Freedom to Speak: Parkinson's Disease and Lee Silverman Voice Treatment

One of the problems that many people with Parkinson's Disease face is difficulty with speech: the voice becomes too soft; the voice becomes grating and raspy; stuttering increases significantly; there is trouble getting words out at all sometimes; and background noise seems to interfere with trying to put words together coherently.

By the time I was diagnosed with Parkinson's in 1999, my speech had already deteriorated considerably. In the months leading up to the diagnosis, my wife would complain about my mumbling; coworkers would frequently ask me to repeat words or phrases; in meetings I would have a terrible time trying to join in a conversation because just as my words were formed and ready to come out of my mouth, someone else would speak up and I would have to start over; and it was very difficult for me to speak in front of a crowd. Tension or nervousness or excitement only exacerbated the problem.

I found out about Lee Silverman Voice Treatment (LSVT), a speech therapy program specifically geared for people with Parkinson's, shortly before I was laid off in 2002.

As I began updating my resume and looking for work, I knew that I needed to do something about my dwindling speech ability or I would never land another job. I called around and discovered that at Duke University's Medical Center in Durham, NC, they had a speech pathologist who was certified in LSVT, and she had an opening in her calendar.

I had an introductory meeting with the speech pathologist to discuss the possibility of going through the LSVT therapy. She explained that it would be fairly intense; we would meet four times a week for four weeks, and there would be mandatory "homework" between each session.

To study my larynx and the back of my throat, the speech pathologist ran a tiny camera through my nose. She showed me some amazing photographs and explained that with Parkinson's, the muscles in the larynx were not functioning at full capacity. The opening was not closing completely, which explained the raspy grating sound of my voice
.
The pathologist explained that part of LSVT included exercises to help make the muscles more pliable and stronger so that we could reduce the raspiness.

Parkinson's patients also speak more softly but are not aware that this is happening. With Parkinson's, the body's muscles do not respond as readily or as efficiently as they used to, and that includes muscles used in speech.

In addition, articulation (which again uses facial and speech muscles) deteriorates. The problem with other speech methods that emphasize diction is that the Parkinson's patient cannot multi task the way he used to be able to. If the speaker has to think about enunciating and moving facial muscles and lip muscles to articulate, it just makes speaking worse.

LSVT uses the idea that increasing volume will both make the speech stronger and will automatically improve diction as well.

With a decibel meter, the pathologist emphasized that I needed to always aim for a volume of 80 decibels. She did a series of tests with me, using a tape recorder and the decibel meter. She demonstrated that when I spoke louder, just focusing on volume and nothing else, my speech was much cleaner and easier to understand. doing that, other problems such as mumbling, slurring, and stuttering would be greatly reduced.

Now, 80 decibels is not shouting, but it is significantly louder than I was used to speaking. But she proved to me that it would help. I had nothing to lose and everything to gain, so I agreed to try it.

The first week was difficult. The exercises consisted of doing sets of "oohs" and "ahhs" on a continual slide from low to high and high to low. Another exercise involved duration and it required me to hold an "ahhh" at 80 decibels for as long as I possibly could. And I needed to do these exercises over and over again.

My kids helped by monitoring the decibel meter and by encouraging me to speak louder throughout the day. We actually had a lot of fun with it.

That first week, I was able to hold an "ahhh" for perhaps forty seconds maximum in the duration exercise.

I practiced faithfully and went to all the sessions. I took it seriously.

By the end of the fourth week, on the duration exercise I actually hit seventy seconds once! My average was in the upper fifties or lower sixties.

And perhaps most important, my confidence in speaking returned! I found that I could jump into conversations more easily and that my stuttering was dramatically reduced.

That was seven years ago as I write this.

I've found that if I go for weeks or months of not doing the exercises, my speech problems return. And when that happens, if I hit all the exercises hard for a few weeks, the problem resolves itself.

I do stutter some; that's part of the progression of the disease. But LSVT has so improved my speech quality, and thus it has had a positive impact on my quality of life.

If you or someone you know has Parkinson's and are having trouble speaking, I urge you to look into LSVT. It is not for everyone, but the possibility of it having a positive benefit makes it worth checking out.

That being said, I believe it is the case that the farther along the patient is with Parkinson's, the less effective LSVT will be. Still, it is worth talking with a speech pathologist to find out if it is right for you.

For more information on LSVT, see: www.lsvt.org.