Lee Silverman Voice Treatment (LSVT)
The evidence for the benefits of speech and language therapy programmes is increasing. One of these is the Lee Silverman Voice Treatment (LSVT) – an intensive Individual programme involving 16 sessions over a month that focuses exclusively on voice, especially volume. Improvements in voice loudness, intonation and quality have been recorded post-treatment and maintained for up to two years afterwards1. Although LSVT can be very effective, this method may not be appropriate for everyone and does not treat all the communication symptoms of Parkinson’s. It may be most beneficial for people who are newly diagnosed and those who are less cognitively impaired.
Click here for more information on LSVT
Swallowing problems (dysphagia)
Between 50-80% of people with Parkinson’s experience some difficulties with swallowing, especially in the mid-advanced stages of the condition. Treating these is vital to prevent serious problems from occurring, such as aspiration (which can lead to chest infections) and choking.
Treatments that the speech and language therapist may suggest include:
- improving posture to make swallowing easier
- exercises to alleviate the swallowing process
- changes to the textures of the diet by selecting food that is easier to swallow
- thickening fluids to make them move more slowly and therefore easier to control
- equipment that makes eating and drinking easier to manage (this is often carried out alongside an occupational therapist).
In severe cases, the best solution may be an alternative method of eating and drinking – for example by a tube inserted directly into the stomach (gastrostomy feeding) or through the nose (nasogastric feeding). These approaches require the involvement of other members of the multidisciplinary team, including doctors and nurses. Nasogastric feeding may be only offered as options to people who are hospital inpatients in some countries.
See Also: Eating and Drinking for more information [under construction].
Drooling
Drooling (where people find saliva leaks out of their mouth) is a common problem that is partly related to swallowing difficulties and can cause considerable social embarrassment.
The problem may not be that too much saliva is produced, but that the natural tendency to swallow regularly is slowed down. This causes the saliva to accumulate in the mouth, rather than being swallowed regularly, and sometimes leak out of the mouth. Drooling is often aggravated by the stooped posture and poor lip closure that some people with Parkinson’s experience.
Treatment strategies may include:
- alleviating swallowing problems
- improving posture and seating
- advising on exercises and techniques to improve lip closure
- exercise programmes such as LSVT which strengthen the pharyngeal and laryngeal muscles
- prescribing anticholinergic medications to reduce the production of saliva
- injections of botulinum toxin (sometimes used to treat dystonia in Parkinson’s)
- using special buttons or brooches that bleep discretely to remind the wearer to consciously swallow.
Speech and language therapy and cognition
Some mental processes are important factors in a person’s ability to communicate, learn and adapt. If these are impaired or slowed down, most strategies that a speech and language therapist may suggest will not work.
Depression, which is very common in Parkinson’s, can have a considerable affect on communication and a person’s motivation to adopt any approaches the speech and language therapist suggests.
Some people with Parkinson’s can also experience changes in cognitive functioning as the condition progresses. Sometimes these indicate the presence of a dementia, but in many cases they are specific to Parkinson’s and may include:
- slow thinking
- slow learning
- difficulty switching from one subject to another in a conversation or doing two things at once
- problems with internal cues to trigger normally automatic and unconscious movements.
Speech and language therapists need to be aware of any cognitive problems that a person has. This will help them to communicate more effectively with their client and plan appropriate treatment strategies that take account of these factors.
