Signs/Symptoms

• Tremors, often in one hand

• Slow movement

• Stiffness, sometimes called "lead pipe rigidity"

• Loss of balance and coordination

• Difficulty walking and talking

• Loss of automatic movements. 

  • You may have a decreased ability to perform unconscious movements, including blinking, smiling or swinging your arms when you walk.

• Speech changes

  •  You may speak softly or quickly, slur, or hesitate before talking. Your speech may be more of a monotone rather than have the usual speech patterns.

• Writing changes

  • It may become hard to write, and your writing may appear small.

Treatment

The first step to living well with Parkinson’s disease is to understand the disease and the progression. Did you know 90% of people with Parkinson’s are at risk of developing a weak voice that can lead to life-threatening swallowing complications? Parkinson Voice Project has developed a unique speech treatment to help patients regain and retain their speech and communication while minimizing swallowing issues. 

We are proud to be providers of Parkinson Voice Project’s SPEAK OUT! therapy. This treatment focuses on: 1). teaching the patient and family the SPEAK OUT! Exercises; 2). helping the patient and family establish a daily home practice routine; 3). teaching the patient how to “speak with intent;” 4). instructing the family on the most effective cue to elicit “intentional speech” from the patient; 5). determining which speech group will provide the best support to help the patient retain the improvements achieved during individual treatment. Patients typically reach their SPEAK OUT! goals in 8 to 12 individual speech therapy sessions. 

Causes

• Stroke

• Head injury

• Brain tumor 

• Disease.

Signs/Symptoms

• Speaking in short or incomplete sentences.

• Speaking in sentences that don't make sense.

• Substituting one word for another or one sound for another.

• Speaking unrecognizable words.

• Having difficulty finding words.

• Inability to understand other people's conversation.

• Inability to understand what they read.

• Writing sentences that don't make sense.

Treatment

Aphasia treatment often uses a person- and family-centered care approach. This is a collaborative approach grounded in a partnership between the person with aphasia, their care partners and support network, and their clinicians. It incorporates individual and family preferences, interests, and priorities in developing a treatment plan, including selecting targets and materials that are relevant to the individual. It represents a range of services, including counseling and emotional support, providing information and resources, coordinating services, and teaching specific skills to facilitate communication. 

Intervention is designed to

• capitalize on strengths and address weaknesses related to underlying structures and functions that affect communication across partners, activities, and settings;

• facilitate the individual’s activities and participation by teaching new skills and compensatory strategies to both the individual with aphasia and their partner(s)

• modify contextual factors that serve as barriers and enhance those that facilitate successful communication and participation—including accommodations such as large print, pictures, and aphasia-friendly formatting to support comprehension of written health materials (e.g., T. A. Rose et al., 2003, 2011).

Helpful Tips 

• Be patient and understanding. If a loved one has aphasia, empower them by giving them time to communicate. Help them feel safe and encouraged. Let them make mistakes without correcting them, and give them time to finish speaking without interrupting or finishing their sentences. Help them if they ask for it but at first, let them try on their own.

• Find ways to connect. Aphasia disrupts a person’s ability to communicate, which often leads to feelings of severe isolation and loneliness. You can make a huge difference if you communicate with your loved one in ways that are easier and more comfortable for them.

• Make it easier for them to communicate. Get their attention before you start talking, maintain eye contact and give them your full attention, and reduce background noise (like turning down the TV) if possible. Offer them alternate ways to communicate like writing, drawing, hand gestures or with smart devices if they prefer, and if doing so helps them.

• Treat them with respect and dignity. People with aphasia can feel embarrassed or ashamed of their struggles with communicating. Treating them with respect and dignity can help with that. If they struggle to understand, you can talk to them using easier-to-understand words or sentences or by using yes/no questions (if that's what they prefer). You should avoid talking down to them or speaking so slowly that it’s insulting or hurtful. You should also avoid talking louder unless they ask you to do that.

Causes

• Cerebral palsy 

• Huntington's disease

• Multiple sclerosis

• Muscular dystrophy

• Parkinson's disease

• Spinal cord injury

• Stroke

• Tumors 

Signs/Symptoms

• Your speech sounds different than before you had any damage to your brain or nerves.

• You say words in a way that is hard for others to understand.

• You "slur" or "mumble" when you talk.

• You talk too slowly or too fast.

• You talk too softly or too loudly.

• You have problems moving your tongue, lips, and jaw.

• You sound "robotic" or "choppy."

• You sound hoarse or breathy.

• You sound like you have a stuffy nose or are talking out of your nose. 

Treatment

Your work with the SLP will depend on the type of dysarthria you have and how much of a problem it is for you. You may work on any or all of these activities:

• Slowing down your speech.

• Talking louder.

• Moving your lips and tongue more.

• Saying sounds clearly in words and sentences

• Learning to make changes in your voice to show emotions

• Improving the way you breathe to support clear and loud speech

• Using other ways to communicate, like using gestures, writing, or working on a computer. These are types of augmentative and alternative communication, or AAC.

The SLP can also work with your family and friends to help them learn ways to talk with and understand you.

Helpful Tips

If you have dysarthria, here are some things you can do to help your listeners:

• Before you start a conversation, tell a new listener that you have trouble talking.

• Say one word or phrase before starting to talk in sentences. This will tell the listener what the topic is and help get them ready to listen. For example, you can say “dinner” before starting to talk about what you want to eat.

• Check with listeners to make sure that they are fully paying attention and understand you. Try to always face the listener, so they can read your facial expressions, mouth movements, and gestures. You can also look at their body language to find out if they understand you.

• Focus on changing one thing about the way you talk. Some people think about talking more slowly, more loudly, or with bigger movements.

• Pause to let the other person think about what you have said.

• Rest before and after talking a lot. Your speech may be harder to understand when you’re tired.

• Add more visual information to what you’re saying. When you have trouble talking, try pointing to things, using gestures, drawing, or writing the most important words.

Tips for the Listener

Share these tips with your family and friends:

• Talk to me in a quiet area with good lighting.

• Pay attention to me when I talk.

• Watch me as I talk. This may help you understand what I say.

• Let me know when you have trouble understanding me. Don't pretend to understand me.

• If you don’t understand my whole message, then repeat the part that you understood. Then I won’t have to start all over again.

• If you still don't understand me, ask me yes or no questions. Or ask me to show you what I was saying by using gestures, pointing, or writing.

Causes

• Age 

• Parkinson's disease

• Heart disease

• Stroke

• Brain injury

• Brain cancers

• Drugs

• Toxins

• Diabetes.

Signs/Symptoms

• You forget things more often.

• You miss appointments or social events.

• You lose your train of thought. Or you can't follow the plot of a book or movie.

• You have trouble following a conversation.

• You find it hard to make decisions, finish a task or follow instructions.

• You start to have trouble finding your way around places you know well.

• You begin to have poor judgment.

• Your family and friends notice any of these changes.

Treatment

Dementia is a progressive disease, and goals change over the course of treatment as communication needs and abilities change. SLPs have an ethical responsibility to provide services that maximize cognitive-communication functioning and safe and/or pleasurable eating at all stages of the disease process.

Dementia treatment may include compensatory or restorative treatment approaches that can target either improvement or maintenance of function. Given the progressive nature of the disease, treatment for dementia is often delivered as maintenance therapy, where services are designed to maintain a level of function or prevent further functional decline associated with the goals in the patient’s plan of care. Maintenance therapy may also be delivered by altering dosage of services into shorter episodes of care with periodic reassessment of needs as the disease progresses. 

Decisions about goals and treatment options are made in collaboration with the individual, family and care partners, and other health professionals. SLPs share information about dementia throughout the course of treatment with the individual and their family/care partners and provide family counseling and care partner training.

Person-centered intervention focuses on maximizing the individual’s ability to participate in meaningful activities (e.g., Bourgeois, 2015; Chapey et al., 2000; Hickey, Khayum, & Bourgeois, 2018). SLPs consider the individual’s cultural and linguistic background, social history, present social context, communication needs, and personal desires when developing a treatment plan and formulating functional, personally relevant goals.