Tim qualified as a Speech and Language Therapist in 2004 from University College London attaining a BSc in Speech Sciences, he later completed a Masters of Research in Speech Language and Cognition from the same institution. He is currently completing a PhD, investigating how medication and stimulation affect hypomimia (reduced facial expression), also at UCL.
Tim holds the position of Consultant Speech and Language Therapist in Movement Disorders at the National Hospital for Neurology and Neurosurgery at Queen square, London. He is part of the Movement Disorders department treating people with PD and associated conditions and Dystonia. He is also part of the Unit of Functional Neurosurgery team treating patients with PD and dystonia with DBS. Tim also spent some years working with patients with acquired voice disorders. This continues to be an area of interest and along with the team at Queen Square they are beginning to look at the viability of DBS for spasmodic dysphonia. Other clinical areas of interest include the management of drooling, reduced facial expression and Functional Neurological Disorders (FND) . Tim has published in the field of speech and voice and Parkinson’s disease and DBS and has been a key note speaker at both national and international symposiums on this subject matter.
Written piece by Tim Grover
Most patients with a diagnosis of Parkinson’ disease will at some point experience changes to their speech. This can differ greatly from person to person but typically the onset of speech changes can appear early are mild and progress slowly, often overshadowed by difficulties encountered with motor skills. The hallmark feature of Parkinson’s speech is a soft breathy voice with some loss of inflection. Individuals may find they are being asked to repeat more often and will often attribute this to other people’s loss of hearing. This is a common occurrence and is due to a change in perception of how loud they are speaking. To the individual with Parkinson’s, it feels like they are speaking normally however to others they sound quiet and in some cases, indistinct.
The same symptoms of slowness of movement (Bradykinesia) and (stiffness) rigidity that affect walking or dexterity for example are the same symptoms than affect speech but of course these are not seen but heard. These symptoms affect the muscles involved in speech production which are many and include muscles of respiration, articulation, and voice production. Changes seen are not related to weakness per say but rather under scaling of movement, slowness of movement, difficulties initiating movement and poor timing of movement. Due to issues of timing and initiation some patients experience what is termed ‘hastening of speech’ or ‘festination of speech’ in which as the utterance increases in length the words can run in to one another causing increasing indistinct speech, this is often accompanied by a progressive loss of volume over the sentence. For a smaller number of patients an acquired neurological stammer can appear. Medication can have a variable affect on speech but does tend to improve loudness and articulation to some degree and like many motor symptoms fatigue can play a big role also.
Management of the above speech changes is determined by the speech changes experienced and their severity. For a mild loss of volume, patients are encouraged to use a louder voice to overcompensate. Addition strategies such as pausing can help if speech is swift and indistinct. Speaking from room to room should be avoided. It is worth noting that it is typically those closest to you that will experience the greatest impact of these changes to communication as opposed to less familiar people with whom you may be inclined to make more effort with. Activities such as singing and reading aloud as if to audience are good activities to maintain the voice. You may be referred for an intensive speech therapy called the Lee Silverman voice Treatment (LSVT LOUD), this treatment aims to increase habitual speaking volume and rescaling of speech production. This intensive treatment involves repeated vocal exercises, talking aloud, and reading aloud. This therapy has been shown to improve loss of volume and speech intelligibility in multiple studies and has also shown benefits for swallowing and loss of facial expression. As for many therapeutic treatments, at the end of therapy you are required to continue practicing on you own or the gains acquired will be swiftly lost.
For patients with more marked speech changes alternative approaches or assistive speech technology can be helpful and your speech therapist can guide you in this process. Another aspect that is perhaps overlooked is how the loss of facial expression can impact on communication. Whilst the individual with Parkinson’s may be interested and happy this may not be shown outwardly due to reduced facial movement. This may surprise or confuse the conversation partner and as such it can be helpful to compensate in both your speech and expression to overcome this.
Patients with Parkinson’s should be aware that changes to speech tend to occur slowly, and people cope extremely well. Most importantly, keep talking and engaging in communicative situation as this will maintain your voice.
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