Banter Speech & Language

Sydney speech pathologists helping adults and children speak for themselves.

LSVT Loud

A voice treatment for Parkinson’s Disease that works: LSVT LOUD (radio interview)

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It’s just not good enough!

  • Voice problems – especially speaking too quietly – are a common symptom of Parkinson’s Disease, affecting between 65-90% of people with the disease.
  • Losing your volume can be devastating for your quality of life, career, and your family and loved ones.
  • Effective, evidence-based treatments to increase volume have been around for decades, including the updated LSVT LOUD program.
  • Despite these facts, as few as 3-4% of people with Parkinson’s currently get help with their voices.

We want people with Parkinson’s Disease and their loved ones to know that effective voice treatments are available in Australia, and worldwide.

A couple of weeks ago, I was interviewed about the LSVT LOUD voice treatment for World Parkinson’s Day by Marnie Roper and Barbara Sullivan from the Ablequest radio program of 2RPH. You can listen to the interview by clicking the link.

For more information about LSVT LOUD, see here and here.

If you have any questions about voice treatments designed for people with Parkinson’s Disease such as LSVT LOUD, please get in touch with us by phone, email, or Facebook.

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Banter Speech & Language Banter Speech & Language
Banter Speech & Language is an independent firm of speech pathologists for adults and children. We help clients in our local area, including Concord, Concord West, North Strathfield, Rhodes, Strathfield and all other suburbs of Sydney’s Inner West.

Banter Speech & Language is owned and managed by David Kinnane, a Hanen- and LSVT LOUD-certified speech-language pathologist with post-graduate training in the PreLit early literacy preparation program by MultiLit, the Spalding Method for literacy, the Lidcombe and Camperdown Programs for stuttering, and Voicecraft for voice disorders. David is also a Certified PESL Instructor for accent modification.

David holds a Master of Speech Language Pathology from the University of Sydney, where he was a Dean’s Scholar. David is a Practising Member of Speech Pathology Australia and a Certified Practising Speech Pathologist (CPSP).

“What did you say?” 10 evidence-based ideas to help others understand your speech

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Speaking is pointless if you’re not understood.  But opinions diverge on how best to improve intelligibility – or even how to measure it.

Having worked with adults and children with a range of communication challenges – from speech disorders, language disorders, fluency disorders, voice problems, professional communication needs and accent issues – a few basic themes crop up time and time again when trying to help clients improve their intelligibility.

Now, no one speaks perfectly in all places with all people.  I certainly don’t – especially in the mornings.  But we can all do things to make it easier for others to understand us – especially if people regularly ask us to repeat ourselves (or, worse, ignore us).

If you are having regular problems being understood by others, here are some no-cost, low-tech, evidence-based ideas to try out before seeking professional help:

1. Focus on saying all your speech sounds – particularly at the end of words

One standard measure of intelligibility is the percentage of sounds you get right.  Leaving sounds out – particularly at the end of words and phrases – makes it much harder for listeners to understand what you are saying (Derwing et al., 2014).  This is one reason strangers find it hard to understand children with speech disorders and many adults who speak English as a second language.  It’s also why speech pathologists often target patterns of missing sounds first, and then “wrong sounds” when treating people with speech disorders and helping people to modify their accents and improve their communication.

2. Learn about and apply the basic rules of speech “prosody”

As we’ve said before, a focus on prosody – things like speech stress, rhythm and intonation – can lead to greater comprehensibility than a focus on speech sounds (Derwing et al., 1998; Seferoglu, 2005).   Sentence stress is probably the most important thing to get right for intelligibility.  This is simply making important words – especially words that convey new or essential information – longer and louder than the words around them.  For example:

  • I want to go to the BEACH (not the office).
  • They’re coming TOMORROW (not today).
  • The BLACK shoes are missing (not the blue ones).
  • The black SHOES are missing (not the black socks).
  • The black shoes are MISSING (not here).

3. Smooth out the rough edges

Hesitations, awkward pauses and repetitions can all hurt your intelligibility – especially if they make it hard for listeners to tell where different thoughts start and end.  Reducing the “ums and ahs”, and pausing between thoughts at grammatically correct times can increase your intelligibility dramatically – even if you make the same number of sound errors (e.g. Kohn et al., 1990; van der Merwe, 2007).

4. Increase your volume

Many speech treatments, notably LSVT LOUD, are based on the simple idea that increased volume will help increase intelligibility.  Increasing volume not only makes you louder.  It’s also been shown to increase articulatory precision and breath control (e.g. Dromey & Ramig, 1998).  This applies both for people with neurological diseases like Parkinson’s Disease as well as to chronic mumblers.

5. Look after your voice

Voice quality and resonance can also affect your intelligibility (e.g. Susman & Tjaden, 2012).  It can be almost painful listening to someone with a very rough, strained, breathy or monotone voice.  At best, it’s distracting.  Here are some tips for protecting your voice.

6. Slow down

Rate control has been described as the most powerful single, behaviourally modifiable variable for improving intelligibility (Yorkson et al., 1992).  But it’s easier said than done.  For some simple ideas to try to control your speech rate, check out this article.

7. Pretend you are speaking into a microphone

Sounds silly, I know.  But there’s evidence to say that some speakers perform better when placed in front of a microphone (e.g. Goberman et al., 2010).  It’s called a “performance effect”.  (Incidentally, it’s one reason speech pathologists can over-estimate a client’s intelligibility when they conduct formal assessments, usually with the client seated in front of a microphone).

8. Don’t multi-task while speaking

Studies of people speaking while balancing a tray, walking around obstacles, standing on tiptoes or sorting out buttons consistently show that dual or competing tasks negatively affect intelligibility (e.g. Bunton & Keintz, 2008; Dromey et al., 2010).  Focus on what you are saying!

9. Pretend you are speaking to the boss

Speakers vary the precision of their articulation on a continuum from highly formal to informal speech depending on who they are talking to and why (e.g. Lindblom, 1996).  You don’t talk to your partner in the same way you talk to your boss or the guy at the service station (unless they are the same person).  Now, it’s better to turn up to a smart casual dinner party in a suit, than a black-tie event clad in flame-retardant tracksuit pants.  The same holds for speech – especially when you are trying to convey important information.

10. Use body language (and everything else at your disposal) to support what you are saying

Speech pathologists sometimes get obsessed by speech sound accuracy, forgetting that much of our communication is conveyed in noisy or distracting environments requiring lots of repetition and the support of non-verbal cues such as gesture and facial expressions.  Even the setting can add (or detract) from your intelligibility.  In face-to-face and video communications (e.g. Skype) we can use these things to help support what we are saying and to increase our functional communication – even if our speech isn’t clear.  It’s much harder on the phone.  But, if you’ve ever watched a group of cranky football fans share critiques with each other in a packed, loud pub, you’ll know just how effectively we can communicate our thoughts and feelings without clear speech signals.

Good luck!  And, if none of these things works for you – and even if you think your speech is getting worse – don’t panic!  Speak to a speech pathologist who can run a full intelligibility assessment on your speech, and then tailor therapy to your specific needs and challenges.

Principal source: Miller, N. (2013). Measuring up to speech intelligibility. International Journal of Communications Disorders, 48(6), 601-612.

Related articles:

Image: http://bit.ly/1GQ7g4N

Banter Speech & Language Banter Speech & Language
Banter Speech & Language is an independent firm of speech pathologists for adults and children. We help clients in our local area, including Concord, Rhodes, Strathfield and all other suburbs of Sydney’s Inner West.

Banter Speech & Language is owned and managed by David Kinnane, a Hanen- and LSVT LOUD-certified speech-language pathologist with post-graduate training in the Spalding Method for literacy, the Lidcombe and Camperdown Programs for stuttering, and Voicecraft for voice disorders. David is also a Certified PESL Instructor for accent modification.

David holds a Master of Speech Language Pathology from the University of Sydney, where he was a Dean’s Scholar. David is a Practising Member of Speech Pathology Australia and a Certified Practising Speech Pathologist (CPSP).

Can LSVT LOUD help people with Parkinson’s Disease to swallow safely?

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As an LSVT LOUD certified speech pathologist, I recently had the opportunity to attend a specialist training seminar on LSVT LOUD and swallowing problems for people with Parkinson’s Disease (PD).  The seminar was hosted by Leslie Mahler and Heather Hodges, both eminent speech pathologists specialising in PD.

Here are some of the key things I learned:

Swallowing problems for people with PD

  • Way back in 1817, James Parkinson (the person PD is named after) observed that people with Parkinson’s Disease often had difficulties swallowing.
  • As many as 95% of people with PD have swallowing problems at some point (Potulska et al, 2003), though few people with Parkinson’s Disease get referred to speech pathologists for help.
  • Swallowing problems can make it hard to swallow medicine and get enough water and food to stay healthy.
  • Sometimes, swallowing problems can lead to pneumonia, e.g. when food and drink go down the wrong way into the lungs, rather than the stomach.  Pneumonia is one of the leading causes of death for people with PD (D’Amelio et al., 2006).
  • PD can affect many parts of the swallowing mechanism.  It can reduce chewing speed and tongue strength, lead to tongue “rocking” and tremors, delay the triggering of the swallow reflex, and reduce the amount of movement in the muscles involved in swallowing, which in turn increases the risk that food might go down the wrong way.  It can also contribute to reflux.
  • The whole swallowing process is slower for people with PD than for other people of the same age (Pinnington et al., 2000).
  • People with PD may not be as aware that they are having swallowing problems compared to other people with swallowing problems because of their disease.  In one study of 18 people with PD and swallowing problems, only 13 reported swallowing problems  (Potulska et al, 2003).

What can be done to help?

  • Common treatments include altering the feeding environment (e.g. making sure people sit up straight in a place with no background noise when they eat), changing diet consistency (e.g. thickening fluids) and assigning specific swallowing exercises.
  • Swallowing exercises should be based on principles of motor speech: they should be of a high intensity, specific to swallowing, and focused on improving real world eating and drinking outcomes (e.g. Burkhead et al, 2007).

Can LSVT LOUD also improve swallowing?

  • For many years, clinicians practising LSVT have noticed that LSVT LOUD treatment – a treatment designed to improve vocal loudness – seems also to help people with PD improve their swallowing.  Although purely anecdotal (i.e. with a very low evidence value, if any), I have seen this in my practice.
  • In 2002, a group of researchers led by El Sharkawi conducted a pilot study to look at the effects of LSVT Loud on swallowing efficiency.  They found a significant increase in swallowing efficiency including, a reduction in tongue and palate residue after swallowing, improved tongue function (including the elimination of tongue rocking), and an improvement in the trigger time for the swallowing reflex.

Why would a voice and speech treatment like LSVT LOUD help swallowing?

We don’t know for sure.  We suspect that LSVT LOUD improves the awareness and control of the entire aerodigestive tract, and improvement in the function of some of the muscles that serve both speech and swallowing (e.g. the vocalis muscle in the vocal chords, and the muscles of the tongue).  Data collected from brain imaging studies suggest that LSVT LOUD may provide sensory stimulation that drives long-term cross-system changes in motor areas of the cerebral cortex that control swallowing (e.g. Hamdy et al., 2000).

Bottom line

For people with PD and swallowing problems, evidence-based treatments are available to help swallowing and you should consult with a speech pathologist.  People with PD who are treated by LSVT-accredited speech pathologists with LSVT LOUD to improve their voice and speech (in particular their loudness) may enjoy improvements in their swallow as a happy side-effect of LSVT LOUD.  But we don’t know why, and it shouldn’t be the sole or main swallowing treatment – particularly for people with severe problems swallowing.  Further, high quality studies are needed. Given the importance of this issue for people with PD, and their carers and loved ones, we hope this research continues.

Main source: Maher, L., & Hodges, H. (2015). Swallowing Problems in PD: Assessment and Treatment. Presentation, May 2015. Supported by the National Institute of Health and the Michael J. Fox Foundation.

Image: http://bit.ly/1KtBujq

Banter Speech & Language Banter Speech & Language
Banter Speech & Language is an independent firm of speech pathologists for adults and children. We help clients in our local area, including Concord, Rhodes, Strathfield and all other suburbs of Sydney’s Inner West.

Banter Speech & Language is owned and managed by David Kinnane, a Hanen- and LSVT LOUD-certified speech-language pathologist with post-graduate training in the Spalding Method for literacy, the Lidcombe and Camperdown Programs for stuttering, and Voicecraft for voice disorders. David is also a Certified PESL Instructor for accent modification.

David holds a Master of Speech Language Pathology from the University of Sydney, where he was a Dean’s Scholar. David is a Practising Member of Speech Pathology Australia and a Certified Practising Speech Pathologist (CPSP).

People with Parkinson’s in Sydney: grab those dancing shoes and get moving!

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When working with people with Parkinson’s Disease, “use it or lose it” is my mantra.  As an LSVT LOUD-certified speech pathologist, I’m passionate about helping people with Parkinson’s overcome their voice and speech problems – especially the very common problem of reduced loudness, which can have devastating effects on relationships and social life.  I’m a proponent of LSVT LOUD treatment – a program supported by the highest level of research evidence – because it’s all about high effort, intensity, and increased volume.

Of course, “use it or lose it” doesn’t just apply to voice and speech.  And there’s a program I’ve just found out about from a client, which targets another common problem for many people with Parkinson’s:  movement.

Sponsored by Parkinson’s NSW and others, the Dance for Parkinson’s Australia program is modeled on the Dance for PD program developed by the prestigious Mark Morris Dance Group and the Brooklyn Parkinson Group.  Their dance classes are appropriate for anyone with Parkinson’s – no matter how advanced.  Everyone is welcome, including partners and carers.

No dance experience is necessary.  Even if you dance as badly as me (and, no, I won’t link to a video of my cringe-worthy wedding-waltz-march-tango).

In Sydney, classes are held at Rozelle on Thursdays at 11.30am; and Alexandria on Tuesdays at 1.30pm.  Full details – including venues and contact details – can be found here.

So give it a go!  Get footloose and fancy free.  Then let me know how you get on.

_______

If you or your loved one has Parkinson’s and having speech or voice problems, read more about LSVT LOUD here.

Images: http://tinyurl.com/mosq4qk and http://tinyurl.com/lxgojpd

Related articles:

Banter Speech & Language Banter Speech & Language
Banter Speech & Language is an independent firm of speech pathologists for adults and children. We help clients in our local area, including Concord, Rhodes, Strathfield and all other suburbs of Sydney’s Inner West.

Banter Speech & Language is owned and managed by David Kinnane, a Hanen- and LSVT LOUD-certified speech-language pathologist with post-graduate training in the Spalding Method for literacy, the Lidcombe and Camperdown Programs for stuttering, and Voicecraft for voice disorders. David is also a Certified PESL Instructor for accent modification.

David holds a Master of Speech Language Pathology from the University of Sydney, where he was a Dean’s Scholar. David is a Practising Member of Speech Pathology Australia and a Certified Practising Speech Pathologist (CPSP).

Parkinson’s Disease Update: Banter now certified to provide LSVT LOUD™!

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Friday was World Parkinson’s Day.  And what better way to spend it than sitting an accreditation exam for LSVT LOUD™!

As we explain here, LSVT LOUD™ is an evidence-based voice treatment for people with Parkinson’s Disease based on principles of motor learning and neuroplasticity.  Published research data support improvements in loudness, intonation, and voice quality for individuals with Parkinson’s Disease who received the treatment.  Research also demonstrates that the improvements are maintained for up to two years after treatment.

The effectiveness of LSVT LOUD™ has been studied for over 20 years.  What we found most interesting during the accreditation course were the findings of recent brain imaging and other research studies documenting changes in brain functioning as well as improvements in articulation, facial expression and even swallowing.  We also learned about the evidence documenting the benefits of LSVT LOUD™ for other groups of clients, including:

  • adults with Multiple Sclerosis;
  • adults who have had a stroke;
  • children with Cerebral Palsy; and
  • children with Down Syndrome.

Banter Speech & Language is pleased to report that David passed the exam (yay!) and is now certified by LSVT Global to offer LSVT LOUD™ to people with Parkinson’s Disease and others who, according to published research, might benefit from it.  For more information about the treatment, check out our LSVT LOUD Fact Sheet, our page on LSVT LOUD™ or contact us to discuss.

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Image: www.LSVTGlobal.com

Banter Speech & Language Banter Speech & Language
Banter Speech & Language is an independent firm of speech pathologists for adults and children. We help clients in our local area, including Concord, Rhodes, Strathfield and all other suburbs of Sydney’s Inner West.

Banter Speech & Language is owned and managed by David Kinnane, a Hanen- and LSVT LOUD-certified speech-language pathologist with post-graduate training in the Spalding Method for literacy, the Lidcombe and Camperdown Programs for stuttering, and Voicecraft for voice disorders. David is also a Certified PESL Instructor for accent modification.

David holds a Master of Speech Language Pathology from the University of Sydney, where he was a Dean’s Scholar. David is a Practising Member of Speech Pathology Australia and a Certified Practising Speech Pathologist (CPSP).