trying to squeeze out those sounds.  Not everybody can sing like Mariah Carey!  Sing things you are familiar with that do not cause distress to your throat.

Question: Swallowing a pill is difficult when you have Parkinson’s.  Can you please address that? 

Answer:  Have a discussion with your neurologist or PCP so you can address the challenges you have with swallowing.  There are two types of studies that can be done to determine your swallowing challenges: 

1. Modified barium study: swallow pills, drink barium, and you swallow will be followed on x-ray; hard swallow, soft swallow, chin tuck, multiple swallows, etc. 
2. FEES: fiber-optic into your nose and watching the tongue, trachea, and swallow movements.  

Here are some more swallowing strategies for cognitive decline: 

• Externalize what you need to recall: put the directions on a paper, read the process, so you can follow the process without skipping steps.  
• Get a care partner involved who can help and supervise which would make your swallowing safer and efficient. 

Question: In social situations, you are trying to join a conversation, but the voice just tapers off, what do you recommend ? 

Answer:  Remember the techniques in the LSVT program.  Taking a deep breath will always be important.  Try to take more frequent breaths.

Question: For caretakers/spouses, what do you recommend they do in social situations? 

Answer:  Giving them the opportunity to say what they have to say.  Be the voice that tells others to be patient with them.  Give them cues to speak up so they are not mumbling.

Question: DBS (Deep Brain Stimulation) – any research that relates to DBS that you’d like to highlight? 

Answer:  What we found about DBS is that it helps with motor functions, but it does not improve speech.  DBS does not change the mechanical movement of the vocal cords.  DBS focuses on movements and tremors, not with articulatory precision.  There is not enough research to show DBS is changing voice or swallowing.  

Question: What is the difference between a speech language therapist and a speech pathologist? 

Answer:  Absolutely nothing!  There are so many names for speech language therapists including speech teacher.  Officially the name is speech language pathologist.  “Pathologist” means they can diagnose and classify speech disorders.