Parkinson's Disease

Question 1

What is Parkinson’s

Answer 1

progressive neurodegenerative disorder characterised by gradually worsening tremor, muscle rigidity and slowness of movement.

Question 2

What causes Parkinson’s disease?

Answer 2

loss of nerve cells in the substantia nigra in the midbrain, leading to a reduction in dopamine (essential for regulating the body)

Question 3

What is the transition from impairment to disability?

Answer 3

3-7 years but people live for a relatively long time after

Question 4

What percentage of people with PD have speech difficulties?

Answer 4

89% (Ramig et al., 2018)

Question 5

What is hypokinetic dysarthria characterised by?

Answer 5

low, monopitch, monoloud, fast/slow rate of speech, repeated phonemes (and is common in basal ganglia disorders

Question 6

What other characteristics of PD can impact on communication?

Answer 6

hypomimia, micrographia, reading, cognitive difficulties

Question 7

any other relevant symptoms?

Answer 7

anosmia, fatigue, sleep difficulties, neuropsychiatric symptoms

Question 8

prevalence of dementia in PD?

Answer 8

40%

Question 9

long term side effects of medication?

Answer 9

around 50% of people who have been on levadopa for a several yeras will begin to experience motor side effects - chorea during ‘on’ phase and dystonia during ‘off;

Question 10

is dysphagia common?

Answer 10

common in the advanced stages of PD (i.e. SLT should always monitor signs of aspiration/E&D difficulties)

Question 11

Key Approaches to assessment?

Answer 11

oro-motor 
perceptual assessment (Frenchary DT; Enderby & Palmer, 2008 
General conversation/observation 
Video recording 
Client self-rating

Question 12

What does the ICF stand for?

Answer 12

International Classification of Functioning, Disability and Health (WHO, 2007)

Question 13

What did Miller et al., 2011 find?

Answer 13

They conducted a large national survey of SLTs in the UK and found they were not keeping with national (DoH, 2005 ) and professional guidelines (RCSLT, 2018) which stipulate the importance of working on activity and participation (as opposed to just impairment based work) for people with PD

Question 14

What are the three things to consider when thinking of intervention?

Answer 14

MDT working
ICF framework
Past-present-future

Question 15

What is LSVT?

Answer 15

LSVT is an intensive treatment for people with Parkinson’s that increased vocal adduction and overall speech production

Question 16

Who is LSVT for?

Answer 16

LSVT is for people with early stage PD with mild-moderate hypokinetic dysarthria, who are motivated

Question 17

How does LSVT work?

Answer 17

it is hypothesised that sensory deficits underlie speech difficulties in PD such that normal volume feels too loud. The approach focuses on the single parameter of loudness and uses clinician feedback to achieve the recalibration of perceptual and motor functioning in respect to vocal loudness

Question 18

Fox et al (2012)

Answer 18

hypothesised that focusing on one element of speech facilitates maintenance and generalisation of the treatment

Question 19

As well as loudness, what has LSVT LOUD demonstrated improvements in?

Answer 19

articulation, rate, intonation, vocal quality, swallowing and facial expression

Question 20

What is the treatment structure?

Answer 20

16 sessions within 4 week time frame, plus homework. the sessions focus on increasing loudness, self monitoring and high effort exercises at maximum loudness

Question 21

Ramig et al. (2018)

Answer 21

RCT comparing LSVT LOUD, LSVT ARTIC and no treatment group. Found that LSVT LOUD group made the most significant improvements on measures of sound pressure (reading & spontaneous speech) and patient reported measures (modified communication effectiveness index) . LOUD group maintained up to 7 months post treatment

Question 22

Sackley et al. (2018)

Answer 22

UK pilot RCT: LSVT LOUD, traditional SLT and no treatment. LSVT LOUD and traditional SLT may be effective in improving communication in PD (need adequately powered trial)

Question 23

Griffen et al (2018)

Answer 23

comparing face-to-face vs. computerised administration. Computerised was non-inferior on measures of sustained vowel phonation, pitch, reading and spontaneous speech

Question 24

pros and cons of intensity of LSVT?

Answer 24

+ intensity of treatment leads to learnt behaviour which leads to spontaneous use
+ good for those who are motivated
- too intense for some individuals
- might be difficult to access (though - Griffin et al., 2018)

Question 25

pros and cons of exclusive focus on loudness

Answer 25

+ Fox et al (2012): the exclusive focus and repetitive nature of the programme reduced the cognitive overload and facilitates maintenance and generalisation

• ICF (WHO, 2007) - focusing on body structure and functioning exclusively
• PCA - is loudness the most important thing?
• NICE (2017) - ensure effective communication at all stages of progression

Question 26

pros and cons of 1:1 sessions

Answer 26

Alves et al., 2008: strong association with depression + closely monitor, - would group/peer support be more beneficial
+ more accurate focus and monitoring of patient performance
- lacks peer feedback and shared experience
- Manor et al (2005): benefits of group - peer feedback, enjoyable atmosphere, sharing experience, support for carers, evidence of maintenance

Question 27

pros and cons re. Flexible Delivery

Answer 27

+ recent research suggesting therapy can be delivered flexibly (e.g. Griffin et al., 2018) - better for people in rural locations
- structure of the session itself is in-flexible - can’t really adapt it to the person

Question 28

What is AAC?

Answer 28

Augmentative and Alternative communication refers to any method of communicating that supplements the ordinary method of speech/handwriting, where these have been impaired (Miller & Scott, 1998). It can be both high tech and low tech - high relating to anything requiring batteries/charge or low tech including

Question 29

What are the principles of communicative competence?

Answer 29

the principles of communicative competence relate the state of being functionally adequate or having sufficient skill/knowledge/judgement for it’s use (Light, 1997)

Question 30

What are the four primary areas of communicative competence?

Answer 30

linguistic: adequate knowledge, skill, judgement
social: knowledge of social rules of communication
operational: technical skills require to operate a system
strategic: use of compensatory strategies to facilitate communication where constraints have been imposed by limitations in linguistic, operational, social skills.

Question 31

What other factor needs to be considered?

Answer 31

also need to consider psychosocial factors such as attitudes toward AAC (Light & McNaughton, 2014)

Question 32

When should AAC be introduced?

Answer 32

Hustad & Beukelman (2000) recommend early introduction for people with reduced speech intelligibility, secondary to neurogenic disorders. This is supported by NICE (2017) guidelines that stipulate that AAC should always be considered for PD - both in terms of maximising and maintaining current communicative function, and in terms of planning for future progression of difficulties

Question 33

What are the aims of an AAC assessment?

Answer 33

to identify the communicative needs of the individaul and to identify barriers and facilitators that lead to acceptance/abandonment (Baxter et al., 2012)