Interview with Kate Kelsall, blog: Shake Rattle and Roll (please go to Kate’s website to read the entire interview, and for other great information and insights about living with Parkinson’s.
http://katekelsall.typepad.com/my_weblog/

“Voice Aerobics™ was created by speech and language pathologist, Mary Spremulli, MA, CCC-SLP. It is an exercise program focusing on breath support, posture and vocal function exercises for improved vocal performance.
I was fortunate to conduct the following email interview with Mary”:
Kate: What attracted you to working with Parkinson’s patients in the area of speech/voice treatment?

Mary: I have always enjoyed working with children and adults with motor and speech disorders. More than 20 years ago when working in pediatrics, I became certified in Neurodevelopmental Treatment, also referred to as NDT. One of the underlying principles of that treatment is that "normal and abnormal cannot co-exist." Based on that understanding, I would incorporate treatment approaches that included techniques to minimize or extinguish the abnormal patterns that were interfering with the more normal expression of movement, voice, speech or swallowing.

When I relocated to Florida in 1989, I began to work with primarily an adult population, including individuals with voice, motor and speech problems from Parkinson's, stroke, and other neurological events. That theory from NDT still applied, and I realized that if someone's goal was "better" or more "normal" speech, then we needed to work together to minimize the interference from the abnormal. Using Parkinson's speech as an example, there may be a number of things that are interfering, such as tremor, too fast of rate, weak voice or hoarseness. We attempted to identify the feature that was causing the most interference and minimize that by strengthening some other aspect of the speech, voice, or respiratory system.

I became certified in the Lee Silverman Voice Treatment® (LSVT) technique in 1997. Dr Lorraine Ramig and her colleagues associated with this program have published an impressive body of research describing its benefit. In my opinion, if someone has been newly diagnosed with Parkinson’s, this is the ideal time to consider the LSVT.

I realize that I may not have answered your actual question. I find that I am attracted to working with individuals with Parkinson’s, in particular, because over the last 15 years or so, I have met so many interesting patients, whose voice and speech changes from Parkinson's really misrepresent the person behind the voice. I can think of many individuals who on first meeting have weak, monotone voices. As we begin to work together, I discover that they are often intelligent, witty individuals, who were teachers, CEO's of companies, athletes, yet their true personalities are beginning to be lost inside their bodies. So, if I can help them to strengthen their system to minimize further physiological changes and to re-capture the spirit of who they are, then, that's fun and rewarding for me. I have audiotapes of patient's first and last sessions, and you can hardly believe that they are the same person talking.

Kate: What are the biggest speech and voice challenges faced by those with Parkinson’s?

Mary: Oh, wow, well, you know that answer better than me, Kate.
I would have to say that one of the biggest challenges is the insidious or sneaky nature of the speech and voice changes. Unlike someone who has had a stroke where the changes in speech are quite sudden, the changes that come about with Parkinson's are slow and gradual. For the persons with Parkinson’s they don't really seem to realize how bad their speech may have actually become.
The LSVT people talk about the need for those with Parkinson’s to become "re-calibrated," and I do think that this is at the heart of the program, but, also the greatest challenge. Even when Parkinson’s patients hear themselves producing better and louder voices, it doesn't feel natural to them. We humans seem quite drawn to the familiar, and even when we don't like some aspect of our behavior, it can be difficult to change.

The other challenge is that the individual with Parkinson’s must realize that even when a formal program of therapy of any sort has been completed, that is not really the end. Parkinson's is still in the background of their lives, sneaking around, and changing the way muscles behave, and so individuals have to make a LIFETIME commitment to exercise. In that regard, with or without Parkinson’s, if a commitment to exercise was easy, our gyms would be overflowing with members, and of course, that is not the case.

Kate: Do you have any advice about voice and speech for those newly diagnosed with PD?

Mary: The best advice I can give, in addition to taking your medications as prescribed, is to begin a voice exercise program. Frequently, I receive a request from a local neurologist to contact a person for therapy, and in doing so, the person will say: "I don't think my speech is that bad, yet." GRRRRR!!!!! If they wait until the day of the "yet," they will already be in trouble.

interview cont’d at: http://katekelsall.typepad.com/my_weblog/

About the author: Mary Spremulli,MA,CCC-SLP, is a licensed speech-language pathologist and licensed nurse. A national lecturer, with publications on the topic of Patient Education and Ethics, and with a special interest in physician-patient communication.