See also Communication
Acknowledgement
We would like to thank speech and language therapists Julia Johnson and Phil Maillard, Regional Neurosciences Centre, King’s College Hospital, London & Clinical Advisor on Progressive Neurological Disease, Royal College of Speech and Language Therapists, London, for their contributions.
We would also like to acknowledge the use of information from:
. ISBN-10: 1861563582.Being able to communicate effectively is essential to maintaining a good quality of life. The impairments that Parkinson’s causes – particularly with communication - can have a detrimental effect on many things, including:
Although some people with Parkinson’s don’t have communication problems, about 50% do develop difficulties with speech and non-verbal communication. Some also have trouble with eating, swallowing and drooling, especially in the more advanced stages.
Speech and language therapists can help with all of these issues. Most recommend early referral to their services for assessment and advice. By seeking help early on, the speech and language therapist can assess the individual and put into place strategies that can help reduce the particular difficulties that a person is experiencing and possibly prevent other problems developing later.
However, although many people with Parkinson’s would benefit from a referral to a speech and language therapist, surveys by the Parkinson’s Disease Society of the UK suggest that only a small number see a speech and language therapist at all. Those who do often only ask for help when their difficulties are having a significant effect on their life.
It is not surprising few people with Parkinson's disease have been treated by a speech and language therapist. According to a survey conducted by the Royal College of Speech and Language Therapists in August 2007, four out of five therapists in the UK believe doctors do not understand their role and 64% of therapists feel doctors do not appreciate the value of the service they provide.
In the early stages of Parkinson’s, the effects on communication may be mild. The speech and language therapist’s focus will be on maintaining as much ability as possible and managing any problems their assessment highlights. Strategies might include exercises to help:
The speech and language therapist will also consider the environments and contexts that the person with Parkinson's communication takes place in as these can sometimes play an important part – for example, if the person works in a very noisy office where a soft voice is difficult to hear.
Communication difficulties often increase as Parkinson’s progresses. In addition, problems with eating and drinking (including swallowing and drooling) become common. The effectiveness of anti-Parkinsonian medication may also start to fluctuate with long-term use, causing side effects, such as motor fluctuations and dyskinesias, which can greatly affect a person’s ability to communicate and swallow.
More intensive speech and language therapy intervention may be required to overcome these difficulties. Where appropriate, the speech and language therapist may also suggest small pieces of equipment and special tools to help with particular problems – for example, voice amplifiers for people whose voice is very soft.
Unfortunately in the advanced stages of Parkinson’s, the problems with communication and swallowing can become severe. Speech and language therapy strategies will focus on managing the problems to ensure as good a quality of life as possible. Where communication is impossible, the speech and language therapist will advise on alternative means of communication, such as alphabet charts and electronic communication aids such as Lightwriters (small handheld computer) and computers with speech synthesisers.
Side effects of levodopa that tend to occur with long-term use (usually several years), because the body’s response to levodopa can become less reliable. These can include early wearing off ‘on/off’ syndrome ; and dyskinesias.
Involuntary movements that tend to occur in people who have had Parkinson's disease for some years as a side effect of long-term use of Parkinson's medication.
