Thursday, June 23, 2011

Parkinson’s and Voice: Express Yourself

When you were a child it is likely that your parents told you it was impolite to stare at others, and yet, staring at faces is exactly what I have been doing since returning home from the Midwest Parkinsons Disease Conference in Iowa last week.

While at the conference, I conducted a Voice Aerobics™ class. The class was well attended, and participants followed along, but I couldn’t’ tell if they were enjoying themselves. Like any “performer”,  when conducting a class or providing a seminar, I look for feedback  to know if people are having fun, that the information is clear and meaningful, and that the audience engaged. But, I couldn’t find the feedback in my participants faces.  At one point, I anxiously pleaded: “c’mon, Iowans, smile at me and let me know you are having fun.” Of course, once I had the opportunity to talk one on one with class participants, they were very kind and generous with their feedback.

Facial expressions, along with body gestures, are an important part of our day to day non-verbal communication with others, and even fleeting changes in expression can convey inner secrets about our emotional and physical states. How we use our non-verbal body language can also impact the quality of our relationships. So, the changes in facial expression that are associated with the bradykinesia ( stiffness/slowness) of Parkinson’s Disease (PD) are an important consideration  when addressing changes in verbal communication such as the speech and voice symptoms that often accompany PD. I didn’t have many novel suggestions when asked the question: “how do we improve expression in our faces?”

So, I’ve been wondering , since returning home, how different, really were the faces in my class from other healthy adults? While working out at the gym yesterday morning, I studied the faces and the movements of others, young and old. The teenage boys seemed the most expressive. Even when they were not actively engaged in exercise, they were moving,  twitching, fidgeting, hats off and on, fists open and closed and eyebrows and mouths  in a dance of movement. The older men clearly moved more slowly and their faces  had less expression, but once engaged in conversation, their arms and faces , too, seemed to gather more momentum, though never quite matching the young boys.  So, I concluded , that even among the general adult population,  expressive facial gestures may be tempered over time when compared to the exuberance of our youth. That was, until, yesterday afternoon, when I witnessed a communication environment that challenged this conclusion.

Yesterday afternoon, I attended a lunch time benefit held to support a local agency, Hearing Impaired Persons. With just over 90 people in attendance, and most of them older adults, at least half were deaf, and communicating in sign language. While waiting for a friend to arrive, I sat and watched, a couple’s conversation, trying not to be too conspicuous with my research. But hands, eyes, cheeks, and lips mouthing silent words were all moving. With my limited understanding of sign language , I picked up something about “a father”, “sick,” ,”home” faces happy, then sad. I sat mesmerized by the conversation that was taking place and the constant shift in facial expression and emotion. As I looked around the restaurant, I wondered how so many silent voices could fill the room with so much energy. When I mentioned my observation to my friend who runs the agency, she smiled, and said, “of course, it’s ALL communication, the facial expressions, the hands, the mouthing of words.”

 When Parkinson’s stiffens and stifles movement, including facial expression we must draw from all parts of our body. Pulling energy from within and without,  and powering our voices with movement the “ahs” are bigger when arms are outstretched, the “ees” prettier when teeth are showing, and  faces friendlier when moved to smile.

So try this simple little task  and judge if the  movement enlivens your voice, improves your posture and brings more expression to your face:

                                             MWOW

While sitting on the edge of the bed, or the toilet, or a chair, first with arms resting on your thighs, vocalize MMMMWOW! Feel the energy of your voice powered by your breath, supported by your abdominal muscles, traveling through your voice box,  resonating on your lips, and charging out of your wide open mouth. Take a new breath and repeat 5 times.

Now, repeat again, but this time, as your voice rises from within, raise your arms up high like you just won the biggest prize and vocalize MMMMWOW! With arms outstretched over your head, notice your posture lifted from your abdominals, feel your mouth and eyes wide open in surprise. Sense the emotion the words convey.
Repeat five times.

                                                   

Friday, June 3, 2011

Voice and Swallowing Therapy: You Have To Do It

I have had some highly motivated patients lately that have achieved great success in response to therapy. They are individuals who remind me of the importance self-motivation plays when participating in speech, voice or swallowing therapy. They also highlight an interesting distinction in patients. The individual who expects to "get" therapy , with the apparent expectation that improvement will come about in response to something I am doing, and the individuals who  "do" therapy. The second type is the patient who faithfully practices prescribed exercises, employs recommended strategies, and  have their eye on the goal. In  the case of Allen, a patient I describe below, his goal was to be able to drink his morning coffee without it looking like sludge, AND, to do it safely without compromising his new lungs.

Allen was referred to my practice for swallowing problems, including aspiration  ( liquids getting into his airway during drinking) which have persisted since he underwent a double lung transplant last July. On our first visit, he and his wife recounted his arduous surgery and  lengthy recovery which lasted several months. His swallowing problem is one of the last rehabilitation issues he faces, and the jar of thickener on the  kitchen counter has been a daily reminder and motivator for his goal from receiving therapy , which is to  safely return to drinking thin liquids.

When I met with him several weeks ago for our first visit, I re-inforced to him the roles we would play. I would serve as his "coach"  instructing him in a variety of exercises designed to strengthen the safety and efficiency of his swallowing mechanism, but he would be required to do the work of daily swallowing exercises. With Allen and others, I do what I can to set them up for success. Sometimes that includes making a video recording of the patient performing the prescribed exercises and downloading it to their computer. Then, between visits, they can review the instructions as often as they need to, with my voice on the recording acting as their virtual coach.

So, in the case of Allen, he did his part. He was diligent about performing the daily exercises, and during our weekly visits  we would review his log discuss his progress and  identify goals for the following week. He has demonstrated strategies he must perform on his own, and asked for clarification of techniques he is unsure of.

Yesterday I had a phone call from Allen who had just returned from his repeat videoswallow study. In only one month of treatment and hard work on his part, his swallow function had improved to the point of being able to discontinue the use of thickened liquids. Needless to say, we were both thrilled. I often kiddingly say to patients that THEY are my walking testimonials. When they do good, I look good.

In reality, every person is different, of course, and not all patients will achieve the remarkeable improvement that Allen did. But the one characteristic I seem to be seeing in several patients lately that does seem to be a predictor of their success is their willingness to do the work.

So, how about you? If you are about to begin a course of therapy, I would ask you to honestly answer the question: are you ready to DO IT?




Hear Manny's story of success....
www.youtube.com/watch?v=0AfkEDT5p2g