“Communication is a skill that you can learn. It’s like riding a bicycle or typing. If you’re willing to work at it, you can rapidly improve the quality of every part of your life.” ~Brian Tracy
Parkinson’s Disease is a progressive neurologic disease affecting men more frequently than women at a ratio of 3:2. Typically the onset is after 50 years of age but it may begin much earlier in life as well. Parkinson’s disease is still not fully understood , we do know that the loss of nerve cells in the select areas of the brainstem are responsible for the symptoms and the progression of this condition. I would like to discuss the issues that those with Parkinson’s may experience with vocal communication.
Speech may be impaired as a result of reduced effort and airflow. It is not thought to be a result of loss of muscular tissue of the vocal folds. Initial treatments focused on surgical manipulation called medialization laryngoplasty of the vocal folds or collagen injections of the vocal folds, known as injection laryngoplasty, which proved to have disappointing results.
It has been recognized that the treatments proving to have the greatest effect are specialized voice therapy treatment known as LVST and working with a certified speech pathologist. LVST LOUD is a program that is administered in 16 sessions and focuses on improving vocal loudness by stimulating the muscles of the voice box through a system of exercises. The treatment improves respiratory, laryngeal and articulatory function in an effort to increase intelligibility of speech. This treatment has been quite successful and the effects can last for upwards of two years. Typically benefits those in the earlier to mid stages of the Parkinson’s process.
The effects on speech have been distinguished as a low volume voice with a monotone quality, speech pattern is often noted to be produced in short bursts with long pauses, this is related to air flow. Speech may be slurred and in approximately 15% of residents speech may be tremulous. Speech Pathology can help the resident to develop strategies for swallowing and for effort of air flow which will enhance the ability to communicate. It is imperative for the care giver to understand that speech patterns and volume will be affected and therefore; we need to understand what we can do to better understand the resident with Parkinson’s.
Patience is key, being close enough to hear a low volume voice and not being afraid to ask a resident to repeat themselves if you have not understood. Residents are able to utilize technology as well such as texting. And books with pictures and words are also helpful so a resident may point to what they want and the care giver gains understanding of what is needed. It may take time for the resident to organize and then communicate the right words.
Keep in mind that a noisy environment, distractions and time of day are all factors effecting good communication. It is important to reduce the noise level and distractions when you are trying to communicate with a resident with Parkinson’s if you are having trouble understanding. If a resident is too tired or having a bad day, communication will be effected.
We may need to modulate our own speech and patterns as well so that resident with Parkinson’s can understand us as well. Remember, a resident may have issues with speech but that does not mean that they are hearing impaired. Don’t yell, speak clearly and slowly so that the resident is able to understand and process what you are saying. Asking closed questions so that they resident does not have to expend excess energy on long answers is also helpful. Gestures to convey meaning and repeating what you have heard for clarification are paramount to good communication.
Remember, communication is part of the human experience and builds trust and relationships between ourselves and our resident’s and is worth every effort. I would add that you will not only enhance your own life but that of a fellow human being.
From Mary Ann Durso RN-BC DON, Director of Nursing Services