Eli's Rehab Report

Enlist everyone in the patient's life to reinforce your work.

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

The clinical problem: Parkinson's disease can lead to "a soft, weak voice, a fast rate, imprecise articulation -- and a monotonous tone," says Nancy Swigert, MA, CCC-SLP, BRS-S, director of respiratory care and speech-language pathology at Central Baptist Hospital in Lexington, Ky. Speech therapy solution: Speech therapists should employ the Lee Silverman Voice Treatment (LSVT) method, Swigert says. "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."

Old way: You may be used to helping patients with PD-related voice/speech changes improve each component (loudness, articulation, and taking deeper breaths) individually 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."

How to do it: Apply the LSVT technique by working "intensively with the person daily for several weeks to encourage the person to concentrate on making his/her voice loud," Swigert explains. Ask any other health care staff, family members, or friends to "remind the patient to talk more loudly" to help him maintain the ability, she advises.