A Group Intervention Model for Speech and Communication Skills in Patients with Parkinson's Disease: Initial Observations

Article excerpt

Various speech and voice disorders affect 70% to 85% of individuals with Parkinson's disease (PD). Speech treatment is generally conducted on an individual basis, with family member involvement. Clinical experience indicates that many patients do not practice treatments at home or apply the learned techniques in everyday situations. An eight-session, task-oriented group intervention with PD patients who also had learned speech techniques individually prior to this program is described. Preliminary observations using subjective and objective measures indicate improvement in voice characteristics, self-perception of speech intelligibility, communication skills, and application of these skills in everyday communication situations.

Speech and voice disorders affect 70% to 85% of individuals with Parkinson's disease (PD; Schulz & Grant, 2000). These disorders are considered to be the result of dysfunction with systems involved in respiration, phonation, articulation, resonance, and prosody (Logemann, Fisher, Boshes, & Blonsky, 1978; Swigert, 1997). Speech disorders associated with PD are known as Parkinsonian dysarthria or hypokinetic dysarthria (Schulz & Grant, 2000). They include hypophonia, reduced loudness, hoarseness, monotone, and mono-loudness (Aronson, 1990). Additional characteristics of Parkinsonian dysarthria include imprecise articulation, reduced stress, and instability in speech rate (Johnson & Pring, 1990). Moreover, there may be a reduction in the pragmatic communication skills, especially in the areas of conversational appropriateness, turn-taking, prosodics, and proxemics (McNamara & Durso, 2003). Furthermore, people with PD often exhibit reduced motivation for communication and low morale (Giladi et al., 2000).

These aspects of PD directly affect the social skills, lifestyle, and psychological well-being of people with PD (Coates & Bakheit, 1997; Ramig, Countryman, O'Brien, Hoehn, & Thompson, 1996). These patients often report experiencing feelings of embarrassment, isolation in social situations, and reluctance to engage in social interaction (Scott & Caird, 1983).

Speech therapy is considered valuable and effective for people with PD, particularly when treatment is administered intensively and patients are motivated and actively involved in the therapeutic process (Kerschan, Pankl, & Auff, 1998). Researchers have suggested various therapeutic approaches for patients with PD who exhibit speech disturbances. During the 1980s, speech therapy mainly addressed the prosodic aspects of speech (Le Dorze, Dionne, Ryalls, Julien, & Ouellet, 1992; Robertson & Thomson, 1984; Scott & Caird, 1983; Scott, Caird, & Williams, 1985). Later other facets of speech and communication were added to the evolving therapeutic scheme, including respiration, articulation, pitch variation, vocal loudness, strength and speed of articulators, speaking rate, intonation and stress patterns, and communication intelligibility (Hammen & Yorkston, 1996). These modifications in the treatment program were reported to have a favorable effect on various aspects of speech. Moreover, most patients reported that the improved speech pattern was maintained after the conclusion of the therapy program (Schulz & Grant, 2000).

At present, speech therapy programs for patients with PD who exhibit hypokinetic dysarthria mainly target vocal loudness, following the Lee Silverman Voice Treatment (LSVT) protocol (Ramig, Countryman, Thompson, & Horii, 1995; Ramig, Pawlas, & Countryman, 1995). In essence, the LSVT focuses on increasing respiratory effort and improving vocal fold adduction, thus increasing vocal loudness. The program is administered systematically and intensively, and patients attend four 50-60 min sessions per day throughout four consecutive weeks (Ramig, Countryman et al., 1995; Ramig & Dromey, 1996; Ramig, Pawlas, & Countryman, 1995; Ramig, Sapir, Countryman, & Fox, 2001). …