Gaining Perspective on Parkinson’s

You've probably heard of the old proverb that says, "you can't understand someone until you've walked a mile in their shoes."

SO CLOSE YOUR EYES, AND IMAGINE THIS...

You're 25 years old, playing basketball with your friends when you notice your hand-eye coordination is off while dribbling the ball.

You're 30 years old, feeding your baby a bottle when your hand starts to tremor.

You're 35 years old, hugging your husband, and can no longer smell his cologne.

You're 40 years old, out for a drink with your friends when you start coughing each time you take a sip of your beer.

You're 45 years old, in a work meeting and you have had to use the bathroom four times in the last hour.

You're 50 years old, leaving the mall and can't remember where you parked.

You're 55 years old, not sleeping at night, resulting in always feeling fatigued.

You're 60 years old, and your firstborn is getting married, but no matter how hard you try, you can't smile for the pictures.

You're 65 years old, feeling depressed that while the rest are enjoying retirement, you're going to endless doctor appointments.

You're 70 years old, your movements are becoming slower and slower, while you're putting all of your effort into taking single steps.

You're 75 years old, and you experience your first hallucination.

You're 80 years old, and you cannot remember the names of your grandchildren.

The list goes on and on…

How Prevalent is Parkinson's Disease?

Most of us only know of Parkinson's disease because of celebrities such as Michael J. Fox, George H.W. Bush, and Muhammad Ali. But did you know?

• Nearly one million individuals will be living with Parkinson's disease (PD) in the U.S. by 2020, which is more than the combined number of people with multiple sclerosis, muscular dystrophy and Lou Gehrig's disease.

• Approximately 60,000 Americans are diagnosed with PD each year.

• More than 10 million people worldwide are living with PD.

• The incidence of Parkinson's disease increases with age, but an estimated four percent of people with PD are diagnosed before age 50.

• Men are 1.5 times more likely to have Parkinson's disease than women.

• In New York State, there are currently 48,000 people living with PD, with ~60,000 new diagnoses made each year nationally.

There is no rhyme or reason to the deficits, symptoms, or timeline of disease progression that each individual with Parkinson's will face. However, the commonly known signs, tremor and rigidity, are just the "tip of the iceberg." As speech-language pathologists, we're told numerous times. "I had no idea speech therapy was an option for me" or, "no one told me that you could help me with speech." These statements portray the lacking knowledge of the speech-language pathology scope of practice as it relates to this disease. It's imperative that individuals with Parkinson's disease understand the motor planning, cognitive, and swallowing difficulties that likely await. When you are well-informed, there are many resources readily available to assist in combatting the disease progression.

Dysarthria

DYSARTHRIA IS A MOTOR SPEECH DISORDER CAUSED BY MUSCLE WEAKNESS, SPECIFICALLY IN THE FACE, LIPS, TONGUE, AND THROAT, AS WELL AS MUSCLES FOR BREATHING DUE TO BRAIN DAMAGE.

Characteristics include:

• speech that is difficult to understand (e.g., slurred or mumbled)

• slow or fast rate of speech

• monopitch sounding speech

• difficulty with movement of the tongue, lips, or jaw

• short rushes of speech

• speaking in short phrases due to difficulty breathing

• reduced loudness

• abnormal voice quality (e.g., rough, breathy, strained, harsh, hoarse)

Your speech-language pathologist will determine the best treatment options as an individual's deficits vary. Strategies frequently used include slowing down your speech, using more breath to speak louder, increasing strength of lips, tongue, and facial muscles, increasing speech intelligibility, and using augmentative-alternative communication if needed.

Dysphagia

DYSPHAGIA IS A DIFFICULTY OR DISCOMFORT IN SWALLOWING. THIS DISORDER MAY OCCUR AS A RESULT OF VARIOUS MEDICAL CONDITIONS, ONE OF WHICH IS PARKINSON'S DISEASE.

Characteristics include:

• coughing during or right after meals

• food or liquid remaining in the mouth after meals

• poor lip closure

• food or liquid spilling from the mouth

• frequent drooling; complaints of food "sticking"

• globus sensation—complaints of a "fullness" in the neck

• complaints of pain when swallowing

• wet or 'gurgly' sounding voice during or after meals

• difficulty coordinating breathing and swallowing

• recurrent pneumonia

• extra effort/time needed to chew

• changes in eating habits—specifically, avoidance of certain foods/drinks

As a result of these difficulties, individuals with Parkinson's Disease are at a higher risk for aspiration and the development of aspiration pneumonia. Aspiration occurs when secretions, food, or any foreign material enters the lungs. Aspiration pneumonia often leads to acute respiratory distress syndrome (ARDS) or acute respiratory failure. Treatment may include the use of physical maneuvers, compensatory strategies, and diet modification to improve the safety and efficiency of the swallow.

Cognitive-Communication

COGNITIVE-COMMUNICATION DEFICITS ARE PROBLEMS WITH COMMUNICATION THAT STEM FROM A COGNITIVE DEFICIT.

Characterized by deficits in:

• attention

• memory

• perception, insight, and judgment

• organization

• orientation

• language

• processing speed

• problem-solving

• reasoning

• executive functioning and metacognition

Individuals with cognitive-communication deficits may have difficulty paying attention to a conversation, staying on topic, remembering information, responding accurately, understanding jokes or metaphors, or following directions. Cognitive-communication disorders vary in severity. Someone with a mild deficit may have difficulty concentrating in a loud environment, whereas a person with a more severe impairment may be unable to socialize in a one-on-one setting. Treatment may include the use of compensation strategies (e.g., external aides), rehabilitating skills to the prior level of functioning, and patient/family education.

Pulling it All Together

Now that you have a better understanding of the disorders associated with Parkinson's disease, we hope that you will advocate & seek out early intervention! Upon diagnosis, or at your next neurology appointment, ask your doctor about receiving a script for speech therapy (we promise you won't regret it).

Therapy is typically conducted in an outpatient clinic, however, if you are nervous to visit an unfamiliar setting, or physically cannot travel to the center, there is still an option for you! Neuro Speech Solutions is the only outpatient private practice in Buffalo, NY focused on providing Speech Therapy in the client's home environment.

By receiving therapy in your home, treatment plans can be made more personalized with client and family involvement. This approach leads to better outcomes, faster recovery time, and more client satisfaction. Our Speech-Language Pathologist, Katie, is certified in SpeakOUT! Parkinson’s Speech & Voice Treatment. Learn how this treatment can be beneficial by giving us a call today!

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ABOUT THE AUTHOR

Allison Walsh, MS, CCC-SLP

Allison is a speech-language pathologist based in Buffalo, NY. Her clinical interests lie in communication related to Parkinson’s disease and dysphagia treatment. Allison is the volunteer coordinator for The Parkinson’s Foundation, Buffalo chapter.

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