A couple of months ago I conducted a "speech survey" in this forum to gain a
clearer understanding of PD speech problems. Below is a reprint of my findings
with one IMPORTANT addition which for me at least is vastly superior to any
previous techniques I have tried.
OBSERVATIONS ON PARKINSONIAN SPEECH
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 syntax
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?). Thought formulation is not the
problem, (i.e. we know what we want to say), but expressing these thoughts is
the challenge. Formulating syntax (i.e. how we say something) is a problem
when one is concentrating on executing speech. This is why maintaining speech
can be so difficult. When speech begins we have stored the initial sentence
syntax in short term memory, it is pre-composed and rehearsed, however, once
speech is initiated then syntax must be composed on the fly 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 syntax
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. Reading from a book is also easier but
less so. Voice intensity may be more of a mechanical problem - perhaps the
vocal cord muscles are not as efficient with PD or perhaps the act of speaking
with volume requires additional attention where none is available.
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 other 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.
There are several techniques which are helpful to varying degrees for improving
speech.
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. Two word couplet speech: This is a technique where speech is divided
into two word increments. It allows one to avoid the conscious slowing down of
speech. Speed control exists by restricting the pace of the couplets rather
than the rate of pronunciation of words making up the couplets.
3. 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.
4. Remind your friends and family to not pretend that they can
understand you when they cannot. Have them say "what" ten times if necessary.
5. 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.
All of the above are superseded by the following discovery. A delayed audio
feedback (DAF) system can normalize Parkinsonian speech. Such a system won't
do much for problems of volume alone but can potentially have a profound impact
on motor speech problems. In such a system the subject (and only the subject)
hears his own voice as he speaks but there is a slight delay between the time he
speaks and the time he hears himself.
Why does this work?
We recognize the presence of our own speech by two normally inseparable events.
The motor act of speaking and the perception of hearing ourselves speak.
Ordinarily these two events are simultaneous occurrences and there is simply an
inadequate amount of time to compose speech while executing speech. However,
if these two components are separated by DAF then the act of executing speech
is no longer instantaneous. It takes slightly but significantly longer than an
instant and this provides us with sufficient time to compose more syntax.
How to make your own DAF system:
Go to your local electric guitar or music synthesizer/electronic keyboard store
and purchase a Boss Digital Reverb/Delay unit (I use the DD-3 unit but the RV-3
can also be used) price is about $79. Next purchase a small, portable amp (I
use a Fender Mini twin - it's about the size of a paper back book, about $70).
Next you'll need an ultra miniature microphone such as The Clip Microphone
available at Radio Shack $29. and a pair of head phones. You will also need a
couple of Jack adapters to hook everything together and change your stereo
headphones to mono. The radio shack employee or the guitar store employee
should be able to do this very easily.
Adjust the reverb controls so that you hear a single echo about a 1/2 second
delay. Then talk, talk, talk! If anyone would like to try such a unit and is
unable to assemble one themselves then contact me directly and we will make some
arrangements.
Regards,
Thomas J. Riess, D.P.M.
April 21, 199
