Communication, speech and swallowing in Parkinson’s

Caroline Bartliff

Specialist Speech & Language Therapist

Derby Team

caroline.bartliff@nhs.net

Introduction

• This presentation will cover:�
• How Parkinson’s affects communication�
• Areas of research that can be applied in therapy�
• Strategies to help communication, voice, swallowing and saliva management�

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How Parkinson’s affects communication

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• Quiet voice
• Rushed/fast speech
• Mumbled
• Reduced melody and pitch inflection
• Reduced facial expression (difficult to know how you feel)
• Less gesture (verbal processing, �signals turn taking)
• Word finding difficulties�‘Losing the thread’

What do listener’s do that makes talking harder?

• Think about it…�
• Who is hard to talk to?

What do listener’s do that makes talking easier?

What do listener’s do that makes talking easier?

Look interested

What do listener’s do that makes talking easier?

• What does looking interested look like?�
• Eye contact, nodding, confirming sounds�
• Waiting, giving lots of time for a response�
• Asking the right kind of questions�- open questions ‘Tell me about…’�- closed questions ‘Was it….?’ ‘Did you…?�
• Clarifying, repairing, working together�‘Are we talking about…’

Means, Reasons, Opportunities

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Money & Thurman (2002)

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Means, Reason, Opportunities

• Means �Speech, body language, facial expression, tone, pointing, gesture, writing (text, email)�
• Reasons�Asking questions, making choices, basic needs, giving opinions, social chat, conversation�
• Opportunities (Listener adjustments)�Give time�Eye level (seating/position)�Environment (reduce background noise)�Asking the right questions�Be present & not pre-empting�Active listening�Knowing likes and interests

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Maintaining a strong voice

• Intensive voice therapy helps to re-learn and establish a new and stronger voice. ��4 factors to consider:

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1. Airflow
2. Manual drive
3. Self-monitoring
4. Lubrication

Singing research

• Sing to Beat network, Parkinson’s UK Information & Support hub�
• Voice and Choral Singing Treatment (Benedetto et al 2009)�pitch, breath support, improves mood, reduces social isolation,�
• Lorraine Ramig (LSVT global) – problem with carryover into speech�
• Research project- Sing to Beat/Skylarks Dr Yoon Irons & Grenville Hancox 2019/2020�Does multitasking and singing improve speech intelligibility?��Improves confidence in voice, power/drive�Psychosocial benefits

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Gesture research

• Co-speech gestures add meaning and emphasis to speech. Eg Size, position, direction of movement.

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• Ellen Poliakoff and her team have looked at how co-speech gestures impact communication in Parkinson’s.

• Ellen Poliakoff, Manchester University

“The most interesting message for people with Parkinson's is that the rate of spontaneous produced gestures alongside speech was not significantly reduced in people with mild to moderate Parkinson's. Our thinking is that the use of gestures could therefore be emphasised as an additional communicative modality during speech”.

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Relax and use more gesture!

Swallowing changes

• Movements can get smaller, reduced in range. �Difficulties getting started.
• Swallow reflex

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swallowing animation – YouTube

• Delayed swallow reflex (food or fluid can enter the airway)
• Prolonged chewing of difficult textures
• Difficulties initiating tongue retraction

Swallowing therapy

• Texture modification�Moist, cohesive foods�Thicker drinks give more time for the muscles to move.�
• Exercises & Postural moves�Chin Tuck with Resistance�Shaker exercise�Masako�Expiratory Muscle Strength Training (EMST)�Christine Sapienza Jacksonville University, Florida�Swallowing & cough strength (2009)�Systematic review (2011)

EMST

• Simple protocol
• Improves cough effectiveness
• Reduces the risk of food/fluid getting into the airway
• Strengthens the voice due to retraining breath support muscles
• Practice needs to be maintained (deconditioning)
• Proven benefits to people with Parkinson’s
• Contraindications

Saliva managment

• Posture
• Lip seal
• Swallow retraining:

*Swallow prompt app

*Cue Band Study Cue Band - Wearables for Parkinson's

• Medications to dry the mouth
• Botulinum toxin to the salivary glands

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Dry mouth

• Very common side effect from medication.
• Can affect speech and swallowing.

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Advice:

• Keep well hydrated
• Steaming
• Artificial saliva can be helpful (pastilles, spray, gel, mouthwash)

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Summary

• How Parkinson’s affects communication?
• What makes a good listener?
• Means, Reasons and Opportunities
• Maintaining a good strong voice
• Research – gesture, singing, swallowing
• Management of saliva

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Thanks for listening

References

• Benadetto, P. et al (2009) Voice and choral singing treatment: a new approach for speech and voice disorders in Parkinson’s. European Journal of Physical Rehabilitation Medicine 45 (1) 13-9

Voice and choral singing treatment: a new approach for speech and voice disorders in Parkinson's disease - PubMed (nih.gov)�

• Cleary, R et al (2011) An Investigation of co-speech gesture production during action description in Parkinson’s diseas. Science Direct Volume 17:753-756

An investigation of co-speech gesture production during action description in Parkinson’s disease – ScienceDirect�

• Della and Money Autumn 2002 | Speech & Language Therapy in Practice #speechmag�
• Humphries, S et al (2016) A third-person perspective on co-speech action gestures in Parkinson’s disease. Science Direct Vol 78: 44-54

A third-person perspective on co-speech action gestures in Parkinson's disease – ScienceDirect

References cont’

• Humphries, S et al (2021). Co-speech gestures are a window into the effects of Parkinson’s disease on action representations. Journal of Experimental Psychology: General, 150(8), 1581-1597

Cospeech gestures are a window into the effects of Parkinson’s disease on action representations :: MPG.PuRe�

• Pitts, T. et al (2009) Impact of expiratory muscle strength training on voluntary cough and swallow function in Parkinson disease. �Chest 135(5): 1301-1308

Impact of expiratory muscle strength training on voluntary cough and swallow function in Parkinson disease - PubMed (nih.gov)

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The Effects of Respiratory Training in Parkinson’s Disease: A Systematic Review - IOS Press�

• Wydenback, N & Vella-Burrows, T (2020) Singing for people with Parkinson’s. Compton Publishing.

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