Lecture Notes: Speech-Language Pathology and Parkinson's Disease

Introduction

• Presenter: Emily Bishop, Speech-Language Pathologist at Novant Health
• Focus: Insight into speech-language pathology, especially pertaining to Parkinson's Disease
• Housekeeping: Restrooms location, open to questions during the presentation

Roles and Workplaces of Speech-Language Pathologists (SLPs)

• SLP Roles: Prevent, assess, diagnose, and treat speech, language, social communication, cognitive communication, and swallowing disorders
• Work Settings:
  • Hospitals (acute care, rehab)
  • Outpatient clinics
  • Skilled nursing facilities
  • VA clinics
  • Home health
  • Colleges and universities
  • Schools and daycares

Focus Areas Related to Parkinson's Disease

Swallowing Disorders (Dysphagia)

• Three Stages of Swallowing:

  • Oral Phase: Lip closure, tongue control, mastication, residue after swallowing
  • Pharyngeal Phase: Initiation of swallow, airway protection, soft palate elevation, laryngeal elevation, muscle strength
  • Esophageal Phase: SLPs assess the top of the esophagus, refer to GI doctors for further issues

• Assessment Methods:

  • Clinical Swallow Evaluation: Case history, signs and symptoms, eating/drinking different consistencies
  • Instrumental Assessments:
    • Modified Barium Swallow Study: Radiographic (X-ray), evaluates aspiration and weaknesses
    • Fiberoptic Endoscopic Evaluation of Swallowing (FEES): Scope through the nose to visualize the throat; no barium, uses food coloring

• Treatment Options:

  • Swallowing exercises
  • Postural techniques
  • Pacing and feeding techniques
  • Electrical stimulation (with caution)
  • Diet modifications (e.g., thickeners)
  • Medical intervention (referrals for surgery or medications)

Speech Disorders (Dysarthria)

• Definition: Neurogenic speech disorders affecting strength, speed, range, steadiness, tone, or accuracy of movements
• Hypokinetic Dysarthria (Common in Parkinson's):
  • Monopitch, monoloudness, reduced loudness and stress
  • Rapid/accelerated rate of speech, repeated phonemes, blurred AMRs
• Treatment Approaches:
  • Restorative: Focus on respiration, intelligibility, prosody
  • Compensatory: Communication strategies, modifying environment, multimodal communication

Voice Disorders (Dysphonia)

• Hypophonia: Key characteristic in Parkinson’s, reduced vocal loudness
• Assessment: ENT evaluation followed by SLP assessment (case history, respiration, acoustic measures)
• Treatment:
  • LSVT Loud: Intensive 4-week program focusing on vocal loudness
  • Generalization: Recalibrating sensory feedback to recognize and use a louder voice

Cognitive Communication Disorders

• SLP Role: Work on memory strategies, attention, executive function, problem-solving
• Treatment: Activities simulating real-life tasks, repetition, caregiver education
• Word-finding strategies: Techniques to help retrieve and use appropriate words

Q&A and Personal Experiences

• Discussion on treatment durations, Medicare coverage, and the importance of caregiver involvement
• Testimonials and personal experiences with LSVT and other therapies

Conclusion

• Emily offers to speak individually with attendees for further questions or concerns
• Breakout sessions facilitated by another organizer