Transcript Parkinson`s - Personal Web Pages

Parkinson’s disease
Interventions
Whitney Mundy
Dr. Davis
Parkinson’s disease
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James Parkinson first described it extensively in 1817.
Is a chronic, progressive disorder of the central nervous system
that belongs to a group of conditions called motor system
disorders.
Direct result of the loss of cells in a section of the brain called
the substantia nigra.
Those cells produce dopamine, which is a chemical messenger
responsible for transmitting signals within the brain.
Loss of dopamine causes neurons in the brain to fire out of
control, leaving the person unable to control their movements in
a normal manner.
Importance of studying
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It is important to study Parkinson’s disease in the
Gerontology field because it affects about 1%* of the
population older than 60.
Mean onset of this disorder was estimated to be in
the late 50’s, but now thought to be in the early-tomid 60’s.*
The course and degree of Parkinson’s varies
substantially
Many people with PD are undiagnosed
I believe on a personal level it is important to study
PD because it affects a close family member of mine
Symptoms of Parkinson’s disease
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Gradually yet with
increased severity:
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Eventually:
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Tremors or trembling
Difficulty maintaining
balance and gait
Rigidity or stiffness of the
legs and trunk
General slowness of
movement (bradykinesia)
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Difficulty walking
Difficulty talking
Completing other simple
tasks
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Speech and Communication in
Parkinson’s disease
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Various speech and voice disorders affect 70-85% of
individuals with Parkinson’s disease.**
They include hypophonia, reduced loudness, hoarseness,
monotone, mono-loudness, imprecise articulation,
reduced stress, and instability in speech rate.**
Moreover, there may be a reduction in the pragmatic
communication skills, especially in the areas of
conversational appropriateness, turn-taking, prosodics,
and proxemics.**
Furthermore, individuals with PD often exhibit reduced
motivation for communication and low morale.**
Why an intervention?
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Communication is an important part of being a human.
We start communicating the day we are born and some would
say even before then.
It can become very frustrating when we are unable to express
how we feel through words.
It is crucial to maintain our sense of communication as long as
we are able.
A combination of interventions could possibly give a person
with PD a better quality of life and would increase confidence
and self-esteem.
(Combination could include speech and physical therapy)
Types of interventions for PD
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Speech therapy
Physical therapy
Drug treatments (i.e. Sinemet)
Surgery (although is usually last resort)
Combination of interventions (i.e. Speech
and physical therapy combined with drug
treatment)
Speech therapy intervention
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Speech therapy is considered a valuable and
effective intervention for people with Parkinson’s
disease, particularly when treatment is administered
intensively and patients are motivated and actively
involved in the therapeutic process.**
Speech intervention by individual or
group?
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The intervention should be conducted individually
so that the therapist is able to maximize the direct
practice time in the therapy session and facilitate
specific exercises designed to the individuals
needs.**
This also is suggested so that the patient can
receive the therapists undivided attention.**
Some people with PD also feel more comfortable
discussing personal problems with one person
versus in a group.**
Intervention Model
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Intervention consists of eight 75-minute sessions.**
Four partsSpontaneous speech
Voice exercises (single word production, phrase production,
sentence production, speech initiation with increased
loudness, question production with focus on modifying
intonation)
Guided discussions (telephone conversations, role-play,
meeting new people, self-evaluation)
Task assignments (10 minutes a day)
Intervention on speech and
communication skills
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During the 1980’s, speech therapy mainly addressed
the prosodic aspects of speech.**
Later other facets of speech and communication
were added to the ever changing therapeutic
scheme, including respiration, pitch variation,
articulation, vocal loudness, strength and speed of
articulators, speaking rate, and intonation and stress
patterns.**
Results of intervention
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Modifications in treatment program were
reported to have favorable effect on various
aspects of speech.**
Most patients reported that the improved
speech pattern was maintained after the
conclusion of the therapy program.**
Why choose a speech therapy
intervention?
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Speech therapy helps PD patients communicate
more effectively.
Gave PD patients a sense of confidence which many
of them lack due to unclear speech.
Assistance in regaining the lost art of conversation.**
Emotional support and understanding from therapist
or other patients about the embarrassment or
frustration some may experience due to speech
difficulties.
Conclusion
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Because the course and degree of Parkinson’s disease varies
in each individual it is important to pick the intervention(s) that
fits the individual.
I believe that because 70-85% of people with PD have speech
and voice disorders, it is important to include a intervention of
speech therapy.
These disorders directly affect the social skills, lifestyle, and
psychological well-being of people with PD, therefore it is
important to assist them in maintaining their communication and
speech.**
References
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*Samii, A., Nutt, J., & Ransom, B. (2004).
Parkinson’s disease. The Lancet, 363, 1783-1789.
**Manor, Y., Posen, J., Amir, O., Dori, N., & Giladi, N.
(2005). A Group Intervention Model for Speech and
Communication Skills in Patients with Parkinson’s
disease. Communication Disorders Quarterly, 26:2,
94-101.