Happy Holidays

To my patients: Thank You for allowing me to participate in your care this year.

To my friends, colleagues and visitors to this blog, I hope I am fulfilling my mission:

To enlist individuals in their treatment and help them express their personality and spirit through voice. To educate and empower.

  Mary and franki, Pet Partners
 http://www.deltasociety.org/

Parkinson's and Speech..why you need to talk to your neurologist!

Researchers estimate that 89% of people with Parkinson's disease (PD) have speech and voice disorders. A similar, or slightly higher percentage have swallowing problems, with both speech and swallowing problems increasing in frequency and intensity as the disease progresses. Yet, despite evidence regarding the prevalence of these problems, the number of individuals referred for speech treatment is estimated to be around 3-4%. (Expert Rev Neurother. 2008;8(2):297-309.)
This past year, I have had the opportunity to speak at several Parkinson's conferences as well as host some Voice Aerobics seminars. In all instances, I have asked those in attendance, with a diagnosis of Parkinson's disease for a year or less or greater than five years, if they received a referral for a speech  and swallowing consult. Consistently, the number of people indicating that they were referred  by their physicians for a speech pathology evaluation  has  been less than 5%. This has been particularly distressing, since more than half of the individuals in attendance will usually acknowledge that they are experiencing changes in speech and/or swallowing function. When interacting with participants, I have noticed that greater than 75% have some impairment in speech, including those who may have DBS ( deep brain stimulation) for control of motor symptoms.

Changes in speech, voice, and swallowing function, in many ways reflect the "sneaky" or insidious nature of Parkinson's disease. Because, even though a newly diagnosed individual may not be expressing noticeable speech and swallowing symptoms (  typical symptoms include: voice and speech which is not as loud or as clear, choking when eating or drinking, stuttering like problems with speaking, etc.), the physiological changes in the muscles of respiration, speech, and swallowing, are nevertheless, taking place.

So, whether your physician, or you, as a person with Parkinson's, wait until you are expressing symptoms to be evaluated by a speech - language pathologist, you have really waited too long. This does not mean that therapy will not still be effective, but, what it means is that doing the work of therapy will be harder.

I have recently been working with two individuals with a diagnosis of Parkinson's disease for approximately 7 years. They both report a decline in speech and swallowing over the last couple of years, and at the present time, both have rather severe problems with generating enough volume to be heard by their spouses. Both have obvious problems with choking with liquids, and both have to be mindful about drooling. Both patients express interest in making improvements, but, their voice habits have become quite set, and the amount of effort to generate greater loudness and speech clarity requires almost constant attention. While Medicare may be currently providing both of them the gift of 30 days of treatment, I fear that the improvements they make will not be long-lasting unless they are able to commit to daily practice.

This same therapy and same practice would have been so much easier for both of these individuals when first diagnosed, and when muscles were not as rigid, overall movement not as difficult, and their spouses not as burdened by other aspects of the disease.

So, why do physicians wait to refer patients for a consultation with a speech- language pathologist? And, why do some individuals wait, until they are having symptoms, to engage in a voice strengthening program?

If you have not yet consulted with a speech-language pathologist, ask your physician for a referral, and put it on your list of resolutions for 2011!

Post Polio Syndrome and Voice Changes

Why does my voice sound this way?

Over the last few years, a number of individuals have been referred to my speech pathology practice with complaints of changes in their vocal function, and also a history of polio 40 to 50 years ago. Since the individuals were often young children at the onset of their polio some of them are unsure if their original diagnosis was bulbar or spinal. Now, however, many of them in their sixties or seventies, report complaints of voice problems or changes, such as: “my voice is weaker, “ “my voice gives out by the end of the day,“ “my voice is scratchy and hoarse.” Not infrequently, these changes in voice are accompanied by changes in swallowing function, with associated complaints of increased” choking” when eating or drinking.

Is this related to PPS?


In many of these instances, the change in voice can represent further weakening of the respiratory and phonatory ( voice production ) system. In particular, if individuals had initial Bulbar polio symptoms, they have likely already spent a lifetime using some compensatory respiratory and oral-pharyngeal muscle function. This muscle function may now be further weakened due to further muscle degeneration, age related changes, muscle disuse atrophy ( loss of muscle mass due to disuse) or vocal misuse. Separating out the causes and contributors to current voice problems can be challenging for the voice therapist or otolaryngologist  (ENT).

Why should I see an Ear, Nose, and Throat Doctor (ENT)?
Any acute (sudden) change in voice function, or any change, such as hoarseness, that persists for more than a few weeks, warrants an examination by an ENT.

The ENT will conduct a direct visualization ( passing a small scope with a camera through your nose)of your vocal folds and larynx (voice box) making sure there are no growths, such as nodules ( calluses that form from misuse) or polyps ( usually benign, fluid filled outgrowth of tissue, also may be from misuse), or tissue changes suggesting a more serious diagnosis

What is a voice evaluation?


Following an ENT examination, patients are typically referred to a speech-language pathologist (voice therapist), who may conduct further instrumental examination using videostroboscopy. Videostroboscopy is conducted by placing a rigid scope with a camera attachment through the mouth to visualize the larynx and evaluate the dynamic movement of the vocal folds. The voice therapist will also perform a clinical evaluation of vocal function. This exam will include thorough history taking, which includes asking questions about how you use your voice throughout the day, medication use that may be affecting your voice, particularly inhalers and steroids, as well as any surgery you may have had on your throat or tubes placed down your throat during surgery or in an emergency to maintain ventilation.

Although not directly related to voice production, the vocal folds’  position at the opening of the windpipe also make them gatekeepers against foreign bodies entering into the upper airway. Therefore, you will be asked about any problems you may be having with choking or coughing when eating or drinking. These symptoms may also be  an indications that the sensation of the larynx or function of the vocal folds ( ability to close efficiently to protect the airway)  have declined in some way, permitting food or liquid to now enter your upper airway.  A separate, swallowing evaluation may be recommended

Can voice therapy help?

 Once an accurate diagnosis of your voice problem is made, voice treatment will likely be a combination of medical and therapeutic management.


Read the full article at: http://www.post-polio.org/edu/pphnews/pph26-2.html





Voice treatment may be offered for 6-8 visits, with development of a home exercise program to encourage strengthening of the system, preservation of muscle function and maintenance of any improvement achieved. For individuals with voice changes from PPS, conservation techniques, including use of personal voice amplification devices may also be beneficial.