1. Speech Therapy

2. Speech Therapy - Objectives Speech therapy exercises will focus on: – Handwriting rehabilitation programs. – Expression rehabilitation. – Breathing exercises. Therapist need to define exercises program adjusted to patient requirements. Default exercises programs required Exercise program = sequence of exercises Evaluated by system (if possible) or therapist Results stored to be consulted whenever Results compared with through time for analyzing patient evolution. Motivation introduced during exercises and before/after session

3. Speech Therapy – Scenario 1  Association working one therapist individually with one patient:  45 minutes sessions.  Therapist will supervise work.  Suitable interface  System recovering handwriting info.  System motivating patient  System evaluating patient responses.  Data stored and consulted whenever  Session repeated with planed periodicity.

4. Speech Therapy – Scenario 2  Patient’s home:  Therapy alone.  System will motivate patient during execution.  System will not evaluate patient responses.  System will not store handwriting information.  No special device needed.

5. Speech Therapy – Handwriting Exercises Handwriting exercises: Patient handwriting models using a template : – Grid with straights. – Grid with curves. – Grid with straights and curves. – Basic stroke of straights and curves over a line: All of these exercises could be done in three modalities Following a template. Repeating a template with reference lines Repeating a template without reference lines.

6. Speech Therapy – Handwriting Exercises Handwriting exercises: Patient handwriting models using a template : – Grapheme: All grapheme (print letter) basic stroke repetition with reference lines. Grapheme (print letter) uppercase and lowercase repetition. All grapheme (print letter) basic stroke repetition cursive letter with reference lines. Uppercase and lowercase grapheme repetition in cursive letter without reference lines – Words or phrases copy. – Dictation.

7. Speech Therapy – Handwriting Evaluation Particular exercise evaluated from 0 to 10 Exercise program evaluated from 0 to 10 (media). Evaluating handwriting: – Each person has got his/her own personal letter – There is not an objective method to define a sample as altered. – Subjective analysis and experience to decide if a writing sample is altered. – Best method compare writing sample before Parkinson with new samples. – Very useful to store samples along time and compare them. – Patient able to see his own old handwriting sample: Very useful feedback.

8. Speech Therapy – Handwriting Evaluation HANDWRITTINGHANDWRITTING ParametersCharacteristics WidthNormal Smaller Bigger Writing Basic Line Sticky No Sticky SpeedNormal Slower Faster Letters omissionYes No Letters substitution Yes No Stroke tremorYes No HANDWRITTINGHANDWRITTING Letter inclination Yes No Stroke direction changes Yes No Writing fluidYes No Vertical and horizontal strokes parallelism Yes No AgglutinationYes No Rounded letters angle Yes No Parameters to take into account evaluating handwriting comparing two samples of the same phrase written at different times:

9. Speech Therapy – Other Exercises Face expression rehabilitation exercises: – Patient face expression against face expression model at the same time: compare both, working to match them. Breathing exercises – Motivation techniques to improve patient concentration along the exercise. – Counting seconds that a patient must be blowing. – Digital Spiro-meter could be used to measure the volume of air inspired and expired.

10. Speech Therapy – Therapist's Recommendations Motivation techniques much appreciated to increase patient interest. Handwriting program: – Store handwriting information to compare samples along time. – “Thickeners” to improve support diameter obtaining more wide strokes. – Parkinson patient’s movement difficulties: support area for writing bigger – Parkinson patient needs to use wrist and forearm and must do more pressure Using a screen to write on, it would have to be reduced to an area where only the pencil could press, not the wrist or the arm – Screen width must not change normal patient movement – Introduce screen into the table in order to have a plane surface to write – Screen big? => Nonslip in order to avoid wrist displacement – Digital pen = not necessary to alter patient writs movement. Face expression exercises: Video models & Store video patient’s face Digital Spiro-meter could be used in breathing exercises.

11. Speech Therapy – Technologies Graphics Tablets: Development difficulty: medium Price: medium (50 - 500€) Interactive Whiteboard: Development difficulty: medium Price: high (400 - 4700€) Touch screens & Tablet PCs: Development difficulty: low Price: medium (200€)

12. Speech Therapy – Technologies Digital Pen & Digital Paper: Development difficulty: medium Price: low (50 -100€) Parkinson diagnosis through calligraphy software Development difficulty: unknown Price: unknown

13. Scenarios: – Association working one therapist individually with one patient –Patient's home Exercises: – Handwriting exercises – Handwriting exercises automatic evaluation – Face expression rehabilitation exercises – Breathing exercises Technologies: – Video models & Self-image capture – Digital Spiro meter – Graphics tablets – Interactive Whiteboard – Touch screens & tablets PC – Digital Pen & Digital Paper – Parkinson diagnosis through calligraphy software Speech Therapy – Proposals