April is Parkinson’s Disease Awareness Month, so I wanted to take this opportunity to shed some light on the services speech-language pathologists can offer to patients with Parkinson’s disease to improve quality of life.
What is Parkinson’s disease and how does it affect voice and swallowing?
Parkinson’s disease is classified as a movement disorder, a hypokinetic neurological disorder to be exact. This means it doesn’t directly result in muscle weakness or muscle loss like some other progressive neurological conditions do, but instead it results in reduced movement of the muscles. However, if those muscles are not moving fully for an extended period of time, they can then become weak from under-use. This is true for the voice and swallowing musculature, just as it is true for our other larger muscles in our arms, legs, etc. There are several tiny little muscles that are used in both voicing and swallowing, and if they are reduced in their range of motion, even minimally, this can have a huge impact on the ability to project the voice, maintain a good voice quality, and swallow safely.
How is the voice affected by Parkinson’s disease?
The vocal cords are housed at the top of the airway, like double doors leading to the lungs. Typically they come together and meet in the middle to vibrate and produce voicing when we speak. If they have reduced range of motion, as with Parkinson’s disease, they won’t fully meet like they should and can have a gap between them. This causes air to escape between the vocal cords and often results in a quieter and breathy-harsh voice quality, which is one of the number one complaints of our patients with Parkinson’s disease. This is often even one of the earliest signs of Parkinson’s disease, and many of our patients tell us this is one of the first symptoms they noticed.
How is swallowing affected by Parkinson’s disease?
In addition to their role in voicing, our vocal cords also play an important role in swallowing. They are one of the forms of protection for our airway when we swallow. When we swallow, they close off (again, meeting fully in the middle) so that our airway is closed off and nothing that we swallowed goes into the lungs. If the vocal cords and the surrounding structures involved in swallowing are not moving fully, this increases the risk of food/liquid leaking into the airway when swallowing and reaching the lungs, referred to as aspiration. Signs of aspiration could include coughing, clearing the throat, and/or a wet vocal quality after eating/drinking. However, if sensation is impaired, there can sometimes be no overt signs that aspiration is occurring. If happening chronically, aspiration can have very serious consequences, such as aspiration pneumonia, so it is important that an
y swallowing impairments are detected and treated as early as possible.
How can voice and swallowing be helped?
It’s true what they say- if you don’t use it you lose it! The best thing that can be done with Parkinson’s disease with regards to the voice and swallowing muscles is exercise to improve and maintain that range of motion to prevent them from becoming weak from disuse. Parkinson’s disease is one of the progressive neurological diseases that has the best response to exercises when compared to other types of conditions, again since it results in reduced movement rather than direct muscle weakness.
Lee Silverman Voice Treatment- LSVT LOUDThe LSVT LOUD program is the most well-researched and world-renowned voice therapy regimen designed specifically for patients with Parkinson’s disease. LSVT LOUD has been well-respected in the medical community for its outcomes for over 20 years now. The intensive program is a 4-week regimen consisting of 4 1-hour sessions 4 days per week and involves exercises to achieve better vocal cord closure to improve voice volume and quality. It has also been shown to improve swallowing safety.
Expiratory Muscle Strength Training
Expiratory muscle strength training involves blowing air into a resistive device to strengthen the muscles involved in swallowing and voice. This can strengthen the cough reflex as well to make it easier to protectively clear anything that enters the airway. There are many recent studies showing great efficacy for EMST use in individuals with Parkinson’s disease.
Intensive Swallowing ExercisesSometimes other structures affecting swallowing, such as the epiglottis for example, may be more the culprit than the vocal cords in affecting safe swallowing. In these cases, intensive pharyngeal exercises can help to strengthen the swallowing musculature. Some patients are also a candidate for neuromuscular electrical stimulation (NMES) and/or surface electromyography as additional modalities during swallowing therapy. NMES involves carefully delivered electrical stimulation to the pharyngeal muscles during therapy in conjunction with exercises led by a specially trained swallowing clinician. Surface electromyography is a means of measuring muscle activity through electrodes placed on the skin in order to reach specific targets during exercises.
Other Areas Affected
Depending on the individual, there can be other areas affected by Parkinson’s disease as well, such as cognition and fluency. Some people’s memory and thinking can be affected, and some individuals may develop a stutter along with their Parkinson’s disease. Each of these are also treatable by speech-language pathologists with individualized treatment approaches depending on the nature and degree of the symptoms.
Symptoms of Parkinson’s disease often respond very well to treatment and can result in great improvements in quality of life. Exercises to strengthen and improve functioning are important initially, and then maintenance exercises are critical for maintaining progress and preventing further decline. At SNR, we offer LOUD for LIFE, a weekly voice maintenance class for LSVT LOUD therapy graduates from any program to help maintain their improvements after individual therapy has ended.
Please feel free to contact us with any questions about any of the above information, to inquire about our programs, or if there is any other way we can help. Thank you for taking this time to learn about the services available to people with Parkinson’s disease, and keep this important information in mind not just during April, but every month!