The following is a repeat of a message I posted a couple months ago. In lieu of
the many recent postings on speech I felt it was still relevant. For those of
you who have seen this before I apologize for the redundancy.
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 sytax (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 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 sytax
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 volume seems to be more of a mechanical problem - perhaps the
vocal cord muscles are not as efficient with PD. And perhaps exercise can
improve this (e.g. Lee-Steinberg technique).
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 - even pretended rage can produce dramatic improvement.
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. 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 if 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.
6. All of the above is superceded by the following descovery. A
delayed audio feedback (DAF) system has the potential to normalize Parkinsonian
speech. In such a system 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 methods. 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.
Thomas J. Riess, D.P.M.
April 21, 1997
