For one of the patients, with nearly inaudible speech, I offered amplification as as a short term solution during our time together, with a suggestion that he and his wife consider this as a long term option for improving communication on a day to day basis. Once I was able to hear him and he was able to participate more fully in the evaluation he revealed his wit , his insights about his Parkinson's as well as some of his concerns regarding declining function due to his disease. Next visit, I will introduce the Voice Aerobics audio CD to determine if he is able to follow the cues and to determine if it yields some better voice for him. Because it is a guided program, there will be nothing for him to remember, reducing the need for his spouse to instruct, or as often feels to him, to "nag".
For the second patient, with rather significant swallowing problems, I knew that instruction in specific strategies and some exercises were warranted. Once I determined that she was able to follow verbal instructions, I began to explore various options for helping her perform these exercises on her own at home, or at least with minimal supervision by her husband. We decided that video-taped instruction will work best for her. I often video-tape patients performing a set of prescribed exercises and download it to their home computer. Watching oneself seems to appeal to many patients, and the video recorded instructions are available after therapy for as long as the patient is willing to practice.
Mild dementia with memory loss does not need to preclude the ability for individuals to achieve benefit from exercise for voice and swallowing. However, my experience has taught me that written instructions are rarely carried out, and that recorded programs introduced early in treatment can provide training in a program that can be easily performed daily at home, offering the best chance for continued practice.
I am always impressed with the support from spouses to constantly be seeking new ways to help their loved ones. But I also know that weekly visits to doctors and therapists along with caretaking duties at home can take its toll. If for 30 minutes once a day, the patient can independently perform their own exercises, the spouse or carepartner is unburdened from another task, and hopefully the patient enriched with a greater sense of independence and self-esteem.