MDS Alert

Nursing staff can help the resident maintain this skill after therapy ends.

If a resident with Parkinson's has voice and speech difficulties, reminders to "speak up" may be just the ticket for improving the person's speech overall.

Parkinson's disease can lead to "a soft, weak voice, a fast rate, imprecise articulation --" and a monotonous tone," says Nancy S wigert, MA, CCC-SLP, BRS-S, a speech language pathologist in Lexington, Ky.

The solution: The speech therapy technique that seems to work best and has the evidence tosupport its use is the Lee Silverman Voice Treatment (LSVT) method, says Swigert. "The essence of the approach is that you have the patient focus on being loud. Doing so not only helps the person speak more loudly --" it also improves his articulation and breath support when speaking," she notes. "The approach seems to reorganize the whole speech system rather than just one part of it."

Swigert notes that therapists used to focus on helping a patient with PD-related voice/speech changes to improve each component (loudness,articulation, and taking deeper breaths) when speaking. "But it's easier to just focus on the loudness aspects," she says. "It's a simpler direction and yields better results than working on the individual components."

Applying the LSVT technique, "the therapist works intensively with the person daily for several weeks to encourage the person to concentrate on making his/her voice loud," Swigert explains. "The therapy should be covered under Part B and Part A, as it's considered a skilled service. The nursing staff can help the person maintain the ability by reminding them to talk more loudly."