1. “Speech and Swallowing Issues for People with Parkinson’s”
Stephen Cutia MS CCC-SLP
Speech and Language Pathologist
LSVT LOUD Certified P: F:

2. Introduction to Speech and Language Pathology
Voice Deficits in People with Parkinson’s
LSVT LOUD*
Swallowing Deficits and Treatment
Cognitive Deficits and Treatment

3. Speech and Language Pathology
1. Speech- articulation, motor speech movements, stuttering, overall intelligibility, etc.
2. Language- receptive and expressive, Aphasia’s, etc.
3. Voice- weakness, vocal hygiene, vocal habits, polyps, nodules, etc.
4. Swallowing- weakness, delay, exercises, compensatory strategies, diet modifications, thickened liquids, etc.
5. Cognition- memory, attention, sequencing, orientation, executive functioning (problem solving, safety awareness, planning, etc.)

4. Voice in People with Parkinson’s
“I am talking normal, your hearing is just bad.”
Weakness
Low Intensity
Too Soft
Insufficient Breath Support
Poor Posture
High Effort

5. Goal of LSVT LOUD
Person will use his/her louder voice automatically in daily communication and demonstrate long-carryover.

6. LSVT LOUD Target: Vocal loudness (amplitude)
Mode: Intensive and High Effort
Calibration: Generalization

7. LSVT LOUD
Target: LOUD
Traditional treatments focus on breathing, posture, and articulation separately.
If we increase effort to be loud everything else will fall into place.

8. LSVT LOUD Mode: Intensive and High Effort
4 consecutive days a week for 4 weeks.
Daily homework practice (All 30 days)
Daily carryover exercises (All 30 days)

9. LSVT LOUD Mode: Intensive and High Effort High effort
Multiple repetitions
Accuracy
Healthy fatigue
“No Junk Minutes!”

10. LSVT LOUD Calibration: Generalization
Sensory Problem: “I feel like I am screaming.”
Internal Cueing: “If I don’t think about it, I am not loud enough.”
Neuropsychological Problem: Cognitive deficits

11. LSVT LOUD Breakdown of Treatment Session Daily Tasks: 25-30 minutes
4 consecutive days a week for 4 weeks
Daily Tasks: minutes
Ah’s: minutes
High/Lows: minutes
Phrases: 5-10 minutes
Functional Speech Tasks: minutes
Structured readings: minutes
Off the Cuff: 5-10 minutes
Homework and carryover assignments: 5 minutes
Calibration: Embedded throughout entire session

12. LSVT LOUD Homework 5-10 minutes on treatment days
10-15 minutes twice a day on non-treatment days

13. LSVT LOUD Homework 6x Ah’s 6x Highs 6x Lows 1x Functional Phrases
5-10 minutes of reading

14. LSVT LOUD How can I make my great voice last?
Homework and routine established
Need to continue practicing at home post treatment
Spouse/caregiver assistance
Clinician check up on patient at 6 months
May require 1-2 “tune-up” sessions

15. LSVT LOUD Limitations: Not for everyone. High intensity/High effort
Requires follow-up and continued practice
Must be LSVT LOUD Certified Clinician

16. Swallowing Issues Swallowing is a very complex system.
Many different components working together for one goal.
Lips
Tongue
Epiglottis
Pharyngeal and laryngeal muscles
UES
Etc…

17. Swallowing Issues Risk factors associated with swallowing deficits
Penetration
Aspiration
Pneumonia
Choking
Weight Loss/malnutrition
Dehydration

18. Swallowing Issues Weakness (solids) Delay (liquids)
Lingual residue, buccal residue, laryngeal residue, aspiration, choking, etc.
Delay (liquids)
Laryngeal residue, wet vocal quality, coughing, penetration, aspiration, etc.
Coordination (combination)
Oral residue, sneezing, nasal regurgitation, oral spillage, etc.

19. Swallowing Issues Weakness Delay
Increase muscle strength, swallow exercises (effortful swallow, Masako, Shakur), compensatory strategies
Delay
Establish timely swallow, thermal stimulation, swallow exercises, compensatory strategies
Coordination
Coordinate all components of swallowing function, combination of above techniques

20. Swallowing Issues Alterations/Modifications:
Diet consistency change- mechanical soft diet, chopped, ground, puree.
Thickened Liquids- nectar, honey, pudding

21. Swallowing Issues Warning Signs! *Coughing* Choking Throat Clearing
Wet vocal quality/ “Gurgled Voice”
Runny Nose
Watery Eyes
Sneezing
*Silent aspiration can only be detected via swallow study. (MBS, FEES)*

22. Swallowing Issues Reduce your risk! Take your time.
Take small bites and sips.
Alternate solids and liquids (2:1, 3:1).
Avoid foods that give you trouble.
Stay upright for minutes following any intake.

23. Cognition Memory Attention Orientation Executive Functioning
Sequencing

24. Cognition Executive Functions: Safety Awareness Problem solving
Planning
Organization

25. Cognition Treatment: Relative and functional Cognitive exercises
Compensatory strategies
Spouse/caregiver/family/patient Education

26. Take Home Sit down and talk about it! Reach out to your physician!
Ask Questions!

27. Thank You!
**Questions**