Therapy

Maintaining communication skills

Speech therapy

All vocal sounds, including spontaneous utterances, are the result of a finely uned combination of breathing (respiration), vocalisation (phonation) and articulation. This requires the precisely timed coordination of over 100 muscles. 80 to 90 percent of Parkinson patients suffer from impaired speech as a result of their neurological disorder. This kind of acquired neurogenic speech impairment is referred to as dysarthria. Speech therapy therefore focuses on exercises to improve breathing, vocal and speech performance.

Dysarthria – symptoms and treatment

When breathing becomes more shallow and faster and speech breathing is restricted as a result of shorter exhalation, exercises to activate deeper abdominal breathing and reflexive compensatory breathing can help make vocalisation rhythmic with breathing.

If the voice becomes quiet, hoarse and husky – the pitch of the voice may be higher, modulation limited and resonance reduced – improvement can be achieved with the following exercises:

• functional voice training
• voice training based on the exercise principles of Lee Silverman Voice Treatment (LSVT).

Prosody (stress, speed, speech volume) is often monotone, hesitant or rushed in Parkinson patients, and repetition of sounds and syllables occurs more frequently. In this case, we concentrate on

• training stress and syllable pronunciation, and
• slowing up speech speed using special aids (e.g. Pacing Board).

If speech becomes slurred, unclear and increasingly incomprehensible, and the patient has problems initiating speech, sound, syllable and word exercises help make speech clearer again.

Mimicry is often less pronounced (amimia), so that the communicative aspect that supports speech is missing. Relatives can no longer read or understand the patient’s mental state from facial expression and think that the patient looks angry.
These deficits can be partially compensated for with the help of the following measures:

• intentional exercises to convey deliberate non-verbal expression
• motor exercises for the mouth to improve the flexibility of lips, cheeks, tongue, soft palate and jaw (also important for articulation and swallowing).

The individual profile as a basis for therapy

Because symptoms vary from patient to patient, a precisely differentiated diagnosis is vital. Only in this way can therapeutic approaches and aids be individually adapted. All the exercises on offer represent a preventive approach and work against a slow, unnoticed impairment or change.

The patient decides for him or herself what he or she wants to change. According to individual needs, communication situations are improved or made possible. By maintaining their ability to speak, patients preserve a central part of their personality and social competence. Depending on psychosocial environment, an individual profile is created and used as a basis for the therapy.

Dysphagia (neurologically determined difficulty in swallowing)

Many patients also suffer from swallowing difficulties. These can vary in severity and range from minimal restriction to an increased, life-threatening risk of aspiration. A precise diagnosis is therefore very important.
Functional Therapy (FDT Functional Dysphagia Therapy based on Bartolome) focuses on the following:

Diagnosis
In what chewing and swallowing phase do problems /deficits occur most frequently?

Restorative measures
to maintain and improve functions.

Compensatory strategies
such as posture maintenance (sitting posture, posture of the head). Even the smallest change in posture can disrupt or positively impact muscular balance.

Counselling
In the counselling sessions, patients are taught exercises and informed about aids and tips (and potential risks) relating to the quantity and consistency of food. The patient should be able to eat and drink without fear every day and know which changes are important and which risk factors he or she may face.