1. Early Stage Parkinson’s Disease PWPD & SLP Brenda Warren, M.A.,CCC-SLP Speech-Language Pathologist UNC Hospitals Chapel Hill, NC

2. Four Main Areas of Focus Swallowing (Dysphagia) Voice - Speech & Oral-Motor Function Communication (verbal & non-verbal) Cognition (Attention, Memory, Verbal Fluency,Visuospatial Skills, Executive Function)

3. Swallowing (Dysphagia) 50% incidence rate Generally emerges in later stages Early indications –Nighttime drooling –Difficulty swallowing pills –Decreased saliva production(medications) –Sensation of food getting “stuck” Reflux

4. Quick Tips Screening by SLP to obtain “baseline” Nighttime Drooling –Elevate head slightly during sleep to restore gravitational pull –Use absorbent pillow case (terrycloth,etc.) to keep moisture away from face

5. Swallowing medications –Coat pills with olive oil –Tip head slightly forward –Sip water BEFORE attempting pill –Take with a thicker liquid or semi-liquid Tomato juice, applesauce, etc. Quick Tips

6. Voice-Speech & Oral-Motor Function 75-85% incidence rate over course of disease Often an early symptom related to PD –Decreases in Volume Intonation (prosody) Clarity (articulation) –Increases in Rate (hypokinetic dysarthria)

7. Quick Tips Screening by SLP Amplication Device Lee Silverman Voice Training (LSVT) Yacker Tracker or other objective feedback device Be sensitive to feedback from spouse, family, friends, and colleagues –Phone –Noisy background *Consider hearing testing for both PD pt. and partner

8. Communication (verbal & non-verbal) Frequently these symptoms emerge subtly in the early stages of PD and may increase in later stages –Difficulty with word finding –Masked face –Reduced eye-blink

9. Quick Tips Screening by SLP Keep distractions to a minimum during conversation; give your full attention Intentionally use words to describe your feelings rather than relying on facial expression Alert your conversational partner to the fact that you are aware that your face is sending an “uninterested” signal

10. Cognition 40-60% incidence rate of impairment in at least 3 domains of cognitive function (not dementia) –Attention –Executive function –Visuospatial skills –Verbal fluency –Free recall –Personality change

11. Quick Tips Talk with MD/neurologist-referral for neuropsychological evaluation –Baseline data –Recommendations SLP for cognitive-linguistic therapy –Compensatory strategies

12. Questions