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The source of this article is Hernando Today: http://tinyurl.com/c6yyg Jun 8, 2005 Treating the 'voice' of Parkinson's disease By LOIS HANNA Hernando Today correspondent Some ideas are so absurdly simple that nobody has honored them with study and acceptance. Complex ideas tend to get attention. Simple ones slip by without our notice. For instance, consider one of the primary indicators of Parkinson's disease. People who have Parkinson's frequently lose their ability to communicate effectively. Their speech becomes muted, flat, without expression. They pronounce words poorly, running them together. Eventually they lose their ability to get noticed. Something can be done about that, while Parkinson's still awaits a cure. Joyce Payne has recently joined the Rehabilitation Department at Oak Hill Hospital. She brought along her training and experience in a newly developed therapy program designed for Parkinson’s patients — "Say It Loud." That's right — if you can't speak up, learn to talk louder. With skilled help, of course. Therapists simply teach these patients to "Say It Loud," and help them know when they’re doing it. How's that for taking the bull by the horns? Why focus on one symptom? While patients with Parkinson's are fighting a neurological disease that can bring physical deterioration to the point of helplessness, says Payne, their quality of life bottoms out. It's the very worst time to be isolated, even sometimes to be in physical danger without a way to get help. Payne showed us a movie clip which demonstrates the problem poignantly. A man lies on the floor, alone in his apartment. He’s not far from a door, so he whispers "Help!" And he lies there, waiting. He can’t tell anyone "I've fallen and I can't get up." Payne explains that these folks have lost their perception of loudness/softness in their own speech. They can't make themselves understood on the phone. They can't give their name and address. They can't ask directions or give them. Friends drift away. Family assume what they would want and often do the wrong thing. Another clip showed a family eating together. Their conversation was animated. One member sat passively. He might as well have been on another planet. To frost the cake, this lost ability to speak intelligibly is probably coupled with lost ability to write legibly, further isolating the patient. When communication is restored, it doesn't cure Parkinson's. But it can make lives more bearable, and even restore some people to productivity. For a while — but isn’t everything in life "for a while?" The new idea is put into use "Say it Loud" is a structured treatment modality based on the Lee Silverman Voice Treatment Program®. It's named for a woman with Parkinson's who supported the program's development. Joyce Payne has prepared information about LSVT® to be used for training at Oak Hill, community education, and medical referral sources. Here it is, condensed: • Four hundred individuals with Parkinson's Disease have been treated with LSVT® in efficacy research studies. Ninety percent show improvement. Approximately 80 percent of those patients maintained improvements for 12 to 24 months after treatment; all report improvement in their ability to communicate. • LSVT® is an intensive training program in which the individual learns to improve loudness, voice quality and variability, to enhance speech intelligibility. (It treats) the underlying physical pathology associated with the disordered voice. Treatment includes four sessions per week for four weeks with additional practice outside the treatment setting. • LSVT® must be administered by a trained and certified speech-language pathologist. Special professional certification is required to perform this treatment. A market survey showed no other center in Hernando County providing this program. Physician referral is required to receive the therapy. The program also requires evaluation of the vocal fold physiology and function by an ear, nose and throat physician prior to start of therapy. The Parkinson's problem — brief run-down "Parkinson's disease is a debilitating and progressive disorder in which the chemicals that facilitate electrical transmission between nerve cells are depleted ... Symptoms usually begin in middle to later life with trembling of the lips and hands, loss of facial expression, and muscular rigidity. As it progresses it may bring on body tremors, particularly in muscles at rest. Movements become slow and difficult; walking degrades to a shuffle. After many years, physical incapacity may occur . . ." — Houghton-Mifflin Dictionary. Current figures indicate that 1.5 million cases of Parkinson's are identified; estimates are that there are an additional one million cases which are undiagnosed. Forty thousand new cases are diagnosed each year. Individuals with Parkinson's describe difficulty communicating in social, family and work situations. Estimates are that 75 percent of individuals diagnosed with Parkinson's will experience speech and voice disorders that reduce effective communication. Speech and voice problems typically include low/soft level of vocal intensity. Reduced loudness and imprecise speech impair sound production. Many patients have a "masked" appearance with minimal movement of the mouth. Parkinson's disease usually appears after the patient is 50 years old. In older age groups, the number of diagnosed cases increases. LSVT® is the first effective treatment established for treating these voice and speech disorders of individuals with Parkinson's and other neurological disorders. Payne says that techniques developed within this program have sometimes been useful in treating similar symptoms in other disorders, such as multiple sclerosis and stroke. "Before and after" demonstration The LSVT® Web site, www.lsvt.org, carries a "before and after" interview of a woman who looks about 50. At entry into the program, her expression is bland. Her voice is flat and low, and her words run together so only some of her answers are intelligible. She was diagnosed with Parkinson's two and a half years ago, six months after a car accident injury, when she saw a doctor for help with constant tremors in hands and body. She says her speech has changed. It's softer and "hoarse." She says she stutters frequently and chooses to speak very little. She was asked to sing an "Ahhhh" and hold it as long as possible. Her voice was low-pitched and raspy. It faded after 10 seconds. During the interview, her expression changed very little. After the course of therapy, she was re-interviewed. Her expression is lively. Some-times she throws her head back and laughs. She looks younger. She describes feedback she is getting from family and friends, and imitates their surprise. She practices talking and reading aloud. She reminds herself to "Talk loud" and adds "Think loud." Her "Ahhhh" is repeated, this time lasting about 25 seconds. The raspiness is gone. Her tone is five notes higher and doesn’t waver or fade away. She plans to practice singing, perhaps join a musical group. She mimics her husband's teasing, imitating his facial expression. Other people sometimes tease her, too, with "I can’t hear you." She interprets the teasing as evidence that people are relating to her more easily. Shirley's mood seemed much better in the "after" clip. Not only was her voice smoother and more pleasant, her answers were quicker and clearer. Her body language was more relaxed, gestures frequent, expression pleasant and appropriate to the topic. Singing the lengthy note in a hearty voice seemed to feel good. Meet Joyce Payne To describe Joyce Payne, MS, CCC, SLP as a speech therapist is like calling a peacock a bird. She is a speech and language pathologist. She has a master's level clinician. The three Cs stand for "Certified Clinical Competence." She has lived in Florida for a long time. She had worked part time at several area hospitals, and in April covered a gap in services at Oak Hill. That developed into a full-time job offer. She started full time at Oak Hill on May 2. She brought to Oak Hill her completed training and experience in LSVT® and Parkinson's. It didn't take long for her new employers to add this program to their repertoire of methods by which people with chronic diseases can learn to help themselves. Payne lives in Holiday. She travels 40 to 45 minutes each morning and evening to and back from Oak Hill. She says that traffic on U.S. 19 can be harrowing. But her enjoyment of the new job and the people she has met makes up for the longer drive. Claudia Jackson, director of Oak Hill Hospital's Rehabil-itation Department, comments that she's happy to welcome Payne to the department. She's impressed with Payne’s extensive training and experience, as well as her talent and personality, which make her a "natural" for the job. The training material prepared by Joyce Payne includes this paragraph: "If music is the pathway to the heart, as Voltaire suggested, then speech is the pathway to other people. Live in silence and you live alone." ---------------------------------------------------------------------- To sign-off Parkinsn send a message to: mailto:[log in to unmask] In the body of the message put: signoff parkinsn