Lewy Body Dementia, is a type of dementia that can accompany a movement disorder like Parkinson's. When LBD is associated with a movement disorder, patients may begin to experience a decline in speech and swallowing which can impact day to day communication and safety during eating and drinking. When these patients are referred for speech and swallowing treatment, they can be a challenge for therapists, and the patient's memory difficulties, anxiety, and variable and unpredictable overall day to day behavior can limit their ability to participate in traditional treatment.
Incorporating treatment methods which reduce memory burden, such as pre-recorded and guided programs available to the patient at home and at any time, may provide the best opportunity for daily practice, while at the same time help to reduce caregiver burden.
Over the last year, I have worked with several patients with LBD, and I have found success with utilizing video-feedback as a means of providing ongoing coaching and cueing for the patient. Below is a brief case study of a recent patient who has benefited from this type of home practice. He has graciously allowed me to also share a video clip:
Case study: Elwin is a retired school teacher who had been previously diagnosed with Parkinson's and more recently, LBD, with symptoms that include decline in speech and swallowing . Our initial visit was in an outpatient clinic setting, but because he easily became anxious, we decided to move the remaining visits to his home. In addition to his speech and swallowing problems, he has been steadily losing his vision and this vision loss and its subsequent challenges are a large trigger for his anxiety and focus of conversation. His visual impairment also limits his ability to benefit from activities which require written instructions.
Elwin was seen for six hour long visits, and at each visit, a video recording was made of him performing prescribed swallowing and speech exercises . None of the video recordings was longer than 12 minutes, and all were downloaded to his home computer. Once downloaded, he required only that his spouse turn on the computer and click on the video. Once started, he required no further instruction from me or his wife. He has been encouraged to complete his swallowing exercises, which include respiratory muscle training, at least one time daily, and also to complete one of his voice practice tapes daily.
Given his diagnosis, it is unknown whether this daily practice will substantially improve function, but, it is hoped that it will reduce the rate of symptom progression and improve quality of life for him and his spouse. Periodic review of the home program at intervals of 6 months was suggested.