Parkinson’s Disease From The Scope Of An SLP

Written by: Kendra Wormald / Medical Rehabilitation / May 31, 2023 / 10 minutes read

This piece serves as a contribution to the series investigating neurodegenerative conditions from the perspective and scope of a Speech-Language Pathologist.

Definition

Parkinson’s disease (PD, Parkinson’s) is a neurological disorder that causes unintended or uncontrollable movements, such as shaking, stiffness, and difficulty with balance and coordination (National institute of Aging, 2022).

Parkinson’s is a complex neurological disorder that may impact nearly every part of the body, physically and emotionally.

Parkinson’s Disease vs. Parkinsonism

Parkinsonism, is used as a general term referring to a set of neurological disorders that cause movement problems similar to those seen in Parkinson’s disease such as tremors, slow movement and stiffness. Parkinson’s disease is the most common cause of parkinsonism.

Cause and Prevalence

There are more than 100,000 Canadians living with Parkinson's Disease and 30 more are diagnosed every day (Parkinson Canada, 2023).

In Parkinson’s disease, nerve cells housed within the motor control system, called the basal ganglia, are impaired or die. Typically these neurons produce the chemical dopamine. Reduced production of dopamine causes the movement and coordination problems seen in this disease. However, the specific cause of this neuron death is still unknown. 

Nerve endings that produce the main chemical messenger of the sympathetic nervous system, called norepinephrine, are also lost. These neurotransmitters control bodily functions such as heart rate and blood pressure. 

Those with Parkinson’s disease typically have brain cells that contain unusual clumps of proteins called Lewy bodies. These proteins disrupt the normal function of the brain and may be associated with dementia within this population. 

It is not yet clear whether Parkinson’s Disease is hereditary. There may be a specific gene that increases the likelihood of developing the disease, but the impact of environmental exposure can impact the severity, timing, and how the disease is experienced. Research presently states Parkinson's Disease is caused by a combination of genetic and environmental factors such as exposure to toxins.

Symptomatology

Parkinson’s can be divided into motor and non-motor symptoms. Motor challenges often present as rigidity, presence of tremors, postural instability and slow movements called bradykinesia. 

Rigidity: Stiffness or tightness of the body. Often this may be mistaken for arthritis or orthopedic problems, particularly in the early stages of the disease

Tremor: Occurs at rest, often initially occurring in the foot, hand or leg, then eventually affecting both sides of the body. Tremors affect 80% of people living with Parkinson’s, however it is often not debilitating. 

Postural Instability: Often more severe in later stages. Experience  balance issues which could lead to stepping or falling backwards (retropulsion). 

Bradykinesia: Defined as ‘slow movement’, may present as reduction of automatic movements (e.g. blinking or swinging arms when you walk). Difficulty initiating movement such as standing out of a chair, reduced facial expressions, and

prolonged reaction time. 

Non-motor symptoms include, but are not limited to: change in taste and smell, bladder dysfunction, hallucinations, excessive daytime sleepiness, restless leg syndrome, excessive sweating, double vision, depression, delusions and impulse control disorders. 

Symptoms of Alzheimer’s can vary from person to person. Different stages of the disease may express symptoms differently and more intensely.

Impact on Speech and Swallowing

Areas and structures that may be impacted by Parkinson’s Disease include (Cleveland Clinic, 2020): 
 

• Larynx (voice box) 

• Respiratory system 

• Tongue lips and roof of the mouth 

• Facial muscle movement 

• Throat 

• Areas of the brain that control hearing, voice and speech processing 

“Of the more than seven million people with Parkinson’s disease worldwide, between 75% and 90% will develop voice and speech problems over the course of their illness” (Cleveland Clinic, 2020). 

Malfunction of the above systems and muscles may lead to a breakdown in communication characteristics: 

Speech: A weakness of speech muscles can lead to dysarthria, deduced volume, increased soft quality of voice, reduced pitch variability (monotone), breathy, hoarse or strained quality of voice, reduced clarity of speech due to reduced pronunciation and slurring of words, reduced emotion within speech, mumbling, trailing off at ends of sentences and reduced oral muscle control. A tongue or jaw tremor may also be present.

Consider our Masterclass to support Breathing for Communication

Sight: Visual disturbances such as blurry or double vision may interfere with the ability to read and write. Eye movements may be slowed and eyelids may be challenging to open.

Writing: Fine motor control to write legibly may be reduced, therefore impacting the effectiveness of communication. 

Swallowing: Difficulty swallowing (dysphagia) can occur at any stage of Parkinson’s disease and may progress in severity. Signs and symptoms may include: difficulty swallowing specific liquids/food textures, need to cough or throat clear during or after eating or drinking, and feeling as though food is ‘stuck’ in the throat. Due to the reduced muscle activation and control, dysphagia can lead to food or liquid entering the lungs, causing aspiration pneumonia, which is the leading cause of death in PD (The Michael J. Fox Foundation, 2015). 

How to Maintain and Improve Communication with PD

(Cleveland Clinic, 2020) 

• Use short phrases 

• Ensure you’re using your breath fully from your diaphragm 

• Plan periods of vocal rest 

• Keep an upright posture 

• Consider using an amplification device

• Consider using augmentative alternative communication devices

• Choose low-noise spaces to converse in 

• Establish the topic before speaking

• Rephrase using synonyms 

• Overdo word emphasis and pitch variability

• Use writing to support oral communication

• Use gestures

• Talk face to face with others 

• Speak slowly 

Speech-Language Pathology Intervention

Parkinson’s Disease is a progressive neurological disorder which may impact each person differently, and at different rates. Your Speech-Language Pathologist will tailor your therapy throughout this progression. Some areas and approaches to focus on may include: 

Breath Work: How you breathe in communication can either support or be a barrier to successful speech interactions. With a reduction in muscle control and coordination, it is imperative to focus on abdominal wall and diaphragm muscle engagement to support the voice.

Pitch Glides/Sirens: Focus on building awareness and control of pitch and overall tone. To provide education on anatomy and physiology of speech structures.

Volume Control: Focus on the use of posture, breath and muscle engagement to promote appropriate volume.  

Assistive Devices: The use of amplification or communication devices can support the effectiveness of your communication. Aim is to provide education on which device could be most appropriate for your challenges, and how to use it effectively. 

To speak with a psychotherapist or one of the speech-language pathologists at Well Said: Toronto Speech Therapy, schedule an initial consultation by clicking the link below or calling (647) 795-5277.