Speech Ramblings - Home
Parkinson’s Disease (PD)GeneralLoss of dopaminergic neurons in basal ganglia and brain stem1.5 million AmericansIncidence increases w/age15% dx-ed at age 50Not fatal in and of itself, but generally lower life expectancy TypesIdiopathic (primary) PD: cause unknownSecondary Parkinsonism: number of disorders with extrapyramidal features that have an identifiable cause agentGeneral Symptoms: TRAPTremor (Resting)RigidityAkinesia/bradykinesiaPostural instability (loss of postural reflexes)Associated DeficitsDementia (15%)Poor handwriting: small, shaky, illegibleSlow motor initiationSLP CONCERNSDysphagiaHIGH incidence! 90%+ in those with moderate to severe PDDysarthriaLater symptomGenerally hypokineticPerceptual CharacteristicsImprecise articWeak voiceMonotoneMonoloudnessDifficulty initiating speechIncreased speech rate d/t lack of respiratory supportTREATMENTStage 1: SLP’s could facilitate Parkinson support groups. Could work to educate the individuals and families. Educate newly diagnosed Parkinson’s patients about what they might experience with speech. Stage 2: Voice therapy to increase vocal fold adduction, maximize phonation, and increase respiratory support (Lee Silverman Voice Treatment). Stage 3: Focus on increasing respiratory-phonatory effort. Also to produce speech with an appropriate rate and naturalness. May provide behavioral rate control techniques and prosthetic devices (delayed auditory feedback units and voice amplifiers). Stage 4: Focus on supplementing natural speech with AAC device such as an alphabet board. Stage 5: If speech is severely unintelligible, SLP can implement augmentative communicationMedical ManagementMedication to regulate dopamine (L-Dopa)Deep brain stimulation: implant pacemaker in brain to target subthalamic nucleus to control motor movements (CONTROVERSAL) ................
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