speech therapist questions

[Candor8]

my mum will be visiting a speech therapist tomorrow, what are the areas you suggest the speech therapist should focus on?

What questions do you think will be helpful?

[LuisRodicioRodicio]

Hi Candor8!

In our case the speech/swallow therapist used "swallowing techniques" and exercises of mouth and ocular muscles

One of the symptoms of PSP is that its speech becomes slower and more difficult to understand but generally its intelligence remains. I reproduce some reflections of Kevin_1:

“As the illness develops their mental processing becomes slower. That is they think slower, but they still think as adults and draw on a lifetime of experience and most likely using all of that wisdom which comes with it. So the way to speak is in a straight forward manner, not fast, simple language, but not slow as if talking to an idiot as in a movie, and to give them time. Ask them of they understand if it is complicated and if they want you to clarify anything. This is basic good communications practice. It works.”

For a time we attended sessions with a speech therapist until the disease progressed and no advantage was obtained, at the same time we combined it with exercises at home with a "Breather" (you breathe with some force in and out through it and it has adjustable resistance). Martina_MP uses a free app (great for iPad) called TalkPath Therapy by Lingraphica which has easy to follow speech and cognitive exercises.

On our case, we intend an App but It was not possible to use it for more than few months. As her dexterity deteriorated, she had problems placing her finger on the appropriate word or letter and we were able to buy a plastic screen cover that had an opening for each key on it; this helped to direct her finger and keep it one the right letter. Another problem she developed was the inability to tap her finger in a key or letter, and as such she would often have several letters in a row. For example if she tried to tap the letter A, it would show as AAAAA because she could not get her finger off the letter A quickly enough.

Some have successfully used for some time a cheap iPad plus free software text-to-talk program called Claro (claro.com) with a BigKeys keyboard that attaches to the iPad through an Apple device that is used for connecting to camera to an iPad . A voice comes from the Claro program. It's like a GPS voice.

Zerachiel contributed this idea:

“It might seem a little odd but did your mum enjoy singing in the past? If so have a try at getting her to sing what she wants to say, like in a musical; Because it is not automatic speech it can work as it engages a different part of the brain.”

La “Salle IRF” and “wobblybee” reports about a voice treatment fot PD (Parkinson Disease):

Lee Silverman Voice Treatment (LSVT LOUD®) is a popular voice therapy that has been shown to improve voice loudness in people with PD for up to two years after treatment. LSVT LOUD therapy consists of intensive, high-effort speech exercises. LSVT LOUD involves 16 treatment sessions (four sessions per week for four weeks), as well as daily home practice. The exercises include prolonged vocal phonation with increasing volumes and changing pitch, functional words and phrases with increasing volumes. Throughout the 16 sessions, participants progress through a systematic hierarchy of speech exercises beyond words and phrases and into "outside the therapy room" conversations and transfer tasks.

Although primarily directed at loudness, there are effects on speech intelligibility, articulation, facial expression, reducing hypomimia, respiratory support, and voice quality.

In addition, LSVT also provides benefits in the safety and efficacy of swallowing, improving pharyngoesophageal swallowing function, as well as the effectiveness of involuntary coughing in people with PD.

Hug and luck.

Luis

[Candor8 in reply to LuisRodicioRodicio]

This is more than helpful, thank you so much

[Bergenser]

Our SALT went through a full Aphasia assessment with my husband, which helps pinpoint where the issues are - she was documenting some word finding difficulty and a loss of fluency but importantly, she could confirm that his recognition and understanding of words was not affected.

She has taken him through some traditional speech exercises - practising sounds that use the tip of the tongue as well as sounds formed at the back of the mouth (" consonants for clarity" and "vowels for volume").

This also included some tongue exercises that I have mentioned in my earlier reply on this forum. healthunlocked.com/psp/post...

Later on we have done the LSVT LOUD training under her guidance, which helped both with speech and breathing.

Finally she has done a swallowing assessment on two occasions - watching him have a meal and looking in his mouth and throat, feeling what happens during his swallow etc. On that basis she could give advice on consistency for food and drink as well as positioning and behaviours during eating to minimise risk of choking/coughing/aspiration.

So to summarise, I would ask for

* a thorough assessment of his speech and language;

* exercises to improve clarity and volume of speech, and

* swallowing assessment/ advice on food & drink.

There may be further aids to strengthen muscles in the mouth and throat, so I would ask about that as well.

One more thing - we read the book "Hard days" by Branko Lugovic, he included advice about using an adult size dummy to suck on - also in combination with dexterity exercises. My husband tried that - feeling a bit embarrassed - but it gives the mouth something safe to do and strengthens the tongue.

Best wishes - hope and hugs 🌻🫂