Speech Treatment for Parkinson's Disease

Lorraine O Ramig, PhD, CCC-SLP; Cynthia Fox, PhD, CCC-SLP; Shimon Sapir, PhD, CCC-SLP

Disclosures

Expert Rev Neurother. 2008;8(2):297-309. 

In This Article

Abstract and Introduction

Abstract

Researchers estimate that 89% of people with Parkinson's disease (PD) have speech and voice disorders including disorders of laryngeal, respiratory and articulatory function. Despite the high incidence of speech and voice impairment, studies suggest that only 3-4% of people with PD receive speech treatment. Here, we review the literature on the characteristics and features of speech and voice disorders in people with PD and the types of treatment techniques available (medical, surgical and behavioral), with a focus on behavioral therapies. We provide a summary of the current status of the field of speech treatment in PD and recommendations for implementation of the current efficacy of treatment interventions. Directions for future research, including a speculative viewpoint on how the field will evolve in 5 years time, are discussed.

Introduction

Oral communication is vital in education, employment, social functioning and self-expression. The prevalence of disordered communication is particularly high (89%) in the nearly seven million individuals worldwide with Parkinson's disease (PD); however, only 3-4% receive speech treatment.[1,2,3] Soft voice, monotone, breathiness, hoarse voice quality and imprecise articulation, together with lessened facial expression (masked faces), contribute to limitations in communication in the vast majority of individuals with PD.[4,5] The reduced ability fo communicate is considered to be one of the most difficult aspescts of PD by many people with the disease and their families.[6] Moreover, speech and languge changes in PD can have a negative impact upon individuals with PD and their family-life long before frank impairments of intelligibility are apparent.[7] Affected individuals often become disabled or retire early, are forced to give up activities they enjoy, incur substantial medical costs and have increased mortality.[8,9,10] Based upon 2004 estimates, PD costs the USA US$34 billion annually in direct health-related expenses, disability-related costs and lost productivity.[11,12] As the number of elderly people greater than 65 years of age increases, these costs are expected to exceed US$50 billion by 2040. The average age of diagnosis of PD is 60 years, but in many individuals the disease develops at a much younger age. Given the relative slow progression of the disease, improvement in the ability of these individuals to communicate increases the chance that they could maintain an improved, productive quality of life, despite living out the rest of their life with a chronic disease. Thus, the value of an effective treatment for disordered communication in this population is clear.

Although medical treatments, including neuropharmacological as well as neurosurgical methods, may be effective in improving limb symptoms, their impact on speech production remains unclear.[14,15,16,17,18,19,20] Moreover, historically, people with PD have been particularly resistant to speech treatment.[1,21,22,23,24,25,26] Recently, however, a speech treatment approach called Lee Silverman Voice Treatment (LSVT® LOUD) has generated efficacy data for successfully treating voice and speech disorders in this population. The purpose of this review is to:

  • Provide a brief summary of speech and voice characteristics associated with PD

  • Discuss medical and behavioral speech treatment approaches for PD

  • Summarize key components of speech treatment that seem to underlie positive outcomes

  • Highlight ongoing and future research directions in speech treatment for PD

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