Posted on 08/17/10, in , by Parky Bill
If you would have asked me a year ago, I would have said that it was my understanding that the only difficulty associated with Parkinson’s disease is the way many Parkies speak softly with whispery, reedy voices. I never thought I would have a problem with that. Still don’t. All my years in have given me the habit of speaking from the diaphragm, not from the throat muscles.
It has been estimated that between 65-90% of Parkinson’s disease sufferers will ultimately have troubles with their speech, and these problems can become apparent in explicit ways which include speaking in either a monotone or unintelligible gibberish. At times, patients hesitate before actually speaking which can give the impression that there is some impairment or dementia with the patient. At other times, the speech is faster than normal, and very often the same words are repeated over and over. Again, this can give the impression that the patient is suffering from dementia or memory impairment problems.
I’ve highlighted the areas I’m having trouble with.
1. Unintelligible gibberish. There are times when I want to say something and all the words come out at once in an unintelligible jumble. For instance, if I want to ask Gail, “When were the dogs outside last,” it might come out “whennerdogoudsidelas?” Then I stop, close my eyes, focus on the words and say them one. At. A. Time.
2. Hesitation before speaking. Last night, I was trying to tell TJ about something I saw on TV. Actually, I had two thoughts I wanted to convey: a) I may have told you this already; and b) I saw this thing on TV. I opened my mouth and nothing came out. So I forced myself to start, and I began with b), switching over to a) in mid-sentence. Stopping. Starting again. Same thing happens. So I closed my eyes, focused on what I wanted to say, and was then able to say it.
3. Speech is faster than normal. I think this is connected to #1.
4. Words are repeated over and over. I call this the “scratched record” syndrome. You can hear this for yourself on last Sunday’s interview on “Boomer Nation Radio” when, early in the interview, I got hung up on a word and said it four or five times before stopping myself. I wrote about this the other day when I wanted to tell Gail, “Don’t forget to check the mail,” and it came out, “Don’t forget chaa… chaa… chaa… chaa…” to which Gail (God love her) said, “I’ll check the mail. I remembered.” (She’s getting very good at finishing my sentences.)
So far, I don’t seem to have any trouble with conveying my thoughts in writing. In fact, I think I’m getting better at it, even though my fat, Parkinsonian fingers tend to mash all the keys at once requiring many corrections. And when I AM speaking clearly (and not slurring like I just drank a gallon of cheap wine), I am able to record a nice podcast (thanks to a great digital, program where I can clip out all the crap that I just wrote about). Love that editing software!
Now, I’m seeing evidence that the Deep Brain Stimulation may be the cause of some of these speech difficulties… or, at least, it can make a pre-existing problem worse.
• There has also been a growing interest in understanding “speech” in individuals with PD who have undergone DBS-STN. Although some studies have noted that DBS can help speech by improving motor systems” involved in speech production,9,13 such as helping individuals increase the motor force needed to produce speech and increase acoustic components of speech, the majority of studies comparing speech before and after DBS-STN have generally shown either no improvement or a decline in speech functioning following surgery.
• Some has found that speech intelligibility (clarity in expressive speech) worsened following DBS, and speech sounded more slurred.
• DBS has also been found to have an adverse impact on intonation or rhythm, articulation, and intelligibility; the stimulation itself can cause changes in speech.
• Speech function is also very susceptible to micro lesions (damage to cellular structures in the brain) due to the surgical procedure itself.
• Krack et al. (2003) examined the long-term outcome of bilateral DBS-STN in 49 PD patients and found that speech functioning declined in these patients after five years.21 This result was interpreted as a reflection of the expected decline in speech that one would see in DBS-STN treated patients. According to this study, DBS-STN does not appear to offer any protection against declines in speech functioning in the long-term.
Yeah, well…
All things considered, with the dyskinesia I do NOT have because of the reduction in the amount of levodopa I need to take because of the DBS… I’m still glad I had it done.
SO…
Because I like testing myself, I took the self-administered Voice Handicap Index , where you measure yourself on 30 questions such as “I feel as though I have to strain to produce voice” and rank yourself at “never,” “almost never,” “sometimes,” “almost always” and “always.” These score from 0 to 4, and they are broken into three areas: P for physical, F for functional, E for Emotional.
I scored: P=22 (75th percentile); F=15 (75th percentile); E=11 (between the 25th and 75th percentile).
Total score: 48 which is right at the 75th percentile (0=great, 100=crappy).
Meh. Like I said. At least I write good.
I’ve highlighted the areas I’m having trouble with.
1. Unintelligible gibberish. There are times when I want to say something and all the words come out at once in an unintelligible jumble. For instance, if I want to ask Gail, “When were the dogs outside last,” it might come out “whennerdogoudsidelas?” Then I stop, close my eyes, focus on the words and say them one. At. A. Time.
2. Hesitation before speaking. Last night, I was trying to tell TJ about something I saw on TV. Actually, I had two thoughts I wanted to convey: a) I may have told you this already; and b) I saw this thing on TV. I opened my mouth and nothing came out. So I forced myself to start, and I began with b), switching over to a) in mid-sentence. Stopping. Starting again. Same thing happens. So I closed my eyes, focused on what I wanted to say, and was then able to say it.
3. Speech is faster than normal. I think this is connected to #1.
4. Words are repeated over and over. I call this the “scratched record” syndrome. You can hear this for yourself on last Sunday’s interview on “Boomer Nation Radio” when, early in the interview, I got hung up on a word and said it four or five times before stopping myself. I wrote about this the other day when I wanted to tell Gail, “Don’t forget to check the mail,” and it came out, “Don’t forget chaa… chaa… chaa… chaa…” to which Gail (God love her) said, “I’ll check the mail. I remembered.” (She’s getting very good at finishing my sentences.)
So far, I don’t seem to have any trouble with conveying my thoughts in writing. In fact, I think I’m getting better at it, even though my fat, Parkinsonian fingers tend to mash all the keys at once requiring many corrections. And when I AM speaking clearly (and not slurring like I just drank a gallon of cheap wine), I am able to record a nice podcast (thanks to a great digital, program where I can clip out all the crap that I just wrote about). Love that editing software!
Now, I’m seeing evidence that the Deep Brain Stimulation may be the cause of some of these speech difficulties… or, at least, it can make a pre-existing problem worse.
Yeah, well…
All things considered, with the dyskinesia I do NOT have because of the reduction in the amount of levodopa I need to take because of the DBS… I’m still glad I had it done.
SO…
Because I like testing myself, I took the self-administered Voice Handicap Index , where you measure yourself on 30 questions such as “I feel as though I have to strain to produce voice” and rank yourself at “never,” “almost never,” “sometimes,” “almost always” and “always.” These score from 0 to 4, and they are broken into three areas: P for physical, F for functional, E for Emotional.
I scored: P=22 (75th percentile); F=15 (75th percentile); E=11 (between the 25th and 75th percentile).
Total score: 48 which is right at the 75th percentile (0=great, 100=crappy).
Meh. Like I said. At least I write good.