PD and Stuttering
I have two patients with the diagnosis if Parkinsons Disease who stutter. One has a history of disfluency the other does not. What is the best way to approach evaluating and treating these patients?
~Anne McKinley, MEd., CCC/SLP
I have two patients with the diagnosis if Parkinsons Disease who stutter. One has a history of disfluency the other does not. What is the best way to approach evaluating and treating these patients?
~Anne McKinley, MEd., CCC/SLP
Thanks for your question, Anne McKinley!
Usually it is hard to advice on a basis of long-distance, and without seeing the persons myself. Also in this context, each person is functioning so differently, and it is depending how the Speech or voice is affected. I also have to inform you that I have noe been involved in too many cases With the Parkinsons Disease and where the fluency is affected too.
I know Lee Silverman Voice Treatment LOUD and LSVT BIG is working well for quite many. My Experience is that the persons With Parkinson seldom benefit from ordinary speech restructuring treatment, but here I would like to know others experiences/comments too.
Anyhow, if you know the persons very well, and you are able to work explorative (experimental), I am tempted to suggest a few Things to explore in addition to the traditional voice treatment. The person has, of course, to be positive about being experimental and trying out something ‘new’ together with you.
I will try to explain so clear as I can in English, since I assume that Norwegian would be difficult to understand:-):
Ask the person to do a controlled movement (either move his finger, hand or foot, or whatever which is easy for the person to move) in a regular, rhytmically way, and then ask him a question or letting him talk about something he want while he is still doing/concentrating on the other movement. What you might see, is that the person starts to talk With a more fluent Speech, and usually the voice is becoming more powerful too (volume of the voice is increasing). This excercise is not always practical to transfer into daily life, but it Depends on how much the person is affected.
The other experimental approach is to include DAF Technology (find a cheap Application, ex DAF/FAF Aid Pro or something similar). I am usually not a big fan of DAF/FAF Technology, but I have in some cases observed that the Speech fluency has improved. As long as you let them decide, I would consider trying it. In a few cases Where the persons With Parkinson have tried the DAF, they have chosen to install the DAF/FAF into their own phone. The individuals you are collaborating With, have to consider how it feels like themselves, and it is important to weight the benefit against the cost also in this sense. Anyhow, you decide what is best for Your People, I just wanted to share those two explorative approaches which I have done myself.
I am wishing you good Luck With Your work!
Best wishes,
Hilda Sønsterud
Thank you Hilda….yes, Norwegian would be difficult for me to understand :-)….. one of my patients does have a DAF devise in his ear and reports he wouldn’t be able to talk at all without it. He has a big presentation next month so I will incorporate your first suggestion into our therapy time. He is very open to trying new techniques. Thank you for sharing your thoughts. ~Anne
Hi Anne,
Many thanks for your question. Very interesting to have two clients with the same diagnosis and some similar symptoms, but with different backgrounds. I just wanted to make a few general points in response to your question…
It’s important to avoid automatically assuming that the dysfluencies are a symptom of the PD or the previous history of dysfluency, just in case they are symptomatic of some other, undiagnosed condition (such as a stroke, for example). To clarify this, I would want to know a little about the medical history and the history of the dysfluencies (e.g. sudden or gradual onset). For the person with a history of dysfluency, I would want to establish whether the pattern of dysfluency has changed recently. With the consent of the individuals concerned, I would then want to highlight to the doctor any new or altered dysfluencies, particularly if they are of sudden onset, so that the doctor can decide whether further investigations are warranted.
Aside from this, my general instinct would be to approach the evaluations from a neutral stance, eliciting from the individuals their functional goals and establishing which of their symptoms they find particularly troublesome.
Dependent on the outcome of these discussions, I might then explore the dysfluencies in more depth, but only if it is relevant to do so. For the person with a history of dysfluency, I would be interested in finding out what they find already helps and if the symptoms of Parkinsons Disease have impacted their attitudes to dysfluency or any strategies they have previously used.
There is some (albeit limited) evidence that long-term use of dopaminergic medication may contribute to increased dysfluency, although it is very difficult to differentiate between the effects of the Parkinson’s Disease itself and the side-effects of the medication used to manage various symptoms. Either way, it is necessary to recognise that, due to the progressive nature of PD, the progression of its symptoms cannot be halted, but there may be the opportunity for short – medium term improvements or for stabilising symptoms for a while.
The literature regarding treatment for neurogenic stuttering (that is stuttering associated with neurological conditions such as PD) is fairly sparse. Hilda has suggested some useful tools and techniques for direct work on increasing fluency if that is relevant for the clients’ therapy goals. Particularly for the individual who does not have a history of dysfluency, it may be necessary to experiment with a few different approaches to find out what works for the client. However, as a therapy dyad, you may also need to step back and take a wider look at communication situations, as dysfluency may well not be the only feature which impacts on social communication for someone with PD (think volume, intelligibility, reduced facial expression, etc).
Changes in communication skills may also influence the individual’s self-image and relationships, and ameliorating negative impact of these changes may be useful and relevant therapy targets.
I appreciate that these are very general points and may not be relevant for the situation of the two people you are working with. Many thanks for sharing your question with us!
Thank You for your thoughtful response, Kirsten. Yes, the review of the literature for neurogenic stuttering was quite disappointing. Dr. Scott Yaruss directed me to this forum which I am very thankful. He also suggested an assessment of attitudes, needs and then working with their particular goals. As a spouse of a parkinson’s patient I do often ask myself ‘is this the disease or the meds or a combination’ when I observe a change of behavior in my husband. One component to PD is anxiety and of course that affects many behaviors in a PWPD, not just speech. I will use your suggestions when I see these patients next. Thank you again for sharing your expertise. ~Anne