Parkinson s Disease Foundation PD ExpertBriefing: Understanding PD ExpertBriefing: the Progression of Parkinson s Led By: Ronald F. Pfeiffer, M.D. Improving Communication in Parkinson's Disease: One Voice, Many Listeners Led By: Angela Roberts, To hear Speech-language the session Pathologist live on: Ph.D. Candidate & Lecturer Western University, Tuesday, London, Ontario June 26, CANADA 2012 Health and Rehabilitation at 1:00 Sciences PM Program EDT. School of Communication Sciences and Disorders DIAL: 1 (888) 272-8710 and enter the passcode 6323567#. This session was recorded on: Tuesday, June 4, 2013 at 1:00 PM ET. To also view the session live on the computer by visiting: http://www.pdf.org/parkinson_briefing_progression If you have any questions, please email webcast@pdf.org or call (212) 923-4700
Funding Acknowledgements Canadian Institutes of Health Research Ontario Ministry of Education Parkinson Society Canada Support Aging and Communication Laboratory, Western University Movement Disorders Laboratory, London Health Sciences Centre, London Ontario
Goals of this PD ExpertBriefing To understand the complex dynamics of communication in Parkinson's disease. To review evidenced-based therapies for improving speech and voice changes in Parkinson's disease. To explore novel approaches for managing communication challenges at all stages of living with Parkinson's disease.
Communication Exchange of concepts, ideas & messages Establish, maintain & change relationships Consists of multiple forms: Social (interactional) Agenda (transactional)
Complex Multidimensional Language Speech Hearing/Vision/Touch Cognition Voice
Cognition Changes Executive functions (Pagonabarraga & Kulisevsky, 2012; Muslimovic et al., 2005) Sequencing Generating solutions to new problems/situations Mental flexibility Attention/focus (Elgh et al., 2009; Muslimovic et al., 2005) Working memory (Muslimovic et al., 2005) Verbal memory and learning (Bohlhalter et al., 2009, Elgh et al., 2005; Green et al., 2002; Muslimovic et al., 2005) Visual spatial/perception skills (Pagonabarraga & Kulisevsky, 2012)
Language Changes Retrieving words: Nouns > verbs (Cotelli et al., 2007; Herrera and Cuetos, 2012; Rodriguez-Ferreiro et al., 2009) Processing complex sentences (Grossman et al., 1991; Grossman et al., 1992; Hochstadt et al., 2006) Processing abstract/figurative language (Holtgraves & McNamara, 2010; Monetta et al., 2009; Berg et al., 2003) Social language (Hall et al, 2011; McNamara & Durso, 2003) Processing of emotional information: semantics, prosody, facial expression (Mikos et al., 2009; Jaywant & Pell, 2010)
Speech/Voice Changes 90 percent will experience some change in voice or ability to make speech sounds Not just slowness or rigidity Scaling problem Internal cueing problem Self-perception & selfregulation problem
Speech/Voice Changes (Cont.) Reduced loudness Reduced pitch variability Reduced stress patterns Breathy, hoarse voice Imprecise speech sounds Excessive rate of speech (6-13 percent) Reduced rate of speech Reduced amplitude and peak velocity of jaw movements
Interactive Processes in Communication Speech/Voice Hearing & Vision Language Movement/Walking Cognition Roberts, 2013
Interaction Effects on Communication in Persons with PD (PWPD) Motor Tasks (e.g., walking, balance) + Talking Speech volume decreased only with increased language demands (Ho, et al., 2010) More pauses during conversation (Ho, et al., 2010) Speech rate decreases (Ho, et al. 2010; Bunton, et al. 2008) Decreased speech intelligibility for some tasks (Bunton, et al. 2008)
Interaction Effects on Communication in PWPD (Cont.) Impaired initiation of talking (Hall et al., 2010; McNamara and Durso, 2003) Impaired turn-taking (Hall et al., 2010; McNamara and Durso, 2003) Shortened response & phrase length (Illes et al., 1988; Cummings, et al. 1988; Griffiths et al., 2012; Murray 2000; Murray & Lenz, 2001; McNamara et al., 1992) Reduced language output (Illes et al., 1988; Cummings, et al. 1988; Griffiths et al., 2012; Murray 2000; McNamara et al., 1992)
Interaction Effects on Communication in PWPD (Cont.) Reduced information content (Cummings, 1988; Holtgraves et al., 2013; Jaywant & Pell, 2010; Murray 2000; McNamara et al., 1992) Increased verbal disruptions with more complex language tasks (Ash et al., 2012; Griffiths et al., 2012) Reduced ability to use gestures (Rousseaux, 2010)
Social Approaches for Communication Disorders in PWPD (Roberts, 2013) Sending and receiving messages All partners have a role in communication success & failure Consider the impairment, abilities & environment Multidimensional: exercise based treatments, devices, compensatory strategies (Adapted from Simmons-Mackie et al., 2000)
LSVT LSVT LOUD Lori Ramig & Cynthia Fox (Fox et al., 2006; Fox et al., 2012; Sapir et al., 2008) http://www.lsvtglobal.com/ Most evidence available to support efficacy (20 years) Good evidence to support increased loudness and swallowing improvement up to two years post treatment Intensive exercise program improving voice loudness, articulation, facial expression & swallowing Systematic approach re-calibrating loudness/effort May not work as well for individuals with more severe disease/cognitive impairment May not work in all communication situations
(Sapienza et al., 2007; Sapienza et al., 2007; Saleem et al., 2005; Pitts et al., 2009) Works by Building: Respiratory Support and Effort Improvements in: Speech volume Swallowing function (reduced penetration/aspiration) Program: http://www.aspireproducts.org/ At home On-line instructions Five sets of five practice trials a day Each week increase resistance on the device Four week total program PLEASE CONSULT YOUR DOCTOR BEFORE USING. SEE WEBSITE FOR PRECAUTIONS & CONTRAINDICATIONS.
Lombard Effect Natural tendency to increase voice volume in a noisy environment Enables ability to adjust voice volume in crowd noise Preserved in PWPD (Adams et al., 1992; Adams et al., 2006)
Devices Optimizing the Lombard Effect Copyright 2012 SpeechVive all rights reserved. Steve Mogensen Phone: 612.723.7200 Email: smogensen@speechvive.com http://www.speechvive.com/product.html
Devices Optimizing the Lombard Effect (Cont.) Casa Futura Technologies Delivers altered feedback to reduce speech rate Delivers multitalker background noise http://casafuturatech.com/index.p hp/products/iparkinsons
Rate Control Approaches Decreasing rate = increased intelligibility Behavioural approaches (pausing, training to slower rate) Don t work well as device approaches Altered auditory feedback (AAF or DAF) AAF devices Modeling Reducing pace of speech/conversation Pacing boards
Altered Auditory Feedback (AAF or DAF)
Pacing Boards
Voice Amplification ALDS MiniBuddy Voice Amplifier ChatterVox CVX/PRO/H Voice Amplifier w/headset Microphone Fortissimo 85 db SPL of voice output volume with speaker phone at 50 cm
FM Systems Receiver Transmitter www.phonak.com
Induction Loop Systems http://www.vivid-acoustics.com
Strategies Minimize resources Optimize strengths Reveal competence PWPD & Partner focused Message focused Relationship focused
Assess hearing & vision (PWPD & communication partners)
Hearing & Speech in PWPD Hearing loss = 3 rd most common chronic condition in individuals > 65 yrs of age (ref) Mild losses of 25-30 db HL = substantial impact on understandability Interacts with speech volume & clarity in individuals with PD, cognition & language Listeners of speech produced by PWPD PWPD language and cognitive processes
Optimize voice/speech output from the speaker (therapy, voice amplification) Optimize input to the listener (hearing aids, FM systems, facial expressions) Position yourself face to face
Minimize distractions Visual & Auditory
Allow extra time Reduce rate of information - present in smaller chunks & slower speech Mark a place in the conversation. Signal that you need more time. Fill in or supply information (when needed) Be patient...
Verify that the message was understood correctly Consider complexity of words & sentences used Use multiple modes of communicating messages (written, pictures, videos, speaking, facial expressions)
Questions & Answers
Resources from PDF Fact Sheets Speech Therapy in Parkinson s Parkinson s Disease Resource List 750 Resources Online PD ExpertBriefing: What s Missing? Communication and the PD Partnership
Upcoming PD ExpertBriefings Sex and Parkinson's Tuesday, September 10, 1:00 PM - 2:00 PM ET Gila Bronner, M.P.H., M.S.W., C.S.T. Sexual Medicine Center, Sheba Medical Center, Israel Caregiving and Parkinson's Tuesday, November 19, 1:00 PM - 2:00 PM ET Gwyn M. Vernon, M.S.N., C.R.N.P., University of Pennsylvania Nursing School & Rhona Johnson, care partner, founding member, PDF People with Parkinson s Advisory Council
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