Strategies for the Speaker
• It is often useful to consult with a speech pathologist who will recommend specific exercises and compensations to address limitations in speech and voice.
• Keep sentences short.
• Repeat the entire sentence when necessary, versus an isolated word, providing a context for the listener.
• Take a deep breath before speaking and breathe often.
• Exaggerate and be deliberate with all speech sounds.
• Use gestures.
• Speak one sentence at a time without immediate repetition, remembering the potential for involuntary repetition of speech in PSP( called palilalia).
• Speak loudly and slowly.
Reports of successful speech intervention for individuals with PSP, CBD, and MSA are limited and infrequent. Strategies beneficial to the voice and speech impairments of Parkinson’ s may have variable benefit. Reasons for limited success include the presence of cognitive impairment, the relatively rapid progression of the disease, delay in an accurate diagnosis, and delay in referral to therapy services.
A speech pathologist can be helpful at all stages of the disease, preferably with early involvement and intervention that emphasize good speaking habits before the underlying problems become so severe that new learning is difficult. It is critical to discuss the limitations and severity of the communication problem, as well as the communication needs. Therapy efforts should focus on increasing loudness, articulatory precision, minimizing repetitions in the setting of palilalia, and enhancing awareness and participation in communication efforts. A therapy program called the Lee Silverman Voice Treatment ®( LSVT ® • www. lsvtglobal. com) is frequently applied to the communication changes in Parkinson’ s. The emphasis of this program is loud voice productions with intensive training and practice in an attempt to optimize voicing effort and performance. This is appropriate to the Parkinson’ s communication impairment because the primary problems are low volume, rapid speech, and imprecise articulation. LSVT may not have the same impact in PSP, CBD, or MSA, given that the speech problems are more pervasive and that apraxia is a problematic component in CBD. However, it is reasonable to pursue this strategy, or others, for a trial period of time. A strategy called“ communication circles” may be helpful. This is when family members and friends are recruited to try to reinforce target speech behaviors.
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What is assistive or alternative communication?
When speech abilities are no longer meeting communication needs, or when speaking is effortful and tiring, communication may be more efficient using alternate means. Handwriting is the most accessible and portable means of alternative communication, such as using a dry erase board. However, writing may be less effective when greater motor impairment is present. Alphabet boards can be used to identify the first letter of each word as it is spoken, or to spell the entire message. Communication books with words or pictures can be used to facilitate conversation. Text-to-speech options with tablets and smartphones are of good quality and easy to access using apps. Text can often be scripted and saved to facilitate conversation and expression of daily needs or appointments with medical providers. Insurance presently will not pay for tablets or apps. Medical-grade augmentative communication systems with more varied means of access are available as well.