What follows is my summary, conclusions and suggestions re the speech survey I
submitted a couple of weeks back. While the number of responses was impressive
(between 30 and 40) one cannot infer any statistically significant conclusions
from such a small sample size. Nevertheless, the data suggests certain
conclusions.
The most common complaints regarding speech are:
voice volume
velocity is too fast
trouble initiating speech
stuttering
breath support
difficulty forming words
I would divide speech into two component parts:
1. formulating thoughts
2. executing speech
A normal person can do both simultaneously without difficulty but in PD there is
an impairment in simultaneous task performance (how many of us have difficulty
in walking and talking at the same time?) Formulating thoughts is rarely a
problem unless one is concentrating on executing speech. So thought formulation
is fine but expressing these thoughts is the challenge. This is why
maintaining speech can be so difficult. When speech begins we have stored the
initial sentence or two in our heads, it is pre-composed and rehearsed,
however, once speech is initiated then thoughts must be composed on the fly so
to speak and executed simultaneously. This simultaneous task performance is
very difficult and as compensation for this impairment we try to rapidly
pre-compose additional lines of speech and execute them before they evaporate
from our short term memory. Thus, the tendency for rapid speech which tends to
accelerate as we go along.
In those instances when speech can take place in the absence of thought
formulation our speech approaches normalcy. An example of such a circumstance
would be singing a familiar song. Whether or not you can carry a melody is
irrelevant what I am talking about here is the ability to express the words.
Well learned poetry should also work or for that matter reading from a book.
Voice volume seems to be more of a mechanical problem - perhaps the vocal cord
muscles are not as efficient with PD.
Performance anxiety situations (tension) impact even more profoundly on the
ability to perform speech. Becoming self-conscious of the performance further
inhibits the performance.
The mere presence of another person in the room is more than enough to induce
this performance anxiety. Speaking while alone is often quite normal.
Similarly situations where the person can be ignored helps speech. For example
if the PD subject were to go into the next room he would likely find it much
easier to speak. Another example is anger. Getting angry is a way of
excluding the presence of others and speech frequently improves when the PD'er
becomes angry.
Recommendations:
1. Melodic Intonation Talking : This is an attempt to exploit the
observation that singing is helpful for PD speech. Melodic intonation is
speaking tonally. The words are all connected and there is kind of a melody
being superimposed over the speech - not so much a musical melody but rather a
kind of monotone singing of the dialogue.
2. Talk while occluding sound in one or both ears (place a finger in
your ear).
This creates a kind of amplified sound and further serves to isolate the speaker
from the environment.
3. Remind your friends and family to not pretend that they can
understand you when they cannot. Have them say "what" ten times if necessary.
4. The Value of the Speech Pathologist
This is truly difficult to evaluate. A lot of PD'ers feel that if they
practice enough they can overcome difficulties of speech. I am not so sure.
One can practice forever and not be able to overcome akinesia. Perhaps voice
volume problems can be improved by such "exercising" of the vocal chords but I
doubt that the other problems can be impacted. The only alternative to
compensatory approaches such as melodic intonation or amplification would be
some way to normalize the simultaneous task performance deficit associated with
PD. One example of such an approach might be walking with external cues. For
example walking over an array of playing card positioned at stride length
intervals on the floor. The subject walks in such a manner as to land each foot
midway between two adjacent cards. Speech tends to improve while walking in
this manner. Still another approach might involve the use of a visually based
therapeutic device (so called virtual vection glasses) which tends to normalize
simultaneous task performance in some individuals.
I apologize for the length of this report and hope that some of you might find
it useful...and of course I welcome your comments.
Regards,
Tom
