If a person's speech reflects any of these problems, seek health from a speech therepist or pathologist as quickly as you can. Time is of the essence. Much can be done for you when your speech is only mildly impaired, but the possibilities for improvement decrease as the problems become more severe.

There are exercises to treat all of these symptoms listed above. You can learn them from a speech therapist and then keep practicing them regularly at home.

Exercises to improve breathing are very important. They increase the loudness of the voice and also help correct the respiratory problems that many patients experience. Other useful techniques include tongue, lip, and jaw exercises, and practice guides to improve pitch, articulation, and rate of speech.

...from NPF newsletter, Summer, 1998

In addition to tradtional speech therapy as applied above, there are three other possibilities for treating speech disorders in Parkinson's patients known to this author at this writing:

• The Lee Silverman Method In 1987, speech language pathologists, Lorraine Olson Ramig, Ph.D., CCC-SLP, and Carolyn Mead, M.A., CCC-SLP, began developing an effective voice treatment program for patients with Parkinson disease. This innovative treatment program, now known as the Lee Silverman Voice Treatment (LSVT), was named for one of the first patients to receive treatment. LSVT is an intensive, behavioral treatment given over sixteen sessions in one month. The techniques are intended to help the patient with Parkinson disease increase intelligibility and vocal loudness. We are now starting to study the effectiveness of the treatment on other neurological disorders.



• Collagen injections
Vocal cord dysfunction occurs when the muscles that control the movement of the vocal cords becomes very rigid (stiff) or weak. As a result, the vocal cords are unable to properly come together and vibrate. Speech sounds become weak and breathy. Researchers estimate the about 12 percent of the elderly experience some degree of vocal dysfunction. The condition is more common in patients with certain types of neurologic conditions, such as Parkinson's disease.

Some physicians are using injections of collagen as a treatment for vocal cord weakness. Collagen is a type of protein found underneath the skin. The collagen is often obtained from cows, but may also be harvested from the patient. Prior to the actual treatment, the patient is given a test dose of the collagen to make sure there is no allergic reaction to the substance. If allergy is ruled out, an anesthetic is sprayed into the throat and nostril. Then, a thin, flexible tube is placed through the nose and down into the throat. The tube allows doctors to view the vocal cords and the injection procedure. Once the area is adequately visualized, a syringe containing the collagen is inserted through the side of the neck. The doctor then injects the collagen into the vocal cords. The procedure generally takes about fifteen minutes.


• Implants

FDA Approves Implants That Restore Lost Voice

BALTIMORE, MD -- June 9, 1998 -- Johns Hopkins physicians have designed a series of implants that restore bulk to weakened vocal cords, returning the power of speech to those who have lost their voices from paralysis associated with throat cancers, strokes or other conditions.

The patented implants were approved by the U.S. Food and Drug Administration in early spring.

The implants, shaped like the heads of tiny hammers, are made of hydroxylapatite, a chalk-like substance that melds into the body's tissue over time. Available in five sizes, the devices add volume to a weakened vocal cord, pushing it to the center of the voice box so it can meet its counterpart and produce sound.

Patients can lose the ability to speak when the nerve supply that normally pushes the cords together is lost. This condition affects about 5,000 to 10,000 people each year and can follow stroke or traumatic injury. It also can arise without an identifiable cause, explained Charles Cummings, M.D., professor and chairman of otolaryngology-head and neck surgery. There are more serious complications, too.

"People who can't close their vocal folds cannot project their voices or trap air effectively, which makes it difficult to exercise or even walk upstairs," he said. "There is also a danger of choking on food, as the folds that normally protect the voice box can't close."

During a half-hour surgical procedure using local anesthesia, physicians drill a small hole in the side of the neck, creating about an inch-size opening in the thyroid cartilage to reach the vocal cord. Using specially designed instruments, they insert sizers, or dummy devices of varying sizes and ask the patients to speak. When the patient recognizes his or her correct voice, the physicians remove the sizer and replace it with a same-size implant, locking it in place with a small shim of the same material.

"There's no greater thrill for both the patient and the doctor than to hear the patient speak again in his or her natural voice," Cummings said. "Patients can talk immediately following the surgery, but it may take up to six weeks for them to gain optimal pitch range."

Cummings and his colleague, Paul Flint, M.D., have used similar implants for about 10 years. Before the FDA's approval of their design, Cummings and Flint had to hand-carve an implant for each patient using sialastic, a less sturdy material. Having the pre-cut hydroxylapatite implants has cut their operating room time in half and helped reduce post-operative swelling.

The National Parkinson Foundation has compiled a manual on speech.

More links about speech may be found on Murray Charters' web pages




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